Health Insurance Portability & Accountability Act (HIPAA)

 For any privacy-related concerns, please contact:

Mindful Synergy Psychiatry PLLC
Email: admin@mindfulsynergypsychiatry.com
Phone: (480) 750‑7443 

Effective Date: May 13, 2025

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.

At Mindful Synergy Psychiatry, we are committed to maintaining the privacy of your protected health information (PHI). This Notice explains how we may use and disclose your PHI and describes your rights regarding this information under the Health Insurance Portability and Accountability Act (HIPAA). We are legally required to maintain the privacy of your health records and to provide you with this notice of our legal duties and privacy practices. 

A. Permitted Uses and Disclosures of Your Health Information

Mindful Synergy Psychiatry collects and maintains information about your health in a confidential medical record. In accordance with federal and state laws, we are committed to protecting your protected health information (PHI). PHI refers to identifiable health information related to your past, present, or future physical or mental condition, the health care services you receive, or payment for those services. We may use or share your PHI under the following circumstances:

1. For Treatment Purposes: Your PHI may be used or disclosed to provide and coordinate your care. This includes sharing information with internal staff members involved in your treatment, or with external health care providers, such as specialists, laboratories, or pharmacists, who participate in your care.
   
2. For Payment Activities: We may use and share your PHI with insurance companies, billing services, or other payers to obtain reimbursement for services provided to you.
   
3. For Appointment Reminders and Related Communications: Using the contact details you provide, we may call or leave messages to confirm appointments or to share information about treatment options, health-related services, or other benefits that may be of interest to you.
   
4. For Health Care Operations: Your information may be used for administrative and operational purposes such as quality assurance, staff training, auditing, licensing, compliance programs, or business planning. We may also share PHI with third-party service providers, known as “business associates,” who assist with administrative tasks. These entities are contractually obligated to safeguard your PHI.
   
5. To Notify or Communicate with Family Members and Caregivers: We may disclose relevant health information to individuals involved in your care or responsible for payment of care, such as family members or caregivers. In emergencies or when you are unavailable, we may use professional judgment to determine what is appropriate to share, including in disaster situations.
   
6. As Required by Law: We are obligated to disclose your PHI when required by federal, state, or local law. This includes mandated reporting of abuse, neglect, domestic violence, responding to subpoenas or court orders, and compliance with public health or regulatory agencies.
   
7. For Public Health Activities: Your PHI may be shared with public health authorities for purposes such as preventing or controlling disease, reporting abuse or neglect, or informing the FDA of medication reactions or product issues.
   
8. For Oversight Activities: Health oversight agencies may access your PHI for audits, inspections, investigations, or licensure activities as permitted by law.
   
9. For Legal Proceedings: In certain legal processes, we may disclose PHI as authorized by a court order or in response to lawful requests, provided appropriate efforts have been made to notify you or obtain a protective order.
   
10. To Law Enforcement: We may disclose PHI for law enforcement purposes, such as complying with a court order or locating a suspect or missing person, as permitted or required by law.
    
11. For Public Safety and National Security: In order to prevent serious threats to health or safety, or as required for national security, intelligence activities, or protection of public officials, PHI may be shared with appropriate authorities.
    
12. For Worker’s Compensation: PHI may be disclosed as required to comply with workers' compensation laws and similar programs.
    
13. Concerning Minors: If you are a minor and not legally emancipated, we may share your health information with a parent or legal guardian in compliance with applicable laws and ethical standards.
    
14. Prohibition on Sale of PHI: We will not sell your PHI for financial gain without your explicit, prior authorization.
    
15. Marketing Communications: Your PHI will not be used for marketing purposes involving financial compensation without your written authorization, which must disclose the compensation involved.
    
16. Uses Requiring Your Written Authorization: Certain uses and disclosures require your prior written permission. These include:
    1. Use or disclosure of psychotherapy notes (if maintained separately from your medical record);
    2. Use or disclosure for marketing involving financial gain;
    3. Disclosures considered a sale of PHI;
    4. Any other uses not expressly described in this Notice.
       

Please note: Although HIPAA may permit some disclosures without your authorization, certain state laws impose additional restrictions. In such cases, we will follow the more stringent requirements and may only disclose PHI with your explicit consent or upon receiving a valid, written request from the authorized party. Additionally, we may be limited in our ability to redisclose information received from other providers.

B. Limitations on Use and Disclosure of Your Health Information

Mindful Synergy Psychiatry will not use or share your protected health information (PHI) without your written permission, except as outlined in this Notice of Privacy Practices. If you choose to authorize us to use or disclose your PHI for a specific purpose, you have the right to withdraw that permission at any time by submitting a written revocation. Once we receive your written request, we will no longer use or share your PHI for the purposes covered by the authorization, unless we have already taken action based on it.

C. Your Rights Regarding Your Health Information

1. Right to Request Special Privacy Protections
You have the right to request that we place specific restrictions on how we use or share your health information. This request must be made in writing and must clearly outline what information you want restricted, how you wish the restriction to be applied, and to whom the restrictions should apply. While we are not obligated to approve all such requests, we are required to honor a restriction if you paid in full for a service out of pocket and asked that your health plan not be informed of that service. We will notify you in writing of our decision regarding your request.

2. Right to Request Confidential Communication
You may request that we communicate with you in a specific manner or at a specific location to maintain your privacy. For example, you can request that your records be sent to a work address or P.O. box. We will accommodate reasonable written requests that clearly state your preferred communication method or location.

3. Right to Access and Copy Your Health Information
You are entitled to review and obtain a copy of your medical records, with limited exceptions. Requests must be made in writing and specify whether you wish to view the information or receive a copy. We may charge a reasonable fee in accordance with applicable laws. If we deny access, you will be informed in writing of the reason for the denial and whether you are eligible to appeal the decision. In most cases, you may request a review of the denial, and we will follow the outcome of that review.

4. Right to Request an Amendment or Supplement
If you believe your medical information is incorrect or incomplete, you may request that we amend or supplement it. This request must be in writing and include your reasons for the proposed correction. While we are not required to make changes, we will inform you in writing if we deny your request and provide instructions for how you may submit a statement of disagreement, which will be included in your record. You may also add a statement of up to 250 words explaining your view.

5. Right to an Accounting of Disclosures
You have the right to request a record of certain disclosures of your health information made by Mindful Synergy Psychiatry during the past six years. This does not include disclosures made directly to you, those for treatment, payment, or operations, or those made with your written authorization. One accounting request is allowed per 12-month period free of charge; additional requests may be subject to a reasonable fee.

6. Right to Receive an Electronic Copy of Your Records
If your health information is stored electronically, you may request that we send a digital copy to you or to a third party. We will provide the information in your requested format if feasible. If not, we will provide it in a standard electronic or paper format. A reasonable cost-based fee may apply for labor involved in producing the electronic copy.

7. Right to Notification of a Breach
If your unsecured protected health information is ever compromised, you have the right to be informed of the breach in accordance with federal guidelines.

8. Right to a Paper Copy of This Notice
Even if you have received this Notice electronically, you are entitled to request and receive a paper copy at any time.

D. Updates to This Notice of Privacy Practices

Mindful Synergy Psychiatry reserves the right to revise this Notice of Privacy Practices at any time. Changes will apply to all protected health information that we maintain, regardless of when the information was created or received. The most current version of this notice will be published on our website. 

E. Filing a Complaint

If you believe your privacy rights have been violated or if you have concerns about how your information has been handled, you may file a complaint by contacting us at with our Privacy Officer. You will not face any form of retaliation or penalty for submitting a complaint.

To exercise any of the rights described above or to receive further clarification, please contact us at the contact information provided at the beginning of this Notice.