Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AT ELEVATE MENTAL HEALTH SUPPORTS AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE DOCUMENT CAREFULLY.
We have summarized our responsibilities and your rights in this first section. For a complete description of our information practices, please review this entire notice.
Our Responsibilities
We are required to:
Maintain the privacy of your health information.
Provide you with this notice of our legal duties and information practices with respect to information we collect and maintain about you.
Notify you if we learn there has been a breach of your unsecured information.
Abide by the terms of this document.
Your Rights
You have several rights regarding your health information. Those include the right to:
Request that we not use or disclose your health information in certain ways.
Request to receive communications in an alternative manner or location.
Access and obtain a copy of your health information.
Request an amendment to your health information.
Request an accounting of disclosures of your health.
We reserve the right to change our information practices and to make new provisions effective for all health information we maintain. If we change these practices, we will publish a revised Notice of Privacy Practices and provide you with an updated hard copy. A copy of the current Notice of Privacy Practices is available on our website and will be provided to clients of Elevate MHS at their initial clinical assessment : www.elevatementalhealthsupports.com
We will not use or disclose your health information without your authorization, except as described in this notice.
If you have questions and would like additional information, you may contact our Privacy Officer, Richard Hayden, at 720-803-9640.
Entities Covered Under This Notice
Elevate Mental Health Supports LLC (Elevate MHS)
Understanding Your Health Record
Each time you visit a mental health provider, such as Elevate MHS, a record of your session is made. Typically, this record could contain: your records from previous mental health care providers (if requested), symptoms, assessment and test results, treatment, relevant clinical details of your sessions, and a plan for future care or treatment. This information, often referred to as your health record or medical record, serves the following purposes:
Basis for planning your care and treatment
Communication among health professionals involved in your care
Legal document describing the care you received
Proof that services billed were provided
A tool to educate mental health professionals
A tool to measure and improve the care we give
Understanding what is in your record and how your health information is used helps you to:
Ensure its accuracy
Understand who, what, where and why others may access your health information
Make informed decisions when authorizing disclosure to others
How We Will Use or Disclose Your Health Information
For Treatment
We will use and disclose your personal health information in providing you with treatment and services. We may disclose any necessary personal health information to personnel who may be involved in your care, such as physicians, psychiatrists, therapists, mental health clinicians, mental health treatment programs, and admissions personnel, but only in the context of receiving care within Elevate MHS. Although the aforementioned disclosures are lawful, Elevate MHS will strive to receive a signed ROI from you or your representative prior to making contact or disclosing any of your personal health information to any of your current healthcare providers.
For Payment
We may use and disclose your personal health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may disclose your personal health information to your representative or another third-party payer. For example, we may send an invoice for your services to a designated family member or financial representative.
For Health Care Operations
We may use and disclose your personal health information for our regular health care operations. These uses and disclosures are necessary to manage our operations and to monitor our quality of care. For example, we may use personal health information to evaluate our services, including the performance of our staff. In addition, the entities covered by this notice may disclose your personal health information to one another to develop treatment protocols.
Business Associates
Outside people and entities provide some services for us. Examples of these “business associates” include our accountants, consultants, and attorneys. We may disclose your health information to our business associates so that they can perform the job we’ve asked them to do. We require the business associates to safeguard your information so that it is protected.
Notification
We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location and general condition. If we are unable to reach your family member or personal representative, then we may leave a message for them at the phone number that they/you have provided us, e.g., on an answering machine.
Communication with Family
We may disclose to a family member, or other relative, close friend or any other person involved in your health care, health information relevant to that person’s involvement in your care or payment related to your care.
Transfer of Information at Death
We may disclose health information to funeral directors, medical examiners, and coroners to carry out their duties, consistent with applicable law.
Worker’s Compensation
We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Correctional Institution
Should you be an inmate of a correctional institution, we may disclose to the institution or its agents, health information necessary for your health and the health and safety of other individuals.
Law Enforcement
In some circumstances, we may need to disclose health information to law enforcement officials. For example, we may disclose your health information in response to a search warrant or a grand jury subpoena, or to assist law enforcement officials in identifying or locating an individual, to report deaths that may have resulted from criminal conduct, and to report criminal conduct at one of our offices. We may also disclose health information necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Reports
Federal law allows a member of our work force or a business associate to release your health information to an appropriate health oversight agency, public health authority or attorney, if the work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more clients, workers, or the public.
Military, Veterans, National Security and Other Government Purposes
We may disclose health information about members of the armed forces, as required by military command authorities or to the Department of Veterans Affairs. If required to do so, we will also provide information to federal officials for intelligence and national security purposes or for presidential protective services.
Judicial Proceedings
We may be ordered to disclose health information by a judge in a court or administrative proceeding or in response to a subpoena.
Electronic Disclosure
Your personal health information is also subject to electronic disclosure. We will obtain your authorization for any electronic disclosure that is not authorized or required by state or federal law.
Elevate MHS Service Communications
We may use your health information to provide you with certain reminders for treatment, case management or care coordination, to direct or recommend alternative treatments, therapies, health care providers, or settings of care, or to describe a service provided by us.
Required by Law
Federal, state, or local laws sometimes require us to disclose your health information. For instance, we are required to report child abuse or neglect and must provide information to law enforcement officials in domestic violence cases.
Mental Health Consulting / Case Management / ILS / Therapeutic Coaching Notes
We will not use or disclose your session notes for any of our services without your authorization, unless the use is by the person who wrote the notes for purposes of treatment, for training of mental health professionals, or for us to defend ourselves in a legal proceeding brought by you. In addition, any other disclosure or use of mental health service notes must be to the Department of Health and Human Services; required by law; for the health oversight of the practitioner that wrote the notes; to the coroner or medical examiner; or to avert a serious threat to the health or safety of a person or the public.
Other Uses and Disclosures
If we wish to use or disclose your health information for a purpose that is not discussed in this Notice, we will seek your permission. For example, we must obtain your permission to share your information with another mental health provider or treatment program. Whenever you provide permission to use or disclose your health information, you may take back your permission at any time, unless we have already acted on your permission. To revoke your permission, please write to the following email: privacyofficer@elevatementalhealthsupports.com
Your Health Information Rights
You have the following rights regarding your personal health information:
Right to Request Restrictions
You have the right to request restrictions on our use or disclosure of your personal health information for treatment, payment, or health care operations. You also have the right to restrict the personal health information we disclose about you to a family member, friend or other person who is involved in your care or the payment of your care. Your request should be submitted to the following email address: privacyofficer@elevatementalhealthsupports.com
Right of Access to Personal Health Information
You have the right to inspect and obtain a copy of your medical records or billing records or other written information that may be used to make decisions about your care, subject to some limited exceptions.
Such records will be provided to you in the time frames established by law. If you are requesting records from Elevate MHS, we will deliver the medical records in electronic format unless you or your personal representative requests otherwise, the original medical records are stored in a HIPAA compliant electronic format, and the medical records are readily producible in electronic format. Your request should be submitted to the following email address: privacyofficer@elevatementalhealthsupports.com
We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to personal health information, in some cases you will have the right to request a review of the denial.
Right to Request Amendments
If you believe that any health information in your record is incorrect or if you believe that important information is missing, you may request that we correct the existing information or add the missing information. Such requests must be made in writing to the email listed below and must provide a reason to support the amendment. We may deny your request for amendment in certain circumstances. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.
Right to an Accounting of Disclosures
You have the right to request an “accounting” of the disclosures we make of your personal health information. This is the listing of certain disclosures of your personal health information made by us or by others on our behalf, but does not include disclosures for treatment, payment and health care operations or certain other exceptions.
To request an accounting of disclosures, you must submit a request via email to the email address listed below, stating a time period beginning within six years from the date of your request. An accounting will include, if requested; the disclosure date; the name of the person or entity that received the information and the address, if known; a brief description of the information disclosed;a brief statement of the purpose of the disclosure or a copy of the authorization request; or certain summary information concerning multiple similar disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs. Requests should be submitted to the email listed below.
Right to Receive a Paper Copy of This Notice
You have the right to obtain a paper copy of this notice, even if you have agreed to receive this notice electronically. You will be provided with a paper copy of this notice at your initial intake assessment. You may request a paper copy of this notice at any time by contacting us at the telephone number and email address listed below.
Right to Request Confidential Communications
You have the right to request that we communicate with you concerning personal health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests.
Right to be Notified in the Event of a Breach
In the event we determine that the confidentiality of your unsecured health information has been breached, you have the right to be notified.
Right to Revoke Authorization
You may revoke an authorization to use or disclose health information, except to the extent that action has already been taken. This request must be made in writing to the applicable address listed below.
For More Information or to Report a Problem
If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the Office of Civil Rights in the U. S. Department of Health and Human Services. To file a complaint with us or to obtain information about how to exercise any of your rights, you may contact the Corporate Privacy Officer by phone at 651-261-8304 and by email at privacyofficer@elevatementalhealthsupports.com
To file a complaint with the Office of Civil Rights you may submit a complaint online at: https://www.hhs.gov/hipaa/filing-a-complaint/index.html. You may also submit a complaint to the Elevate MHS via email at privacyofficer@elevatementalhealthsupports.com. We will not penalize you or retaliate against you in any way for filing a complaint with the federal government.
Notice of HIPAA Compliance Practices
Elevate MHS is compliant with HIPAA law and best practices for securing your private health information. Elevate MHS utilizes HIPAA compliant programs for all client electronic health records, virtual sessions, email communication, and electronic signatures. Elevate MHS also holds all client meetings in private office spaces (or in a client’s home by request). Any communications outside of these avenues are not secured. If you or your representative choose to text an Elevate MHS clinician, any Elevate MHS clinician will uphold confidentiality by not disclosing any private health information via text message, and will refer to you as “the client” or by your initials. Elevate MHS is not liable for the private health information disclosed voluntarily by you or your representative outside of the forms of communication mentioned above. If you have any questions, please contact the Elevate MHS Safety Officer.
Elevate MHS Privacy Officer Contact:
Name: Richard Hayden
Phone: 720-803-9640
Email: privacyofficer@elevatementalhealthsupports.com
Mailing Address: 1427 Sanborn Place, Longmont, CO 80501
Effective: 1/22/25
