Notice of Privacy Practices

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EFFECTIVE DATE OF THIS NOTICE This notice went into effect on 1/1/24

Medical Information Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice applies to the behavioral health care providers and entities that are owned or controlled by

Empowered Pathways, LLC.

For purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”).

References in this notice to “we,” “us,” and “our” mean health care providers and entities that are owned or controlled by Empowered Pathways, LLC. 

We are required by law to protect the privacy of your health information. We are also required to provide you this notice, which explains how we may use information about you, and when we can give out or "disclose" that information to others. You have rights regarding your health information that are described in this notice. We are required by law to abide by the terms of this notice. The terms “information” or “health information” in this notice include any information we maintain that reasonably can be used to identify you and that relates to your physical or mental health condition, the

provision of health care to you, or the payment for such health care. We will comply with the requirements of applicable privacy laws related to notifying you in the event of a breach of your health information.

We have the right to change our privacy practices and the terms of this notice. If we make a material change to our privacy practices, and if we maintain a website, we will post a copy of the revised notice on our website EmpoweredPathways.life. If we maintain a physical delivery site, we will also post a copy in our office. The notice will also be available upon request. We reserve the right to make any

revised or changed notice effective for information we already have and for information that we receive in the future.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we am permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. we may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

We collect, use, and disclose your health information to provide information:

*To you or someone who has the legal right to act for you (your personal representative) in order to administer your rights as described in this notice; and

*To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected.

We have the right to collect, use, and disclose health information for your treatment, to bill for your health care and to operate our business. For example, we may collect, use and disclose your health information:

* For Payment. We may collect, use, and disclose health information to obtain payment for health care services. For example, we may collect information from, or disclose information to, your health

plan in order to obtain payment for the medical services we provide to you. We may ask you for advance payment.

* For Treatment. We may collect, use, and disclose health information to aid in your treatment or the coordination of your care. For example, we may collect, information from, or disclose information

to, your physicians or hospitals to help them provide medical care to you.

*For Health Care Operations. We may collect, use, and disclose health information as necessary to operate and manage our business activities related to providing and managing your health care. For example, we might analyze data to determine how we can improve our services. We may also

de-identify health information in accordance with applicable laws. After that information is deidentified, it is no longer subject to this notice, and we may use it for any lawful purpose.

* To Provide You Information on Health-Related Programs or Products such as alternative medical treatments and programs or about health-related products and services, subject to limits imposed by law.

*For Reminders. We may collect, use, and disclose health information to send you reminders about your care, such as appointment reminders with providers who provide medical care to you, or

reminders related to medicines prescribed for you.

* For Communications to You. We may communicate, electronically or via telephone, these

treatment, payment, or health care operation messages using telephone numbers or email

addresses you provide to us.

We may collect, use, and disclose your health information for the following purposes under limited

circumstances:

* As Required by Law. We may disclose information when required to do so by law.

* To Persons Involved with Your Care. We may collect, use, and disclose your health information

to a person involved in your care or who helps pay for your care, such as a family member, when

you are incapacitated or in an emergency, or when you agree or fail to object when given the

opportunity. If you are unavailable or unable to object, we will use our best judgment to decide if

the disclosure is in your best interests. Special rules apply regarding when we may disclose health

information to family members and others involved in a deceased individual’s care. We may

disclose health information to any persons involved, prior to the death, in the care or payment for

care of a deceased individual, unless we are aware that doing so would be inconsistent with a

preference previously expressed by the deceased.

*For Public Health Activities such as reporting or preventing disease outbreaks to a public health

authority. We may also disclose your information to the Food and Drug Administration (FDA) or

persons under the jurisdiction of the FDA for purposes related to safety or quality issues, adverse

events or to facilitate drug recalls.

* For Reporting Victims of Abuse, Neglect or Domestic Violence to government authorities that

are authorized by law to receive such information, including a social service or protective service

agency.

* For Health Oversight Activities to a health oversight agency for activities authorized by law, such

as licensure, governmental audits and fraud and abuse investigations.

* For Judicial or Administrative Proceedings such as in response to a court order, search warrant

or subpoena.

* For Law Enforcement Purposes. We may disclose your health information to a law enforcement

official for purposes such as providing limited information to locate a missing person or report a

crime.

* To Avoid a Serious Threat to Health or Safety to you, another person, or the public, by, for

example, disclosing information to public health agencies or law enforcement authorities, or in the

event of an emergency or natural disaster.

* For Specialized Government Functions such as military and veteran activities, national security

and intelligence activities, and the protective services for the President and others.

* For Workers’ Compensation as authorized by, or to the extent necessary to comply with, state

workers compensation laws that govern job-related injuries or illness.

* For Research Purposes such as research related to the evaluation of certain treatments or the

prevention of disease or disability, if the research study meets federal privacy law requirements.

* To Provide Information Regarding Decedents. We may disclose information to a coroner or

medical examiner to identify a deceased person, determine a cause of death, or as authorized by

law. We may also disclose information to funeral directors as necessary to carry out their duties.

* For Organ Procurement Purposes. We may collect, use, and disclose information to entities that

handle procurement, banking or transplantation of organs, eyes or tissue to facilitate donation and

transplantation.

* To Correctional Institutions or Law Enforcement Officials if you are an inmate of a correctional

institution or under the custody of a law enforcement official, but only if necessary (1) for the

institution to provide you with health care; (2) to protect your health and safety or the health and

safety of others; or (3) for the safety and security of the correctional institution.

* To Business Associates that perform functions on our behalf or provide us with services if the

information is necessary for such functions or services. Our business associates are required,

under contract with us and pursuant to federal law, to protect the privacy of your information and

are not allowed to collect, use, and disclose any information other than as specified in our contract

and permitted by law.

* Additional Restrictions on Use and Disclosure. Certain federal and state laws may require

special privacy protections that restrict the use and disclosure of certain health information,

including highly confidential information about you. Such laws may protect the following types of

information:

1. Alcohol and Substance Abuse

2. Biometric Information

3. Child or Adult Abuse or Neglect, including Sexual Assault

4. Communicable Diseases

5. Genetic Information

6. HIV/AIDS

7. Mental Health

8. Minors Information

9. Prescriptions

10. Reproductive Health

11. Sexually Transmitted Diseases

If a use or disclosure of health information described above in this notice is prohibited or materially

limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.

Except for uses and disclosures described and limited as set forth in this notice, we will use and

disclose your health information only with a written authorization from you. This includes, except for

limited circumstances allowed by federal privacy law, not using or disclosing psychotherapy notes

about you, selling your health information to others, or using or disclosing your health information for

certain promotional communications that are prohibited marketing communications under federal law,

without your written authorization. Once you give us authorization to release your health information,

we cannot guarantee that the recipient to whom the information is provided will not disclose the

information. You may take back or "revoke" your written authorization at any time in writing, except if

we have already acted based on your authorization. To find out how to revoke an authorization, use the

contact information below under the section titled “Exercising Your Rights.”

CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

What Are Your Rights

The following are your rights with respect to your health information:

*You have the right to ask to restrict uses or disclosures of your information for treatment,

payment, or health care operations. You also have the right to ask to restrict disclosures to family

members or to others who are involved in your health care or payment for your health care. Please

note that while we will try to honor your request and will permit requests consistent with our

policies, we are not required to agree to any restriction other than with respect to certain

disclosures to health plans as further described in this notice.

* You have the right to request that we not send health information to health plans in certain

circumstances if the health information concerns a health care item or service for which you or a

person on your behalf has paid us in full. We will agree to all requests meeting the above criteria

and that are submitted in a timely manner.

*You have the right to ask to receive confidential communications of information in a different

manner or at a different place (for example, by sending information to a P.O. Box instead of your

home address). We will accommodate reasonable requests. In certain circumstances, we will

accept your verbal request to receive confidential communications; however, we may also require

you confirm your request in writing. In addition, any request to modify or cancel a previous

confidential communication request must be made in writing. Mail your request to the address listed

below.

* You have the right to see and obtain a copy of certain health information we maintain about you

such as medical records and billing records. If we maintain a copy of your health information

electronically, you will have the right to request that we send a copy of your health information in an

electronic format to you. You can also request that we provide a copy of your information to a third

party that you identify. In some cases, you may receive a summary of this health information. You

must make a written request to inspect or obtain a copy your health information or have your

information sent to a third party. Mail your request to the address listed below. In certain limited

circumstances, we may deny your request to inspect and copy your health information. If we deny

your request, you may have the right to have the denial reviewed. We may charge a reasonable fee

for any copies.

* You have the right to ask to amend certain health information we maintain about you such as

medical records and billing records if you believe the information is wrong or incomplete. Your

request must be in writing and provide the reasons for the requested amendment. Mail your

request to the address listed below. If we deny your request, you may have a statement of your

disagreement added to your health information.

*You have the right to receive an accounting of certain disclosures of your information made by

us during the six years prior to your request. This accounting will not include disclosures of

information made: (i) for treatment, payment, and health care operations purposes; (ii) to you or

pursuant to your authorization; and (iii) to correctional institutions or law enforcement officials; and

(iv) other disclosures for which federal law does not require us to provide an accounting.

* You have the right to a paper copy of this notice. You may ask for a copy of this notice at any

time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper

copy of this notice. If we maintain a website, we will post a copy of the revised notice on our

website. You may also obtain a copy of this notice on our website, EmpoweredPathways.life or

Exercising Your Rights

* Contacting your Provider. If you have any questions about this notice or want information about

exercising any of your rights, please call your provider.

*Submitting a Written Request. You can mail your written requests to exercise any of your rights,

including modifying or cancelling a confidential communication, requesting copies of your records,

or requesting amendments to your record, to us at the following address:

Mental Health Privacy Administrator

5540 Centerview Dr Ste 204 #456228 

Raleigh, NC 27606

*Filing a Complaint. If you believe your privacy rights have been violated, you may file a complaint

with us at the address listed above.

You may also notify the Secretary of the U.S. Department of Health and Human Services of yourcomplaint. We will not retaliate against you for filing a complaint.

If you do not receive a response or are unable to successfully contact using the above information, please let your counselor/group facilitator know as soon as possible so that they may assist you.