Legal

HIPAA Notice of
Privacy Practices

Effective Date: February 2026  ·  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. How We May Use and Disclose Your PHI

We may use and disclose your protected health information (PHI) for the following purposes without your written authorization:

• Treatment — To provide, coordinate, or manage your healthcare and related services. For example, sharing information with other providers involved in your care.
• Payment — To obtain payment for services rendered, including submitting claims to your insurance company and billing.
• Healthcare Operations — For administrative, financial, legal, and quality improvement activities, such as staff training or audits.
• As required by law — When required by applicable federal, state, or local law.
• Public health activities — For disease reporting, product recalls, or other public health purposes as permitted by law.
• Serious threats to health or safety — To prevent a serious and imminent threat to the health or safety of a person or the public.

All other uses and disclosures of your PHI require your prior written authorization. You may revoke an authorization at any time in writing, except where we have already acted in reliance on it.

2. Your Rights Regarding Your PHI

You have the following rights with respect to your protected health information:

• Right to Access — You have the right to inspect and obtain a copy of your health records. We will provide access within 30 days of your request.
• Right to Amend — You may request that we correct or amend your records if you believe information is inaccurate or incomplete.
• Right to an Accounting of Disclosures — You may request a list of certain disclosures we have made of your PHI in the past six years.
• Right to Request Restrictions — You may request limits on how we use or disclose your PHI. We are not required to agree to all requests, but we will let you know our decision.
• Right to Confidential Communications — You may request that we contact you by alternative means or at an alternative location for reasons of privacy.
• Right to a Paper Copy of This Notice — You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
• Right to be Notified of a Breach — You have the right to be notified if there is a breach of your unsecured PHI.

3. Our Duties

We are required by law to:

• Maintain the privacy and security of your PHI.
• Follow the privacy practices described in this notice.
• Notify you promptly if a breach of your unsecured PHI occurs.
• Not use or disclose your PHI other than as described in this notice without your written authorization.

We reserve the right to change our privacy practices and to make changes effective for PHI we already hold. An updated notice will be available at our practice and on this website.

4. Our Platform and Business Associates

We use SimplePractice, a HIPAA-compliant practice management platform, to store and manage your protected health information. SimplePractice is a Business Associate under HIPAA, and we have a Business Associate Agreement (BAA) in place with them. Your health information stored within SimplePractice is subject to their security practices and our BAA.

5. Complaints

If you believe your privacy rights have been violated, you have the right to file a complaint:

• With our practice: Contact us using the information below. We will not retaliate against you for filing a complaint.
• With the U.S. Department of Health and Human Services (HHS): You may file a complaint with the Office for Civil Rights (OCR) at www.hhs.gov/hipaa or by calling 1-800-368-1019.

6. Contact Information

For questions about this notice or to exercise your rights, please contact:

• Privacy Officer: Lori Jardine, PMHNP-BC
• Well-I-AM Mental Health
• St. George, Utah
• Phone: 435-500-6529
• Email: lori.jardine@well-i-am.net