Now accepting new patients in Tennessee and California!
Schedule an Appointment — Patient Portal
Inspire Youth Psychiatry and Wellness
Book a Consult

HIPAA Notice of Privacy Practices

Inspire Youth Psychiatry and Wellness is committed to maintaining and protecting the confidentiality of your Protected Health Information (PHI). Inspire Youth Psychiatry and Wellness is required by federal and state law, including the Health Insurance Portability and Accountability Act (“HIPAA”), to protect your PHI and other personal information. Inspire Youth Psychiatry and Wellness is required to provide you with this Notice of Privacy Practices regarding our specific policies, safeguards, and practices. When Inspire Youth Psychiatry and Wellness uses or discloses your PHI, we are bound by the terms of this Notice of Privacy Practices, or the revised notice of Privacy Practices, if applicable. 

I. Our Pledge Regarding Your Personal Health Information:

We understand that health information about you and your health care is personal. We are committed to protecting your health information. We create a record of the care and services you receive to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Inspire Youth Psychiatry and Wellness. This notice will tell you about the ways in which we may use and disclose your health information. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

  • Make sure that protected health information (“PHI”) that identifies you is kept private.
  • Give you this notice of our legal duties and privacy practices with respect to health information.
  • Follow the terms of the notice that is currently in effect.
  • We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.

II. How We May Use and Disclose Your Health Information:

The following describes the ways Inspire Youth Psychiatry and Wellness may use and disclose PHI. Except for the purposes described below, Inspire Youth Psychiatry and Wellness will use and disclose PHI only with your written permission. Once permission is given, you may revoke such permission at any time by writing to Inspire Youth Psychiatry and Wellness via the Secure Patient Portal; this will be forwarded to our Compliance Officer.

  • For Treatment: We may use and disclose PHI for your services. For example, we may disclose PHI to doctors, nurses, outside therapists, technicians, or other personnel, including people outside Inspire Youth Psychiatry and Wellness, who are involved in your medical care and need the information to provide the individual with medical care.
  • For Payment: We may use and disclose PHI so that others may bill and receive payment from your insurance company or third party for the treatment and services you received. For example, we may tell your insurance company about a treatment you are going to receive to determine whether your insurance company will cover the treatment.
  • For Health Care Operations: We may use and disclose PHI for health care operation purposes. The uses and disclosures are necessary to make sure that all Inspire Youth Psychiatry and Wellness patients receive quality care and to operate and manage our office.
  • Appointment Reminders, Treatment Alternatives, and Health Related Benefits and Services: We may use and disclose PHI to contact you to remind you of upcoming appointments. We also may use and disclose PHI to tell you about treatment alternatives or health-related benefits and services that may be of interest.
  • Research: Under certain circumstances, we may use and disclose PHI for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition. Inspire Youth Psychiatry and Wellness will generally ask for your written authorization before using your PHI or sharing it with others to conduct research. Under limited circumstances, we may use and disclose PHI for research purposes without your permission.
  • Incidental Use and Disclosure: We are not required to eliminate every risk of an incidental use or disclosure of your PHI. Specifically, a use or disclosure of your PHI that occurs as a result of, or incident to an otherwise permitted use or disclosure is permitted as long as we have adopted reasonable safeguards to protect your PHI, and the information being shared was limited to the minimum necessary.

III. Special Situations in Which We May Disclose PHI Without Your Consent:

  • As Required by Law: We will disclose PHI when required to do so by international, federal, state, or local law.
    • To Avert a Serious Threat to Health or Safety: We may use and disclose PHI when necessary to prevent a serious threat to your health and safety or the health and safety of others. Disclosures, however, will be made only to someone who may be able to help prevent or respond to the threat, such a law enforcement or potential victim.  For example, we may need to disclose information to law enforcement when a patient reveals participation in a violent crime.
    • Law Enforcement: We may release PHI if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, Inspire Youth Psychiatry and Wellness is unable to obtain your agreement; (4) about a death Inspire Youth Psychiatry and Wellness believes may be the result of criminal conduct; (5) about criminal conduct on Inspire Youth Psychiatry and Wellness premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
    • Abuse or Neglect: We may disclose your PHI to a state or local agency that is authorized by law to receive reports of abuse or neglect. However, the information we disclose is limited to only that information which is necessary to make the required mandated report.
    • Essential Government Functions: We may be required to disclose your PHI for certain essential government functions. Such functions include but are not limited to: assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.
  • Business Associates: We may disclose PHI to any business associates that perform functions on our behalf or provide Inspire Youth Psychiatry and Wellness with services if the information is necessary for such functions or services. All of Inspire Youth Psychiatry and Wellness’s business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
  • Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, Inspire Youth Psychiatry and Wellness may disclose PHI in response to a court or administrative order. Inspire Youth Psychiatry and Wellness also may disclose PHI in response to a subpoena, discovery request, or other lawful request by someone else involved in the request or to allow the individual to obtain an order protecting the information requested.
  • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors) and peer review organizations performing utilization and quality control. If we disclose PHI to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your information.
  • Psychotherapy Notes: If kept as separate records, we must obtain your authorization to use or disclose psychotherapy notes with the following exceptions: We may use the notes for your treatment. We may also use or disclose, without your authorization, the psychotherapy notes for our own training, to defend Inspire Youth Psychiatry and Wellness or our providers in legal or administrative proceedings initiated by you, as required by Tennessee or California law or the US Department of Health and Human Services to investigate or determine my compliance with applicable regulations, to avert a serious and imminent threat to public health or safety, to a health oversight agency for lawful oversight, for the lawful activities of a coroner or medical examiner or as otherwise required by law.

IV. You Have the Following Rights with Respect to Your PHI:

  • The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request if we believe it would negatively affect your health care.
  • The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
  • The Right to Choose How We Send PHI to You: You have the right to ask Inspire Youth Psychiatry and Wellness to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
  • The Right to See and Get Copies of Your PHI: Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 10 business days of receiving your written request.
  • The Right to Get a List of the Disclosures We Have Made: You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 30 calendar days of receiving your request. The list we give you will include disclosures made over the past 1 year, unless you request a shorter or longer time, up to 6 years. We will provide the list to you at no charge.
  • The Right to Correct or Update Your PHI: If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may deny your request if there is an appropriate reason; in that case, we would provide the reason in writing within 60 days.
  • The Right to Get a Paper or Electronic Copy of this Notice: You have the right receive a copy of this Notice in paper, by e-mail, and/or through the Patient Portal (which may be printed).
  • Right to Get Notice of a Breach: Inspire Youth Psychiatry and Wellness is committed to safeguarding your PHI. If a breach of your PHI occurs, Inspire Youth Psychiatry and Wellness will notify you in accordance with state and federal law.
  • Right to Request Restrictions: Individuals have the right to request a restriction or limitation on the PHI Inspire Youth Psychiatry and Wellness uses or disclose for treatment, payment, or health care operations. Individuals also have the right to request a limit on the PHI we disclose to someone involved in your care or the payment for your care, like a family member or friend.
    • To request a restriction, the individual must make their request in writing to the provider who delivered the care. Inspire Youth Psychiatry and Wellness is not required to agree to the individual’s request unless the individual is asking us to restrict the use and disclosure of the individual’s PHI to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid out-of-pocket in full. If we agree, we will comply with your request unless the information is needed to provide the individual with emergency treatment or to comply with law. If we do not agree, we will provide an explanation in writing.
  • Out-of-Pocket Payments: If you pay out-of-pocket in full for a specific item or service, you have the right to ask that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.