Notice of Privacy Practices 

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

PRISM Mental Health is committed to protecting your privacy. We are required by law to: 

  • Maintain the privacy and security of your protected health information (PHI)

  • Provide you with this Notice of Privacy Practices

  • Follow the duties and privacy practices described in this Notice 

  • Notify you if a breach occurs that may compromise the privacy or security of your information. 

  • We will not use or disclose your information other than as described in this Notice unless you give us written permission. You may change your mind and revoke that permission at any time in writing, except where we have already acted in reliance on it.

This Notice applies to all records created or received by PRISM Mental Health. 

Our Uses and Disclosure

We may use or share your health information, without written authorization, in the following ways: 

Treatment

We may use your health information and share it with others involved in your care to provide, coordinate, or manage your health care and related services. Examples include: A provider treating you for an injury asks another provider about your overall health condition. Consultation with colleagues for clinical or quality-of-care purposes. 

Payment

We may use and disclose your health information to bill and collect payment from health plans or other entities. Examples include: We give information about you to your health insurance plan so it will pay for your services. Responding to payor audits or requests. 

Running Our Organization/Operations

We may use and disclose your health information to run our practice, improve your care, and contact you when necessary. Examples include: We use health information about you to manage your treatment and services. Quality improvement and compliance activities. Training staff and supervision. 

Future communications 

We may communicate to you via phone, emails, or other means regarding your treatment, care coordination, appointments, medications, or other health-related information, as well as practice-related matters such as wellness or disease-management programs, or other activities in which we participate. 

Business associates 

Some of the services provided to you may be performed on our behalf by outside vendors called Business Associates. We will disclose your health information to our Business Associates to allow them to perform these services for us. Business Associates are required by federal law to safeguard your information. Example: We may contract with an accounting service to handle our patient billing and accounting. 


Other ways we may use or disclose your health information

We are permitted or required by law to use or disclose your health information in certain situations without your authorization. These uses and disclosures are limited and occur only when specific legal requirements are met under applicable federal and state privacy laws. 

For more information see: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

Help with public health and safety issues 

We may use or disclose health information about you for certain situations such as: 

• Preventing disease 

• Helping with product recalls 

• Reporting adverse reactions to medications 

• Reporting suspected abuse, neglect, or domestic violence 

• Preventing or reducing a serious threat to anyone’s health or safety 

Research

We may use or disclose your health information for research purposes in certain circumstances, as permitted by law.  

Comply with the law 

We may use or disclose your health information when required to do so by federal, state, or local laws, including disclosure to the Department of Health and Human Services for oversight of compliance with privacy laws. 

Respond to organ and tissue donation requests 

We may use or disclose health information as necessary to support organ and tissue donations, transplantation, or related activities. 

Work with a medical examiner or funeral director 

We may use or disclose health information with a coroner, medical examiner, or funeral director when an individual dies. 

Address workers’ compensation, law enforcement, and other government requests 

We may use or disclose health information about you: 

• For workers’ compensation claims 

• For law enforcement purposes or with a law enforcement official 

• With health oversight agencies for activities authorized by law 

• For certain government functions such as military, national security, and presidential protective services 

Respond to lawsuits and legal actions 

We may use or disclose health information about you in response to a court or administrative order, or in response to a subpoena. 

Special rules for substance use disorder (SUD) information (42 CFR Part 2)

Some information in your medical record may be protected by federal law governing the confidentiality of substance use disorder treatment records (42 CFR Part 2). In general, we may not use or disclose this information without your written consent, except in limited circumstances as permitted or required by law. 

When you provide written consent, your substance use disorder treatment information may be used and disclosed for treatment, payment, and health care operations, consistent with federal law. You have the right to revoke consent for SUD disclosures at any time, except to the extent that action has already been taken in reliance on your consent. 

Your Choices 

For certain situations, you have choices about how we use or disclose your information. If you have a preference for how your information is shared in the situations described below, you may let us know, and we will respect your preferences as required by law. 

In these situations, you have both the right and choice to direct us to: 

• Share information with your family, close friends, or others involved in your care 

• Share information in a disaster relief situation 

• Include your information in a hospital directory 

If you are not able to tell us your preference, for example if you are unconscious, we may use or disclose your information if we believe it is in your best interest. We may also use or disclose your information when necessary to lessen a serious and imminent threat to health or safety. 

In the case of fundraising: We may contact you for fundraising efforts, but you can tell us not to contact you again. 
In these situations, we will not use or disclose your information unless you give us written permission: 

• Marketing purposes 

• Sale of your information 

• Psychotherapy notes, which require your separate written authorization. Psychotherapy notes are kept separate from your medical record and do not include medication management notes. 

You may revoke an authorization at any time in writing, except in the extent that we have already taken action in reliance on your authorization. 

Your Rights 

When it comes to your health information, you have the following rights: 

Get an electronic or paper copy of your medical record 

• You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you by submitting a request.

• We may deny your request for some of your health information as permitted by law. If we deny your request, we will provide a written explanation and information about how the denial may be reviewed, when applicable. 

• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. 

Ask us to correct your medical record 

• You may ask us to amend health information about you that you believe is incorrect or incomplete. Ask us how to do this. 

• We may deny your request but will provide you with a written explanation within 60 days. 

Request confidential communications 

• You may ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

 • We will accommodate all reasonable requests.  

Ask us to limit what we use or disclose 

• You may ask us not to use or disclose certain health information for treatment, payment, or our operations. We are not required to agree to all requests and we may deny a request if it would affect your care. 

• If you pay for a service or health care item out-of-pocket in full, you may request that we do disclose information related to that service for the purpose of payment or our operations with your health insurer, unless disclosure is required by law. 

• You have the right to authorize or revoke consent for the use or disclosure of substance use disorder treatment records protected by 42 CFR Part 2. Revocation of consent applies only to disclosures made after the revocation.

Get a list of those with whom we’ve shared information 

• You may request a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. 

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). 

•We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee for additional requests within a 12 month period. 

Get a copy of this privacy notice 

• You may request a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. 

Choose someone to act for you 

• If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information on your behalf. 

• We will verify the person has this authority and can act for you before we take any action. 

File a complaint if you feel your rights are violated 

• You may file a complaint if you feel we have violated your rights by contacting PRISM Mental Health at 303-351-2173 or admin@prismmentalhealthcare.com

• You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights in writing by mail, fax, e-mail, or via the OCR Complaint Portal . Mailing address 200 Independence Avenue, S.W., Room 509F HHH Bldg Washington, D.C. 20201. For more information visit: https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html

• We will not retaliate against you for filing a complaint. 

Changes to the Terms of this Notice 

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

Effective date: This Notice is effective January 10th, 2026

For questions about this Notice of Privacy Practices or your rights described herein, please contact PRISM Mental Health, reachable by phone/ email at 303-351-2173 or admin@prismmentalhealthcare.com