Notice of Privacy Practices

We are required by law to maintain the privacy and security of your protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by letting us know in writing.

• Treatment: to provide evaluations and therapy, and, with your permission or as allowed by law, to coordinate with other professionals involved in your care.
• Payment: to bill and get payment for services, and to provide documentation such as a superbill if you request one.
• Health care operations: to run the practice, for example scheduling, record keeping and improving the quality of our services.

We are allowed or required to share information in certain situations, usually under specific legal conditions:

• When required by federal, state or local law.
• To prevent or lessen a serious and imminent threat to the health or safety of you or others.
• To report suspected abuse or neglect of a child, an elderly person or a vulnerable adult, as state law requires.
• For health oversight activities, such as audits or licensing reviews by a state board.
• In response to a court order, or a subpoena or other lawful process that meets legal requirements.
• For certain law enforcement purposes, to coroners or medical examiners, for workers’ compensation claims, and for specialized government functions, as the law permits.
• For public health activities, such as preventing disease, when required.

• Most uses and disclosures of psychotherapy notes.
• Marketing, and any sale of your information. We do not sell health information.
• Any other use or disclosure not described in this notice.

Where the laws of the states in which we practice (North Carolina, South Carolina, Missouri, Kansas and Florida) give your information more protection than federal law, we follow the more protective law.

• Get an electronic or paper copy of your health record. We will provide it, usually within 30 days of your request, and may charge a reasonable, cost-based fee.
• Ask us to correct information you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.
• Ask us to contact you in a specific way, for example at a different phone number or address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. We are not required to agree, except that if you pay for a service in full yourself, you can ask us not to share that information with your health insurer, and we will agree unless the law requires us to share it.
• Get a list of the times we have shared your information in the six years before your request, with whom and why, other than for treatment, payment and operations and certain other disclosures.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you, such as a person with medical power of attorney or a legal guardian.

If you feel your privacy rights have been violated, you can complain to us using the contact details below, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at www.hhs.gov/ocr/privacy/hipaa/complaints.

We will not retaliate against you for filing a complaint.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on this website.

Privacy Officer: Karrah Wood Dempster. Wildflower Psychotherapy & Assessment, PLLC, 903 Northeast Dr., Suite 102, Davidson, NC 28036. Phone (816) 685-0624. Email [email protected].