(Effective Date of 11/20/2021) As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA),

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A CLIENT OR REPRESENTATIVE OF THIS SERVICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

Please review this notice carefully.

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Our commitment to patient privacy

 

Fleurish and Bloom Behavior Center, PLLC is dedicated to maintaining the privacy of our patients protected health information (PHI). As we conduct business, we will need to create records regarding our patients, the treatment and services we provide to our patients. We are required by law to maintain the confidentiality of health information that identifies our patients. We also are required by law to provide our patients with this notice of our legal duties and the privacy practices that we maintain in our practice concerning patient PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time of care.

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We must provide you with the following important information:

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• How we may use and disclose your PHI

• Your privacy rights regarding your PHI

• Our obligations concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are created or retained by Fleurish and Bloom Behavior Center. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and in the future. Fleurish and Bloom Behavior Center will always provide a copy of our current Notice when amendments occur, in addition you may request a copy of our most current Notice at any time.

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You have the right to:

• Receive a copy of your paper or electronic medical record

• Correct your paper or electronic medical record

• Request confidential communication

• Ask us to limit the information we share

• Receive a list of those with whom we have shared your information

• Receive a copy of this privacy notice

• Choose someone to act for you

• File a complaint if you believe your privacy rights have been violated

We may use and share your information as we:

• Provide you services

• Run our organization

• Bill for services we provided

• Comply with the law

• Address workers’ compensation, law enforcement, and other government requests

• Respond to lawsuits and legal actions

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File a complaint if you feel your rights are violated:

• You can complain if you feel we have violated your rights by contacting Fleurish and Bloom Behavior Center.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending written communication to:

Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201

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Consent

By using this Website, you consent to the collection and use of information as specified above. If we make changes to our Privacy Policy, we will post those changes on this page. Please review this page frequently to remain up-to-date with the information we collect, how we use it, and under what circumstances we disclose it. You must review the new Privacy Policy carefully to make sure you understand our practices and procedures.