Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Freedom Health Behavioral Servicesis required by law to maintain the privacy of your protected health information (“PHI”), to provide you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

[PLACEHOLDER: this document is a standard-form starting point. It must be reviewed, completed, and approved by the practice's legal counsel or compliance advisor before launch, including any Ohio-specific requirements for mental health and substance-use records.]

How we may use and disclose your health information

• Treatment. We may use and share PHI to provide and coordinate your care, for example with a therapist, primary care provider, or pharmacy involved in your treatment.
• Payment. We may use and share PHI to bill and collect payment from you, your insurance plan, or other payers, such as verifying benefits before a visit.
• Health care operations. We may use PHI to run the practice, such as quality improvement, training, and scheduling.
• As required or permitted by law. This includes public health activities, reporting suspected abuse or neglect, health oversight, certain legal proceedings, and situations involving a serious threat to health or safety.

Psychotherapy notes, where kept, receive additional protection, and most uses beyond treatment, payment, and operations require your written authorization. You may revoke an authorization at any time, in writing, except where we have already acted on it.

Your rights regarding your health information

• Right to inspect and copy. You may ask to see or receive a copy of your health record, with limited exceptions.
• Right to amend. You may request a correction to information you believe is inaccurate or incomplete.
• Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your PHI.
• Right to request restrictions. You may request limits on how we use or share your PHI. We must agree when the request concerns disclosure to a health plan for an item you paid for in full out of pocket.
• Right to confidential communications. You may ask us to contact you in a specific way or at a specific location, for example, only by phone, or not at a shared address.
• Right to a paper copy. You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Right to breach notification. We will notify you if a breach occurs that may have compromised the privacy or security of your information.

Minors and families

For patients who are minors, parents or legal guardians generally exercise these rights on the child's behalf, subject to Ohio law governing minors' consent to certain mental health services. Please ask us if you have questions about how this applies to your family.

Changes to this notice

We reserve the right to change this notice and to make the revised notice effective for PHI we already hold. The current notice will always be posted on this page and available at the office.

Complaints and questions

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

Privacy Officer [PLACEHOLDER: name], Freedom Health Behavioral Services, 5541 Westerville Rd., Westerville, OH 43081 · (220) 205-2035 · intake@freedomhealthbehavioral.com