NOTICE OF PRIVACY PRACTICES
Serene Soul Psychiatric Services, PLLC
Effective Date: September 25, 2026
Your Information. Your Rights. Our Responsibilities.
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.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or obtain an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you believe is incorrect or incomplete. We may deny your request in certain circumstances, but we will explain the reason in writing, usually within 60 days.
Request confidential communications
You can ask us to contact you in a specific way, such as by phone or email, or to send communications to a different address. We will accommodate reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are generally not required to agree to your request.
If you pay for a healthcare service or item out-of-pocket in full, you can ask us not to share information about that service or item with your health insurer for payment or healthcare operations. We will honor the request unless a law requires us to share the information.
Get a list of disclosures
You can ask for a list (an accounting) of certain times we have shared your health information during the six years prior to the date of your request, including who we shared it with and why. Certain disclosures are excluded from this accounting.
Get a copy of this privacy notice
You can request a paper copy of this notice at any time, even if you agreed to receive the notice electronically.
Choose someone to act for you
If you have given someone medical power of attorney or someone is your legal guardian, that person may exercise your rights and make choices about your health information as permitted by law. We will verify that the person has appropriate authority before taking action.
File a complaint if you believe your privacy rights have been violated
You may contact Serene Soul Psychiatric Services, PLLC if you believe your privacy rights have been violated. 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.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, tell us what you want us to do, and we will follow your instructions when required.
You may tell us whether to:
• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster-relief situation.
If you are unable to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest and as permitted by law. We may also share information when necessary to lessen a serious and imminent threat to health or safety.
Marketing and sale of your information
We will not use or disclose your health information for marketing purposes or sell your health information without your written authorization when authorization is required by law.
Fundraising
If we ever contact you for fundraising efforts, you may tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We may use your health information and share it with other healthcare professionals who are involved in your treatment.
Example: We may share relevant information with another healthcare provider who is involved in your care.
Run our organization
We may use and share your health information to operate our practice, improve the quality of care we provide, and contact you when necessary.
Example: We may use health information to manage your treatment and services.
Bill for your services
We may use and share your health information to bill and receive payment from health plans or other entities.
Example: We may provide information about the services you receive to your health insurance plan so that it will pay for those services.
How else can we use or share your health information?
We are allowed or required to share your health information in other ways, usually in ways that contribute to the public good, such as public health and research. We must meet applicable legal requirements before sharing your information for these purposes.
Help with public health and safety issues
We may share health information about you for certain situations, such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence when permitted or required by law, and preventing or reducing a serious threat to anyone’s health or safety.
Comply with the law
We may share information about you when state or federal law requires it.
Respond to organ and tissue donation requests
We may share health information with organ-procurement organizations when applicable.
Work with a medical examiner or funeral director
We may share health information with a coroner, medical examiner, or funeral director when an individual dies, as permitted by law.
Address workers’ compensation, law enforcement, and other government requests
We may use or share health information as permitted or required by law for workers’ compensation claims, certain law-enforcement purposes, health-oversight agencies, and certain special government functions.
Respond to lawsuits and legal actions
We may share health information in response to a valid court or administrative order or in other circumstances permitted or required by law.
Substance Use Disorder Records
To the extent that Serene Soul Psychiatric Services, PLLC creates or maintains substance use disorder patient records that are subject to 42 CFR Part 2, those records receive additional confidentiality protections.
We will not use or disclose information from Part 2 records in civil, criminal, administrative, or legislative investigations or proceedings against you unless you provide the required consent or the disclosure is authorized by a court order and subpoena as required by applicable law.
Uses and disclosures of substance use disorder records will be made in accordance with applicable federal and state privacy laws.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and provide you with a copy of it.
We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you give us written authorization, you may change your mind at any time by notifying us in writing. Your revocation will not affect actions already taken in reliance on your authorization.
For more information about your privacy rights, visit the U.S. Department of Health and Human Services website.
Changes to This Notice and Contact Information
Changes to the Terms of This Notice
We may change the terms of this notice, and the changes will apply to all information we have about you. If this notice is revised, the updated notice will be available on our website and upon request.
Questions or Complaints
If you have questions about this notice, want to exercise your privacy rights, or believe your privacy rights have been violated, please contact:
Serene Soul Psychiatric Services, PLLC
Email: info@serenesoulpsychiatric.com
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.