Privacy Policy

Notice of Privacy Practices Policy SS3

Elysium Mental Health LLC

Privacy Officer: Gustavo Rabines

Notice of Privacy Practices Policy

Effective Date: 11/01/2022

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Please Review this Notice Carefully

Our Commitment to Your Privacy

Our practice is dedicated to maintaining the privacy of your individually identifiable protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. You are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices we maintain concerning your PHI. By federal and state law, we must follow the terms of this notice of privacy practices that we have in effect now.

The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

We May Use and Disclose Your PHI in the Following Ways:

1. Treatment: Our practice may use your PHI to treat you. For example, we might disclose your PHI to a pharmacy when we order a prescription for you. Your PHI may also be shared among the individuals who make up our practice to determine your appropriate treatment plan. Finally, we may also disclose your PHI to other healthcare providers for purposes related to your treatment.
2. Payment: Our practice may use and disclose your PHI to bill and collect payment for services you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits. We may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for your treatment. Also, we may use your PHI to bill you directly for services and treatment. We may disclose your PHI to other healthcare providers and entities to assist in their billing and collection efforts.
3. Health Care Operations: Our practice may use and disclose your PHI to operate our business, such as using a clearinghouse for electronic claims, software vendor support, and our accountant. Our Business Associate agreements have been amended to ensure that all HIPAA security administrative procedures, safeguards, policies, and documentation requirements apply directly to the Business Associate.
4. Appointment Reminders: Our practice may use and disclose your PHI to contact you and remind patients of their upcoming appointments. Please notify us immediately should you not desire us to do so.
5. SMS opt-in or phone numbers: for the purpose of SMS are not being shared with any third parties or affiliate company for marketing purposes.
6. Treatment Options: Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
7. Health-Related Benefits and Services: Our practice may use and disclose your PHI to inform you of health-related benefits that may be of interest to you.
8. Disclosures Required by Law: Our practice will use and disclose your PHI when required to do so by federal, state, or local law.

Use and Disclosure of Your PHI in Certain Special Circumstances

The following categories describe unique scenarios in which we may use or disclose your PHI:

• Public Health Risks: Our practice may disclose your PHI to public health authorities authorized by law to collect information for various purposes such as reporting child abuse, controlling disease, and notifying individuals of product recalls.
• Health Oversight Activities: Our practice may disclose your PHI to a health oversight agency for legally authorized activities such as inspections or compliance monitoring.
• Lawsuits and Similar Proceedings: Our practice may use and disclose your PHI in response to court orders, subpoenas, or other lawful processes.
• Law Enforcement: We may release PHI to law enforcement officials for specific purposes, such as identifying suspects or complying with legal requirements.
• Deceased Patients: PHI may be released to medical examiners, coroners, or funeral directors as necessary.
• Organ and Tissue Donation: PHI may be disclosed to facilitate organ or tissue donation and transplantation if you are a donor.
• Research: PHI may be used for research purposes when approved by an institutional review board.
• Military: PHI may be disclosed to appropriate authorities if you are a member of the military.
• National Security: PHI may be disclosed for intelligence and national security activities authorized by law.
• Workers Compensation: PHI may be disclosed for workers’ compensation and similar programs.

Your Rights Regarding Your PHI

You have the following rights regarding the PHI that we maintain about you:

• Confidential Communications: You can request communication in a specific manner or location.
• Requesting Restrictions: You may request restrictions on certain uses or disclosures of your PHI.
• Inspection and Copies: You have the right to inspect or request a copy of your medical records, with some exceptions.
• Amendment: You may request amendments to your health information if you believe it is incorrect or incomplete.
• Restriction for Self-Paid Services: You may restrict disclosure of information to your health plan for self-paid services.
• Right to a Paper Copy: You are entitled to receive a paper copy of this notice at any time.
• Right to File a Complaint: Complaints regarding privacy violations can be submitted without penalty.
• Authorization for Other Uses: Written authorization is required for uses or disclosures not outlined in this notice.
• Accounting for Disclosures: You may request a list of disclosures made regarding your PHI, excluding certain exceptions.

Acknowledgment of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you acknowledge receiving a copy of the HIPAA Notice of Privacy Practices.

BY GIVING MY CONSENT TO BE TREATED BY ELYSIUM MENTAL HEALTH LLC, I AGREE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.