Legal
This Notice describes how Power MH may use and disclose your protected health information (PHI) and your rights regarding that information. Please review this notice carefully. A signed acknowledgment of receipt will be requested during your onboarding.
Power MH is committed to protecting the privacy of your health information. As a covered entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations (45 CFR Parts 160 and 164), we are required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of Privacy Practices, and follow the terms of this Notice as currently in effect.
"Protected health information" (PHI) means information about you — including demographic information — that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or the payment for that health care, and that identifies you or could reasonably be used to identify you.
We are required by law to:
We may use and disclose your PHI to provide, coordinate, and manage your psychiatric care. For example, your provider may share your information with a specialist or other treating clinician involved in your care, with your written authorization.
We may use and disclose your PHI to process payment for services you receive. Because Power MH is a private-pay practice, this use is limited to internal billing and payment processing only. We do not submit any information to insurance companies.
We may use and disclose your PHI for internal operations, including quality assessment, provider supervision, training, and accreditation activities. These uses are limited to what is minimally necessary.
We may disclose your PHI when required to do so by federal, state, or local law, including disclosures to public health authorities, law enforcement in limited circumstances, or in response to a valid court order or subpoena.
We may disclose your PHI to prevent or lessen a serious and imminent threat to the health or safety of you or another person or the public, consistent with applicable law and ethical standards.
Any use or disclosure of your PHI not described above — including uses for marketing, sale of PHI, or psychotherapy notes — will be made only with your signed written authorization. You may revoke any such authorization in writing at any time, except to the extent we have already relied upon it.
Power MH does not accept insurance of any kind, including Medicare and Medicaid. We do not submit claims, superbills, or any documentation to insurance companies, clearinghouses, or government health programs. Your treatment at Power MH will not generate an Explanation of Benefits (EOB) or appear on any insurance record as a result of our actions.
You have the right under HIPAA to request that we restrict disclosures of your PHI to a health plan for payment purposes related to care you paid for out-of-pocket. Because Power MH operates entirely on a private-pay basis, this protection is inherent to our model.
You have the following rights with respect to your protected health information. To exercise any of these rights, please submit a written request to our Privacy Officer using the contact information below.
Request a copy of your PHI maintained by Power MH, including your medical record.
Request that we correct or amend PHI you believe is inaccurate or incomplete.
Request restrictions on how we use or disclose your PHI, including for payment purposes.
Request an accounting of certain disclosures of your PHI made by Power MH.
Request that we communicate with you in a specific way or at a specific location.
Receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically.
You have the right to inspect and obtain a copy of your PHI that we maintain in a designated record set, which includes your medical records and billing records. To request access, submit a written request to our Privacy Officer. We will respond within 30 days. In limited circumstances, we may deny your request; if we do, we will provide a written explanation.
We may charge a reasonable, cost-based fee for copying and transmitting records as permitted by applicable law.
If you believe your PHI is inaccurate or incomplete, you may request that we amend it. Submit your request in writing to our Privacy Officer, including the reason you believe the amendment is needed. We will respond within 60 days. We may deny your request if the PHI was not created by us, is not part of our records, is not available to you for inspection, or is already accurate and complete.
You may request that we restrict the use or disclosure of your PHI for treatment, payment, or healthcare operations purposes. We are required to agree to your request to restrict disclosures of PHI to a health plan for payment purposes if you paid for the services in full out of pocket and the disclosure is not otherwise required by law. For other requested restrictions, we will consider your request but are not required to agree.
You may request a list of certain disclosures of your PHI made by Power MH in the six years prior to your request. This accounting does not include disclosures made for treatment, payment, or healthcare operations; disclosures made with your authorization; or certain other disclosures as permitted by HIPAA. We will respond to your written request within 60 days.
You have the right to receive a paper copy of this Notice at any time, even if you agreed to receive it electronically. To request a paper copy, contact our Privacy Officer.
If you believe your privacy rights have been violated by Power MH, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).
Submit your complaint in writing to our Privacy Officer using the contact information below. We will not retaliate against you for filing a complaint.
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
You may also file electronically at: hhs.gov/ocr/privacy/hipaa/complaints
We reserve the right to change this Notice and to make any new Notice provisions effective for all PHI we currently maintain. We will post any revised Notice on our website and make it available upon request. If we make a material change to this Notice, we will notify active patients via the contact information on file.
For questions about this Notice, to exercise your rights, or to file a complaint with Power MH, please contact our designated Privacy Officer:
Power MH — Privacy Officer
Email: privacy@powermh.com
All written requests for access, amendment, restriction, or accounting should be submitted to the above address. We will acknowledge receipt within 5 business days.
Related documents: Privacy Policy · Terms of Use