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Notice of Privacy Practices

Template — pending legal review. This page is a starting point and is not legal advice. It must be reviewed and finalized by qualified healthcare/privacy counsel (and checked against the laws of each state served) before the site goes live.

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.

Effective date: [TODO: effective date]

We recommend basing this notice on the free HHS Model Notice of Privacy Practices, tailored to V&B Psychiatric Services PLLC and reviewed by counsel. The 2024–2026 HIPAA updates (including substance use disorder record provisions) should be reflected in the final version.

Our commitment to your privacy

V&B Psychiatric Services PLLC is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your health information

  • Treatment: to provide, coordinate, and manage your psychiatric care.
  • Payment: to bill and obtain payment from you or your insurer.
  • Health care operations: for quality, training, and administrative functions.
  • As required or permitted by law: including certain public health, safety, and legal situations.

[TODO: counsel to confirm uses/disclosures, including any heightened protections for psychotherapy notes and substance use disorder records.]

Your rights regarding your health information

  • The right to inspect and request a copy of your records
  • The right to request corrections (amendments)
  • The right to an accounting of certain disclosures
  • The right to request restrictions and confidential communications
  • The right to a paper copy of this notice
  • The right to file a complaint without retaliation

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Contact

Privacy Officer: [TODO: name/title]
V&B Psychiatric Services PLLC
[email protected] · (000) 000-0000