Notice of Privacy Practices

Effective date: [EFFECTIVE DATE — to be supplied by the practice]

Louisville Behavioral Health Systems, PLLC ("the practice," "we," "us") is required by law to maintain the privacy of your protected health information (PHI), to give you 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

We use and disclose your PHI to provide, coordinate and manage your care — for example, sharing your medication list with your pharmacy, consulting with another clinician involved in your treatment, or sending records to a hospital or referring provider.

Payment

We use and disclose PHI to bill and collect payment for services — for example, verifying benefits, obtaining prior authorization, and submitting claims to your health plan.

Health care operations

We use and disclose PHI for routine business operations — quality assessment, clinician review and training, licensing, accreditation, business planning, and general administration.

Other uses and disclosures permitted without your authorization

• Appointment reminders and information about treatment alternatives.
• When required by law, court order, subpoena, or administrative request.
• Public health activities, communicable disease reporting, and FDA reporting.
• Reporting suspected abuse, neglect, or domestic violence.
• Health oversight activities, audits, and investigations.
• To prevent or lessen a serious and imminent threat to the health or safety of you or another person.
• Workers' compensation, law enforcement, coroners, and organ procurement.
• Specialized government functions, including military and national security.
• Research approved by an institutional review board or privacy board.
• To family members or others involved in your care, when you agree or when, in our professional judgment, it is in your best interest and you are not present or able to agree.

Uses and disclosures that require your written authorization

The following always require your written authorization, and you may revoke that authorization at any time in writing (except to the extent we have already acted on it):

• Psychotherapy notes — notes recorded by a mental health professional documenting a counseling session and kept separate from the rest of your record, other than the limited exceptions HIPAA allows.
• Marketing — most uses or disclosures of PHI for marketing purposes.
• Sale of PHI — any disclosure that constitutes a sale of your information.
• Most other uses and disclosures not described in this notice.

Substance use disorder records (42 CFR Part 2)

Records created in connection with our LivingFree365 medication-assisted treatment program receive additional federal protection. These records are generally not disclosed without your specific written consent, beyond the narrow exceptions federal law allows.

Your rights regarding your health information

• Right of access. You may inspect and obtain a copy of your record, including an electronic copy when we maintain it electronically. We may charge a reasonable, cost-based fee.
• Right to amend. You may ask us to correct information you believe is incorrect or incomplete. We may deny the request in certain circumstances and will tell you why in writing.
• Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your PHI.
• Right to request restrictions. You may ask us to limit how we use or disclose your PHI. We are not required to agree, except that we must agree to withhold information from your health plan about a service you paid for in full out of pocket.
• Right to confidential communications. You may ask us to contact you a specific way or at a specific address or phone number.
• Right to a paper copy of this notice. You may request one at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach. We will notify you if a breach occurs that may have compromised the privacy or security of your information.
• Right to choose someone to act for you. A personal representative with legal authority may exercise these rights on your behalf.

Our legal duties

• We are required by law to maintain the privacy and security of your protected health information.
• We are required to give you this notice of our legal duties and privacy practices with respect to your PHI, and to provide a copy on request.
• We are required to abide by the terms of the notice currently in effect.
• We are required to notify affected individuals following a breach of unsecured protected health information.
• We will not use or share your information other than as described here unless you tell us in writing that we may.

Changes to this notice

We reserve the right to change this notice, and to make the revised notice effective for all protected health information we already maintain as well as information we receive in the future. When this notice changes we will post the revised notice on this page with a new effective date, keep copies available at our front desk on request, and provide it to new patients at their first appointment. You may request a paper copy of the current notice at any time.

Website, email and text messaging

This website does not ask for medical information. Our appointment request form collects only your name, contact details, insurance carrier, and the service you are interested in. Standard email and standard text messaging are not secure channels — please do not send clinical details by email or text. See our Website Privacy Policy and Text Messaging Terms.

We do not place advertising, remarketing, or social media tracking pixels on this website. See our Cookie Policy.

Who to contact — our Privacy Officer

The person responsible for the privacy of your information at Louisville Behavioral Health Systems, PLLC, and the contact for any question, request, or complaint about this notice, is:

• Name: [PRIVACY OFFICER NAME — to be supplied by the practice]
• Title: Privacy Officer
• Direct phone: [PRIVACY OFFICER DIRECT PHONE — to be supplied by the practice] (main office (502) 454-8800)
• Email: [PRIVACY OFFICER EMAIL — to be supplied by the practice]
• Mailing address: Privacy Officer, Louisville Behavioral Health Systems, PLLC, 3430 Newburg Road, Suite 210, Louisville, KY 40218

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the practice or with the federal government. We will never retaliate against you for filing a complaint.

With the practice

Submit your complaint in writing to the Privacy Officer at the name, address, phone, or email listed above. We will respond in writing.

With the U.S. Department of Health and Human Services

You may file a complaint with the Office for Civil Rights (OCR), U.S. Department of Health and Human Services:

• Mail: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C. 20201
• Phone: 1-800-368-1019  •  TDD: 1-800-537-7697
• Online: ocrportal.hhs.gov/ocr/portal/lobby.jsf
• Complaint forms: hhs.gov/ocr/complaints