INTERSECT MENTAL WELLNESS
Intersect Mental Wellness is not a crisis center — call 911, 988, or go to your closest hospital emergency room if you’re having an emergency.

HIPAA Notice of Privacy Practices

Intersect Mental Wellness  •  480-680-7706  •  info@itsmentalwellness.com

Effective Date:

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.

Introduction

We are committed to protecting your health information. This notice explains how we may use and share your protected health information (PHI) and outlines your rights. PHI includes any information about your health, treatments, and payments that can identify you.

How we use and share your information

  • Treatment: We may use and share your PHI with doctors, nurses, or other healthcare providers to provide or coordinate your care.
  • Payment: We may use and share your PHI to bill and receive payment for the services you receive.
  • Healthcare Operations: We may use and share your PHI to run our practice and improve patient care, including staff training and quality checks.
  • Substance Use Disorder (SUD) Records: If we receive records regarding substance use disorder treatment from a federally assisted program (a "Part 2 Program"), those records are protected by 42 CFR Part 2. With your one-time written consent, we may use and disclose these records for your future treatment, payment, and healthcare operations. You may revoke this consent at any time in writing, except to the extent we have already acted in reliance on it.
  • Other Uses Without Your Authorization: We may share your PHI without your permission as required by law for public health issues, health oversight, or national security.

Important Limitation: Records protected by 42 CFR Part 2 (SUD records) cannot be used against you in any civil, criminal, administrative, or legislative proceedings without your specific written consent or a specialized court order.

Your rights

  • Inspect and Copy Your Records: You can request to view and obtain a copy of your health information. Fees may apply.
  • Request Restrictions: You can ask us to restrict certain uses of your PHI. We are not required to agree unless the PHI pertains to a service you paid for out-of-pocket in full.
  • Confidential Communication: You can request that we communicate with you in a specific way (e.g., by mail only).
  • Amend Your Records: You may ask us to amend incorrect or incomplete information.
  • Accounting of Disclosures: You can request a list of disclosures we’ve made of your PHI. For disclosures made through an electronic health record for treatment, payment, or operations, you may request an accounting of disclosures made over the past three years.
  • Paper Copy of this Notice: You have the right to receive a paper copy of this notice at any time.

Our responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this Notice and give you a copy of it.
  • We will not use or share your information other than as described in this Notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Notice regarding redisclosure

Information disclosed pursuant to your consent may be subject to redisclosure by the recipient and may no longer be protected by federal privacy regulations. However, for SUD records, the recipient is generally prohibited from making any further disclosure unless express written consent is provided or otherwise permitted by 42 CFR Part 2.

Complaints

If you believe your privacy rights have been violated, you can file a complaint without fear of retaliation. You may contact us at Intersect Mental Wellness.

Contact person: Heidi Reed Phone: 480-680-7706 Email: info@itsmentalwellness.com

Changes to this notice

We reserve the right to change this notice. The current notice will be posted on our website.

Our pledge regarding your personal health information

INTERSECT MENTAL WELLNESS is committed to maintaining and protecting the confidentiality of the individual’s PHI. INTERSECT MENTAL WELLNESS is required by federal and state law, including the Health Insurance Portability and Accountability Act ("HIPAA"), to protect the individual’s PHI and other personal information. INTERSECT MENTAL WELLNESS is required to provide the individual with this Notice of Privacy Practices regarding their specific policies, safeguards, and practices. When INTERSECT MENTAL WELLNESS uses or discloses an individual’s PHI, INTERSECT MENTAL WELLNESS is bound by the terms of this Notice of Privacy Practices, or the revised notice of Privacy Practices, if applicable.

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record 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 this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. 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 on our website at www.itsmentalwellness.com.

How we may use and disclose your health information

The following describes the ways INTERSECT MENTAL WELLNESS may use and disclose PHI. Except for the purposes described below, INTERSECT MENTAL WELLNESS will use and disclose PHI only with the individual’s written permission. The individual may revoke such permission at any time by writing to INTERSECT MENTAL WELLNESS via email at info@itsmentalwellness.com.

  • For Treatment: We may use and disclose PHI for the individual’s services. For example, INTERSECT MENTAL WELLNESS may disclose PHI to doctors, nurses, technicians, or other personnel, including people outside INTERSECT MENTAL WELLNESS, who are involved in the individual’s medical care and need the information to provide the individual with medical care.
  • For Payment: We operate strictly as a private-pay practice and do not submit claims to, or interact directly with, commercial insurance companies, Medicaid, or Medicare. However, we may use and disclose your PHI to generate a statement of services (a "Superbill") directly to you. You may choose to submit this documentation to your insurance provider to seek out-of-network reimbursement. You, the individual, assumes full financial responsibility for ensuring payment is made directly to our practice at the time of service.
  • 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 INTERSECT MENTAL 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 the individual to remind them that they have an appointment with INTERSECT MENTAL WELLNESS. We also may use and disclose PHI to tell the individual about treatment alternatives or health-related benefits and services that may be of interest to the individual.
  • Research: Under certain circumstances, INTERSECT MENTAL WELLNESS 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. INTERSECT MENTAL WELLNESS will generally ask for the individual’s written authorization before using the individual’s PHI or sharing it with others to conduct research. Under limited circumstances, we may use and disclose PHI for research purposes without the individual’s 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.

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 the individual’s 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 as 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, INTERSECT MENTAL WELLNESS is unable to obtain the individual’s agreement; (4) about a death INTERSECT MENTAL WELLNESS believes may be the result of criminal conduct; (5) about criminal conduct on INTERSECT MENTAL 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 business associates that perform functions on our behalf or provide INTERSECT MENTAL WELLNESS with services if the information is necessary for such functions or services. All of INTERSECT MENTAL WELLNESS’ business associates are obligated to protect the privacy of the individual’s information and are not allowed to use or disclose any information other than as specified in our contract.
  • Lawsuits and Disputes: If the individual is involved in a lawsuit or a dispute, INTERSECT MENTAL WELLNESS may disclose PHI in response to a court or administrative order. INTERSECT MENTAL 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 our organization in legal or administrative proceedings initiated by you, as required by the States of Arizona or Nevada or the US Department of Health and Human Services to investigate or determine our 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.

Your rights with respect to your PHI

  • The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and may say "no" if we believe it would 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 us 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 that 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 15 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 days of receiving your request. The list we will give you will include disclosures made in the last six (6) years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost-based fee for each additional request as allowed by law.
  • 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 say "no" to your request, but we will tell you why in writing within 30 days.
  • The Right to Get a Paper or Electronic Copy of this Notice: You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
  • Right to Get Notice of a Breach: INTERSECT MENTAL WELLNESS is committed to safeguarding the individual’s PHI. If a breach of the individual’s PHI occurs INTERSECT MENTAL WELLNESS will notify the individual in accordance with state and federal law.
  • Right to Request Restrictions: Individuals have the right to request a restriction or limitation on the PHI INTERSECT MENTAL WELLNESS uses or discloses 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 the individual’s care or the payment for the individual’s care, like a family member or friend.

To request a restriction, the individual must make their request, in writing, to the Department in which their care was provided. INTERSECT MENTAL 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 the individual wishes to restrict pertains solely to a health care item or service for which the individual has paid out-of-pocket in full. If we agree, we will comply with the individual’s 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.

Insurance and privacy

INTERSECT MENTAL WELLNESS is a cash-only practice. We do not bill or share information with health insurance plans.

A paper or electronic copy of this notice is available on request at any time. Contact info@itsmentalwellness.com or call 480-680-7706.