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PRIVACY POLICY AT Premier Behavioral Health & Wellness


Notice of Privacy Practices & Commitment to Confidentiality (HIPAA) Guidelines.

1. Our Promise to Safeguard Your Privacy
At Premier Behavioral Health & Wellness, we know that your mental, emotional, and physical well-being is deeply personal. When you choose to share your story—your health history, your challenges, and your treatment journey—you place your trust in us. That trust is sacred, and we are committed to protecting it. Your medical and mental health information, known as Protected Health Information (PHI), is guarded with the highest level of confidentiality. We strictly comply with federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA), and we go above and beyond those requirements to ensure your information remains secure, private, and used only in ways that benefit you.

2. How We Protect Your Information

We apply multiple layers of safeguards to protect your PHI at every stage:
2.1 Secure Handling – Every member of our team is trained in HIPAA compliance, confidentiality, and ethical handling of sensitive data. We follow strict protocols for storing, transmitting, and discussing your PHI.
2.2 Limited Access – Only authorized staff involved directly in your care, billing, or essential administrative duties have access to your PHI—and even then, only the minimum information necessary.
2.3 Breach Response – In the unlikely event of a privacy breach, you will be promptly informed with a clear explanation of what happened, the corrective actions being taken, and steps to prevent it from happening again.


3. Your Rights as Our Patient

We believe you should have full visibility and control over your PHI. You have the right to:

  • View & Receive Copies of your medical and mental health records (with limited exceptions such as psychotherapy notes).
  • Request Corrections if you believe your information is incomplete or inaccurate.
  • Set Communication Preferences so we contact you in the way you feel most secure.
  • Request Restrictions on how your information is used or shared (we will honor agreed-upon limits unless the law requires otherwise).
  • Review a History of Disclosures made without your authorization.
  • Receive This Notice at any time in paper or electronic form.
  • File a Complaint Without Fear of retaliation if you believe your privacy rights have been violated.

4. Understanding Disclosures
A disclosure means releasing, transferring, or granting access to your PHI outside of Premier Behavioral Health & Wellness. Depending on the situation, disclosures may require your written authorization or may be permitted without authorization under HIPAA rules.
4.1 Disclosures Requiring Your Written Authorization
We will obtain your signed authorization before:

  • Sharing psychotherapy notes (except where law allows).
  • Using your PHI for marketing purposes.
  •  Selling your PHI for direct or indirect compensation.
  • Any non-routine use or sharing not described in this Notice or permitted by law. 

You may revoke authorization at any time in writing, except where we have already relied on it.

4.2 Disclosures That Do Not Require Authorization
Certain disclosures are allowed by law without your written permission, including:
A. Treatment – Coordinating care with other therapists, psychiatrists, physicians, or healthcare providers.
B. Payment – Sharing necessary details with your insurance provider for claims and coverage verification.
C. Healthcare Operations – Quality improvement, staff training, compliance audits, and operational oversight.
D. Legal or Safety Requirements –Complying with valid court orders, subpoenas, or legal processes.

  • Reporting threats to safety or suspected abuse/neglect under mandatory
    reporting laws.
  • Cooperating with authorized law enforcement requests.
    E. Special Mental Health Provisions –
  • Duty to Warn/Protect if there is a serious risk of harm to self or others.
  • Respecting minors’ privacy rights where state law limits parental access to
    certain records.

5. Extra Safeguards for Mental Health Information
Because mental health information is especially sensitive, we apply enhanced
protections:
5.1 Psychotherapy Notes – Stored separately from your medical record and released
only with your written consent, except in emergencies or as legally required.
5.2 Emergency Safety Measures – If necessary to prevent immediate harm, we may
disclose limited PHI to protect you or others.
5.3 Legal Compliance – Information will be disclosed only when mandated by law, court order, or reporting requirements.
6. Your Voice Matters
Transparency is part of our culture. If you have questions about this Notice, how your PHI is handled, or if you believe your privacy rights have been violated, please contact our Privacy Officer directly. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights—with no fear of retaliation. At Premier Behavioral Health & Wellness, privacy is not just a legal requirement, it is a core value woven into everything we do. We pledge to uphold the highest ethical and professional standards to keep your information safe, secure, and respected always.

Premier Behavioral Health & Wellness
Acknowledgment of Receipt of Privacy Practices
Patient Name: ___________________________________________
Date of Birth: _______________________
I acknowledge that I have received and been given the opportunity to review a copy of Premier Behavioral Health & Wellness’ Notice of Privacy Practices.
This Notice describes how my Protected Health Information (PHI) may be used and disclosed, and how I may access this information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
I understand that:

  • I have the right to review the Notice of Privacy Practices before signing this acknowledgment.
  •  I may request a copy of the Notice of Privacy Practices at any time.
  • 3. Premier Behavioral Health & Wellness has the right to change its Notice of Privacy Practices in accordance with applicable law, and that an updated copy will be made available upon request and posted in the office.
  • I have the right to request restrictions on the use or disclosure of my PHI, but Premier Behavioral Health & Wellness is not required to agree to all requests.
  • This acknowledgment does not authorize the release of my PHI for any purpose other than as described in the Notice of Privacy Practices or as otherwise permitted by law.

Patient or Legal Representative Signature:
__________________________________
Date: _______________________
If Legal Representative, Relationship to Patient: ____________________________
Staff Witness Signature (optional): _________________________ Date:
__________
For Office Use Only:
☐ Patient refused to sign acknowledgment
☐ Reason:
___________________________________________________________
☐ Date acknowledgment offered: _______________ ☐ Staff Initials: _______

Here’s a clear outline of the penalties for violating HIPAA rules under the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR):
Civil Penalties
HIPAA violations can result in tiered civil monetary penalties depending on the
level of knowledge and corrective actions taken:
Tier 1 – Lack of Knowledge

  • The entity did not know and could not reasonably have known of the  violation.
  • Penalty: $100 to $50,000 per violation, capped at $25,000 per year for repeat violations.

Tier 2 – Reasonable Cause

  • The violation was due to reasonable cause, not willful neglect.
  • Penalty: $1,000 to $50,000 per violation, capped at $100,000 per year.

Tier 3 – Willful Neglect (Corrected)

  •  The violation was due to willful neglect but corrected within the required
    time.
  • Penalty: $10,000 to $50,000 per violation, capped at $250,000 per year.


Tier 4 – Willful Neglect (Not Corrected)

  • The violation was due to willful neglect and not corrected.
  •  Penalty: Minimum $50,000 per violation, capped at $1.5 million per year.

Criminal Penalties
Serious or intentional violations can result in criminal charges being prosecuted by the Department of Justice (DOJ):
1. Basic Offense – Knowingly obtaining or disclosing PHI without authorization.

  • Penalty: Up to $50,000 fine and 1 year imprisonment.


2. False Pretenses – Committing the offense under false pretenses.

  • Penalty: Up to $100,000 fine and 5 years imprisonment.

3. Intent to Sell, Transfer, or Use PHI – For commercial advantage, personal gain, or malicious harm.

 Penalty: Up to $250,000 fine and 10 years imprisonment.

Other Consequences

  • State Penalties: States may impose their own penalties under local privacy
    laws.
  • Civil Lawsuits: Individuals may file lawsuits if harmed by a violation.
  • Reputational Damage: Organizations can face significant loss of trust and
    business.
  • Corrective Action Plans (CAPs): OCR may require entities to adopt new
    policies, training, and audits as part of a settlement.
    ✅ Summary:
    HIPAA violations carry serious financial and criminal penalties ranging from $100 fines for unintentional lapses to $1.5 million per year in civil penalties and up to 10 years in prison for deliberate misuse of health information.

REFERENCES

Primary Sources
1. Health Insurance Portability and Accountability Act of 1996 (HIPAA)

  • U.S. Public Law 104-191
  • Full Text of HIPAA Law (Congress.gov)

2. U.S. Department of Health & Human Services (HHS) – HIPAA Regulations

  •  Privacy Rule (45 CFR Part 160 and Subparts A and E of Part 164)
  • Security Rule (45 CFR Part 160 and Subparts A and C of Part 164)
  • Breach Notification Rule (45 CFR §§ 164.400-414)
    HHS HIPAA Rules Summary

3. Office for Civil Rights (OCR) – Enforcement
Details on investigations, penalties, and compliance programs.
OCR HIPAA Enforcement

Guidance and Educational Resources
1. HHS Guidance Materials
Includes FAQs, guidance documents, and fact sheets for providers and patients.
HIPAA Guidance Materials
2. National Institutes of Health (NIH) – HIPAA and Research Guidance
NIH HIPAA Guidance
3. Centers for Medicare & Medicaid Services (CMS) – HIPAA Administrative
Simplification CMS HIPAA Administrative Simplification

Key Federal Regulations

  • 45 CFR Part 160 – General Administrative Requirements
  • 45 CFR Part 162 – Administrative Requirements for Electronic Transactions
  • 45 CFR Part 164 – Security and Privacy Protections

Professional Conduct

We uphold an environment of mutual respect, dignity, and courtesy, ensuring that
every interaction reflects professionalism and fosters a safe space for healing.

Appointments & Cancellations

  • 24-hour notice is required for cancellations or rescheduling. Late cancellations or no-shows incur a $60 fee.
  •  Late arrivals may reduce session time.
  • Returned checks are subject to a $25 fee.

Session Length

  • Psychiatric Evaluation: 60 minutes
  • Follow-up / Medication Management: 20-30 minutes
  • Genetic Testing Evaluation: 60 minutes
  • T.O.V.A. Testing
    -Duration: Visual and auditory components (21.6 minutes each); combined testing ~30–40 minutes.
    -Cost:
  • Single test: ~$150
  • Combined session: ~$250 (varies by clinic $225–$300).
  • Additional: $15 test credit fee for storage/retrieval results.

Communication

  • Use the secure Patient Portal for clinical communications.
  • Do not leave sensitive information on voicemail.
  • For inquiries, text 469-320-1755. By texting, you consent to receive practice-related messages (never shared with third parties).
  • Video sessions preferred; phone/audio sessions available under special
    circumstances.
  • Emergencies: Dial 911 or go to the nearest emergency room.

Payment Policy

  • Payment Due: All fees are due at the time of service.
  • Accepted Methods: Credit/debit cards, HSA/FSA cards, and secure online
    payments.
  •  Insurance: Patients are responsible for co-pays, deductibles, and any non-covered services.
  • Unpaid Balances: May result in suspension or cancellation of future
    appointments.
  • Returned Checks: Subject to a $25 service fee.
  • Financial Hardship: Patients experiencing financial difficulties are encouraged to contact our office to discuss possible payment arrangements.

CRISIS LINES

  • National Crisis Text Line:
    Text HOME to 741-741 to connect with a crisis counselor any time.
  • National Domestic Violence Hotline:
    Call 1-800-799-SAFE (7233) or visit thehotline.org for 24/7 help with domestic violence or abuse.
  • Lifeline Crisis Chat:
    Access online chat support via 988 or visit 988lifeline.org/chat.
  • National Alliance on Mental Illness (NAMI):
    Advocacy, education, and support for people affected by mental illness.
    Helpline: 1-800-950-NAMI (6264) or info@nami.org (Mon–Fri, 10 am–6 pm EST).
  • Sexual Assault Hotline (RAINN):
    24/7 support for sexual assault victims. Call 1-800-656-HOPE (4673) or visit rainn.org.
  • National Human Trafficking Hotline: 1-888-373-7888
  • Trans Lifeline: Peer support for trans and questioning individuals. Call 1-877-565-8860 for support.