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.

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OUR COMMITMENT TO YOUR PRIVACY

TelebehavioralHealth.US (the “Practice”) is committed to protecting the privacy and security of your Protected Health Information (“PHI”). PHI is information that identifies you or could reasonably be used to identify you and that relates to your past, present, or future physical or mental health condition, the provision of healthcare to you, or payment for that care.

 

We are required by federal law to:

• Maintain the privacy and security of your PHI, including electronic PHI (“ePHI”)

• Provide you with this Notice of Privacy Practices (“Notice”)

• Follow the terms of the Notice currently in effect

 

This Notice explains how we may use and disclose your PHI, your rights regarding your PHI, and our legal duties.

 

YOUR RIGHTS

You have the following rights regarding your PHI. To exercise these rights, you must submit a written request to the Practice using the contact information listed at the end of this Notice.

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1. Right to Inspect and Obtain a Copy

• You may request to inspect or obtain a copy of your PHI in paper or electronic form.

• We will provide the information in the form and format you request if it is readily producible.

• We may charge a reasonable, cost-based fee.

• We may deny your request in limited circumstances, such as when access may endanger life or safety. You may request a review of certain denials.

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2. Right to Request an Amendment

• You may request that we correct PHI you believe is incorrect or incomplete.

• Your request must be in writing and include a reason.

• We may deny the request and will provide a written explanation and allow you to submit a statement of disagreement.

 

3. Right to Request Confidential Communications

• You may request that we communicate with you in a specific way or at a specific location.

• We will accommodate all reasonable requests.

 

4. Right to Request Restrictions

• You may request restrictions on certain uses or disclosures of your PHI.

• We are not required to agree to all requested restrictions.

• If you pay out-of-pocket in full for a service, you may request that we not disclose related PHI to your health plan.

 

5. Right to an Accounting of Disclosures

• You may request a list of certain disclosures of your PHI made during the prior six years.

• One accounting is provided free every 12 months; reasonable fees may apply for additional requests.

 

6. Right to Obtain a Copy of This Notice

• You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

 

7. Right to Choose a Personal Representative

• If you have designated a legal guardian, healthcare proxy, or power of attorney, that person may exercise your rights.

 

8. Right to File a Complaint

• You may file a complaint if you believe your privacy rights have been violated.

• Contact the Practice:
  Telebehavioral.Health.US
  PO Box 26
  Belmont, MI 49306
  Attn: Privacy Officer
  Phone: 616-327-2405

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You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

 

9. Right to Opt Out of Fundraising Communications

• If we contact you for fundraising purposes, you may opt out at any time.

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HOW WE MAY USE AND DISCLOSE YOUR PHI

1. Treatment

• We may use and disclose your PHI to provide, coordinate, or manage your healthcare.

• Example: Sharing information with another provider involved in your care.

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2. Payment

• We may use and disclose your PHI to bill and receive payment for services.

• Example: Submitting claims to your health plan.

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3. Healthcare Operations

• We may use and disclose your PHI to support business operations, quality improvement, training, care coordination, and administrative activities.

• Example: Reviewing records to ensure quality of care or contacting you about appointments.

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USE OF TECHNOLOGY-ASSISTED TOOLS (INCLUDING ARTIFICIAL INTELLIGENCE)

The Practice may use technology-assisted tools, including artificial intelligence–based systems, to support healthcare operations, care coordination, quality improvement, documentation support, and administrative efficiency. These tools are used only to assist licensed professionals and staff. Clinical, medical, and administrative decisions are not made solely by automated systems and always involve appropriate human review and professional judgment. The Practice does not use artificial intelligence tools to replace clinical decision-making, and we do not use your PHI to train public or consumer-facing artificial intelligence models.

 

OTHER PERMITTED USES AND DISCLOSURES WITHOUT AUTHORIZATION

We may use or disclose PHI without your authorization when required or permitted by law, including for:

• Public health and safety activities

• Health oversight activities (audits, investigations, inspections)

• Reporting abuse, neglect, or domestic violence

• Judicial and administrative proceedings

• Law enforcement purposes

• Serious threats to health or safety

• Workers’ compensation

• Coroners, medical examiners, and funeral directors

• Organ donation

• Research approved by an Institutional Review Board

• Inmates

• Business associates performing services on our behalf under required agreements

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USES AND DISCLOSURES WITH OPPORTUNITY TO OBJECT

Unless you object, we may share PHI with family members, friends, or others involved in your care or payment for care, or when it is in your best interest and you are unable to express a preference.

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USES AND DISCLOSURES REQUIRING WRITTEN AUTHORIZATION

We will obtain your written authorization before using or disclosing PHI for:

• Marketing purposes

• Sale of PHI

• Psychotherapy notes (with limited exceptions)

You may revoke an authorization at any time in writing.

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OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of PHI and ePHI.

• We will follow the terms of this Notice currently in effect.

• We reserve the right to change this Notice. Changes apply to all PHI we maintain.

• Updated Notices will be available upon request and on our website.

• We will notify you if a breach occurs that compromises the privacy or security of your PHI.

 

This Notice applies only to Protected Health Information governed by HIPAA. Information collected through our public website that does not relate to healthcare services is governed by our Website Privacy Policy.

 

EFFECTIVE DATE

This Notice is effective as of 1/21/2026