Notice of Privacy Practices
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.
Bear Path Psychology and Wellness, L.L.C., (the “Practice”), is committed to protecting your privacy. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice’s legal duties and privacy practices and your rights regarding PHI that we collect and maintain.
The Practice is also required by law to provide you with adequate notice of your rights and the Practice’s legal duties with regards to substance use disorder (SUD) records protected by 42 C.F.R. Part 2.
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.
To inspect and copy PHI.
• You can ask for an electronic or paper copy of your medical record. The practice will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, usually within 30 days of receiving your written request, and may charge a reasonable fee for administrative duties.
• The Practice may deny your request if it believes the disclosure will cause harm.
To amend PHI.
• You can ask the Practice to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
• The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.
To request confidential communications.
• You can ask the Practice to contact you in a specific way. If the Practice determines that the request is reasonable and feasible, it may agree to your requests.
To limit what is used or shared.
• You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer. The Practice will agree unless there is a law that requires the disclosure of that information.
• You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.
To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently. You also have the right to request an accounting of disclosures specifically for your substance use disorder records protected under 42 C.F.R. Part 2.
To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
To choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
To file a complaint if you feel your privacy rights have been violated.
• You can complain if you feel the Practice has violated your rights by contacting the Practice by phone at 603-457-7493, by fax at 603-988-0596, or by email at anthony@bearpathpsychology.com.
• You may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/ocr/privacy/hipaa/complaints/. You may also send a written complaint to the New Hampshire Secretary of State Office of Professional Regulation, 121 South Fruit Street, Concord, NH 03301.
• The Practice will not retaliate against you for filing a complaint.
OUR USES AND DISCLOSURES
1. The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
To treat you.
• The Practice can use and share PHI with other professionals who are treating you.
• Example: Your primary care doctor asks about your mental health treatment.
To run the health care operations.
• The Practice can use and share PHI to run the business, improve your care, and contact you.
• Example: The Practice uses PHI to send you appointment reminders if you choose.
To bill for your services.
• The Practice can use and share PHI to bill and get payment from health plans or other entities.
• Example: The Practice may disclose your PHI to your health insurance plan.
2. The Practice may use or disclose PHI for purposes outside of treatment, payment, and health care operations, without your authorization or an opportunity for you to object, in the following instances:
To help with public health and safety issues.
• Serious threat to health or safety: To prevent a serious and imminent threat, including a threat to self-harm or a threat to someone’s property. If a client communicates a serious risk of danger to themselves or an identifiable victim or their property, we have a mandated duty to take protective actions, including notifying the potential victim and contacting the police. We may also seek hospitalization of the client or contact others who can assist in protecting the client or the victim.
• Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs, and civil rights laws. If a complaint is filed against us with the New Hampshire Secretary of State Office of Professional Regulation (“OPR”), the OPR has the authority to subpoena confidential mental health information from us relevant to that complaint.
• To report child abuse. If we have reasonable cause to believe that a child under 18 has been the victim of child abuse or neglect, the law requires that a provider file a report with the appropriate governmental agency. Once such a report is filed, we may be required to provide additional information.
• To report elder abuse or abuse of a dependent adult. If we have reasonable cause to believe the abuse, neglect, or financial exploitation of a vulnerable adult, the law requires that a therapist file a report with the appropriate governmental agency. Once such a report is filed, we may be required to provide additional information.
To comply with law, law enforcement, government, or other requests.
• Required by law: If required by federal, state, or local law.
• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request. If there is a court order requiring the disclosure of information, then we will have to provide information in accordance with the court order. If, as part of a court proceeding, we are served with a subpoena to produce records where the party seeking your records provides us a showing that you or your attorney have been served with the subpoena, affidavit and the appropriate notice, and you have not notified us that you are bringing a motion to block or modify the subpoena, then we will produce the requested records.
• Law enforcement: For law enforcement to locate and identify you or disclose information about a victim of a crime.
• Specialized government functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
• National security and intelligence activities: For intelligence; counterintelligence; protection of the President, other authorized persons, or foreign heads of state; for the purpose of determining your own security clearance; and other national security activities authorized by law.
• Workers’ compensation: To comply with workers’ compensation laws or support claims.
• Business associates: To organizations that perform functions, activities, or services on our behalf.
3. Certain disclosures require your authorization or require you to have an opportunity to object:
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Disclosing PHI to your family, friends, or others. The Practice may provide PHI to a family member, friend, or other person involved in your care or the payment of your care, if you have provided a released of information (“ROI”).
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Psychotherapy Notes: Psychotherapy notes are notes created by a mental health clinician documenting or analyzing the contents of a session. These notes are kept separately from the rest of your medical record, and they are not the same as “progress notes”, which are routinely documented for every psychotherapy visit. The Practice does not routinely create or maintain psychotherapy notes as defined in 45 CFR Part § 164.501. Any psychotherapy notes created or maintained will not be released without your written authorization, unless otherwise required or permitted by law.
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Substance Use Disorder (SUD) Records: Any SUD records that are protected by 42 C.F.R. Part 2 will not be released without your written authorization, unless otherwise required or permitted by law.
If your records are protected under 42 C.F.R. Part 2, certain uses and disclosures permitted by HIPAA for treatment, payment, and health care operations are materially limited by the stricter standards of those regulations. Furthermore, information disclosed pursuant to these rules may be subject to redisclosure by the recipient and may no longer be protected by federal privacy standards. In all cases, including those listed above, if the Practice has substance use disorder patient records about you, subject to 42 C.F.R. Part 2, the Practice cannot use or share information in those records in a civil, criminal, administrative, or legislative investigation or proceeding against you without (1) your consent or (2) a court order and a subpoena.
For any authorizations to disclose your PHI, you may revoke or modify all such authorizations at any time; however, the revocation or modification is not effective until the Practice receives it.
OUR RESPONSIBILITIES
• The Practice is required by law to maintain the privacy and security of PHI.
• The Practice will not use or share PHI other than as described in this Notice unless you give your permission.
• The Practice will never market or sell your personal information.
• The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.
• The Practice reserves the right to amend the Notice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, or by viewing a copy in your Client Portal, or by reviewing the Practice’s Privacy Policy on the Practice’s website: www.bearpathpsychology.com
• The Practice will inform you if PHI is compromised in a breach.
The effective date of this notice is 6/30/26. For any questions or concerns regarding this notice, please feel free to contact Dr. Anthony Kelemen, Psy.D. at 603-457-7493 or anthony@bearpathpsychology.com at any time.