Notice of Privacy Practices
Blooming Arc Psychiatric Care PLLC
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.
1. Our Commitment to Your Privacy
Blooming Arc Psychiatric Care PLLC ("we," "us," or "our practice") is required by law to maintain the privacy of your protected health information, to provide you with this Notice describing our legal duties and privacy practices, and to notify you following a breach of unsecured protected health information.
"Protected health information," or PHI, means information that identifies you and relates to your past, present, or future physical or mental health condition, the health care we provide to you, or payment for that care.
We are required to abide by the terms of the Notice currently in effect. This Notice applies to all records of your care generated by our practice, whether created by our provider, our staff, or a business associate acting on our behalf.
2. How We May Use and Disclose Your Health Information Without Your Written Authorization
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your psychiatric care and related services. Examples include:
Documenting your evaluations, diagnoses, medications, and progress in your medical record.
Transmitting prescriptions electronically to your pharmacy.
Consulting with your primary care physician, therapist, or another treating clinician about your care.
Coordinating a referral to a specialist, hospital, laboratory, or higher level of care.
Sharing information with a laboratory that performs testing ordered as part of your treatment.
Payment
We may use and disclose your PHI to obtain payment for the services we provide. Examples include:
Submitting claims to your health plan, including your diagnosis, dates of service, and procedure codes.
Verifying your eligibility and benefits before your appointment.
Obtaining prior authorization for a medication or service.
Providing you with a superbill or itemized statement.
Pursuing collection of an unpaid balance.
Health Care Operations
We may use and disclose your PHI for activities necessary to operate our practice and ensure quality care. Examples include:
Reviewing charts for quality assessment and clinical improvement.
Evaluating provider and staff performance.
Conducting compliance audits, licensing activities, and accreditation reviews.
Consulting with our attorneys, accountants, or other professional advisors.
Business planning, administration, and management of the practice.
Business Associates
We contract with outside vendors — including our electronic health record and telehealth platform, our billing service, our telephone and messaging provider, and our secure email provider — to perform functions on our behalf. These vendors are called business associates. We require each business associate to sign a written agreement obligating them to safeguard your PHI in accordance with HIPAA.
3. Uses and Disclosures That Require Your Written Authorization
We will obtain your written authorization before using or disclosing your PHI for any purpose not described in this Notice. Specifically, your written authorization is required for:
Psychotherapy notes. These are notes recorded by our provider documenting or analyzing the contents of a counseling session, kept separate from the rest of your medical record. Limited exceptions apply, including use by the originator for treatment, our own training programs, defense in a legal action you bring against us, and certain disclosures required by law.
Marketing. We will not use your PHI for marketing purposes without your authorization.
Sale of protected health information. We do not and will not sell your PHI.
You may revoke an authorization in writing at any time. Revocation stops future uses and disclosures but does not undo disclosures already made in reliance on your authorization.
4. Other Permitted and Required Uses and Disclosures
We may use or disclose your PHI without your authorization in the following circumstances, subject to applicable state law:
As Required by Law. When federal, state, or local law requires the disclosure.
Public Health Activities. To public health authorities for purposes such as preventing or controlling disease, reporting births and deaths, reporting adverse events related to medications or products, and reporting to the FDA.
Victims of Abuse, Neglect, or Domestic Violence. To a government authority authorized to receive such reports. We are mandated reporters of suspected abuse or neglect of a child, an elderly person, or a person with a disability.
Health Oversight Activities. To agencies conducting audits, investigations, inspections, licensure actions, or civil, administrative, or criminal proceedings related to oversight of the health care system — including state boards of nursing.
Judicial and Administrative Proceedings. In response to a court order, subpoena, discovery request, or other lawful process, subject to the special protections that federal and state law give to mental health records.
Law Enforcement. For limited purposes such as responding to a court order, warrant, or grand jury subpoena; identifying or locating a suspect, fugitive, or missing person; or reporting a death we believe may have resulted from criminal conduct.
To Avert a Serious Threat to Health or Safety. When we determine in good faith that disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health or safety of another person, and the disclosure is made to a person reasonably able to prevent or lessen the threat, including law enforcement or medical personnel.
Coroners, Medical Examiners, and Funeral Directors. To identify a deceased person, determine cause of death, or permit them to carry out their duties.
Organ and Tissue Donation. To organizations that handle procurement, banking, or transplantation.
Research. When an institutional review board or privacy board has approved a waiver of authorization, or as otherwise permitted by law.
Workers' Compensation. As authorized by and necessary to comply with workers' compensation laws.
Specialized Government Functions. For military and veterans' activities, national security and intelligence activities, protective services for the President and others, and correctional institutions and custodial situations.
Individuals Involved in Your Care. With your agreement, or where we can reasonably infer from the circumstances that you do not object, we may disclose relevant information to a family member, relative, close personal friend, or another person you identify who is involved in your care or payment for your care. If you are not present or are incapacitated, we will use professional judgment to determine whether disclosure is in your best interest.
Appointment Reminders and Health-Related Communications. We may contact you to remind you of an appointment, discuss treatment alternatives, or inform you of health-related benefits and services that may be of interest to you.
5. Special Protections for Mental Health and Substance Use Records
Mental health records receive heightened protection under the laws of the states in which we are licensed, including Texas, Connecticut, New Hampshire, and Florida. Where state law is more protective of your privacy than HIPAA, we follow state law.
Records of substance use disorder treatment may also be protected by federal law under 42 C.F.R. Part 2, which generally requires your written consent before such records may be disclosed, including to family members or in response to a subpoena that is not accompanied by a court order.
If you have questions about how these protections apply to your specific records, please contact us.
6. Telehealth Services
We provide telehealth services to patients located in Texas, Connecticut, New Hampshire, and Florida. Telehealth appointments are conducted through a HIPAA-compliant, encrypted platform under a business associate agreement.
Please note that you are responsible for choosing a private location for your telehealth appointment. We cannot control who may be present on your end of the connection, and we cannot guarantee the security of the internet connection or device you use.
7. Electronic Communications and Text Messaging
Email. Standard email is not a secure method of communication. If you choose to communicate with us by email, you accept the risk that a message could be intercepted. We use a secure, HIPAA-compliant email system and encourage you to use our patient portal for clinical communication.
Text Messaging. If you provide your mobile number and consent to receive text messages, we may send appointment reminders, scheduling messages, and administrative communications. Message and data rates may apply. Message frequency varies. You may opt out at any time by replying STOP, or reply HELP for assistance. We do not sell or share your mobile number or SMS consent with third parties for their marketing purposes. Text messages are not encrypted; we limit their content to the minimum necessary.
Patient Portal. Our patient portal is the most secure way to communicate with us about clinical matters. Neither email, text, nor the portal should be used for emergencies.
8. Your Rights Regarding Your Health Information
Right to Inspect and Obtain a Copy
You have the right to inspect and obtain a copy of your PHI held in a designated record set, including an electronic copy if we maintain it electronically. You may also direct us to transmit a copy to a person you designate. We may charge a reasonable, cost-based fee. Psychotherapy notes are excluded from this right.
In limited circumstances, access may be denied. If we deny access on certain grounds, you may request that the denial be reviewed by a licensed health care professional who was not involved in the original decision.
Right to Request an Amendment
If you believe information in your record is inaccurate or incomplete, you may request in writing that we amend it. We may deny your request if the information was not created by us, is not part of the designated record set, is not available for inspection, or is accurate and complete. If we deny your request, you may submit a written statement of disagreement, which will be included in your record.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we made of your PHI, generally for the six years prior to your request. The accounting does not include disclosures made for treatment, payment, or health care operations, disclosures made to you, or disclosures you authorized. The first accounting in any twelve-month period is free; we may charge a reasonable fee for additional requests.
Right to Request Restrictions
You have the right to request a restriction on our use or disclosure of your PHI for treatment, payment, or health care operations, or to a person involved in your care. We are not required to agree to most restriction requests.
However, we must agree to a request to restrict disclosure of PHI to your health plan if the disclosure is for payment or health care operations, is not otherwise required by law, and the PHI pertains solely to an item or service you have paid for in full out of pocket.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location — for example, only by mail to a specified address, or only at a particular phone number. We will accommodate reasonable requests and will not ask you to explain the reason for your request.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you agreed to receive it electronically. Please ask us and we will provide one.
Right to Be Notified of a Breach
You have the right to be notified in the event of a breach of your unsecured protected health information.
Right to Opt Out of Fundraising
We do not conduct fundraising communications. If this changes, you will have the right to opt out.
How to Exercise Your Rights
To exercise any of the rights described above, please submit your request in writing to the Privacy Officer at the contact information in Section 11. Requests to inspect or copy records will be handled within the timeframes required by federal and applicable state law.
9. Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the contact information in Section 11. Please submit your complaint in writing so that we can respond fully.
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services:
Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Phone: 1-877-696-6775 Online: www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be retaliated against, penalized, or denied care in any way for filing a complaint.
10. Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for all PHI we maintain, including information created or received before the change. The current Notice will always be posted on our website with its effective date, and paper copies will be available at our office upon request.
11. Contact Information
Privacy Officer Blooming Arc Psychiatric Care PLLC Suite #1182 7055 Old Katy Rd Houston, TX 77024
Phone: (346) 826-9197 Fax: (346) 724-3404 Email: diweni@bloomingarc.com Website: bloomingarcpsychiatry.com
12. Emergencies
This Notice and our website are not a substitute for emergency care. If you are experiencing a psychiatric emergency, call 911, call or text 988 (Suicide & Crisis Lifeline), or go to your nearest emergency room.
This Notice is provided in accordance with the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations at 45 C.F.R. Parts 160 and 164, as amended.
Contact
Privacy Officer
Blooming Arc Psychiatric Care
Houston, Texas
Phone: (346) 724-3404
Fax: (346) 547-0313
diweni@bloomingarc.com
This Notice is provided in accordance with the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations at 45 C.F.R. Parts 160 and 164, as amended.