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Privacy Practices

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.

I, Henry Maxwell, providing services as Maxwell Recovery Services, LLC, am a Licensed Clinical Social Worker in Colorado (CSW.09928508). I have a legal duty to safeguard your protected health information (PHI). I am legally required to protect the privacy of your PHI, which includes information that can be used to identify you that I’ve created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. I must provide you with this Notice about my privacy practices, and such Notice must explain how, when, and why I will “use” and “disclose” your PHI.

Uses and Disclosures Not Requiring Consent

I may use or disclose your PHI without your consent or authorization in the following circumstances:

  • Child Abuse: If I have reasonable cause to know or suspect that a child has been subjected to abuse or neglect, I must immediately report this to the appropriate authorities.
  • Adult and Domestic Abuse: If I have reasonable cause to believe that an at-risk adult has been mistreated, self-neglected, or financially exploited, I must report this to the appropriate authorities.
  • Health Oversight Activities: If the Colorado State Grievance Board or another regulatory board is investigating my practice, I may be required to disclose PHI to the board.
  • Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment, such information is privileged under state law, and I will not release information without your written authorization or a court order.
  • Serious Threat to Health or Safety: If you communicate to me a serious threat of imminent physical violence against a specific person, I have a duty to warn that person and notify law enforcement. If I believe you are at imminent risk of taking your own life, I may take necessary action to protect you.
  • Worker’s Compensation: I may disclose PHI regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs.

Uses and Disclosures Requiring Authorization

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. In those instances when I am asked for information for purposes outside of treatment, payment and health care operations, I will obtain an authorization from you before releasing this information. I will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record.

Patient’s Rights

  • Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.
  • Right to Receive Confidential Communications: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.
  • Right to Inspect and Copy: You have the right to inspect or obtain a copy (or both) of PHI in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record.
  • Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. I may deny your request.
  • Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization.
  • Right to a Paper Copy: You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.

Provider’s Duties

  • I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
  • I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.
  • If I revise my policies and procedures, I will provide you with a revised notice in writing by mail or in person.

Questions and Complaints

If you have questions about this Notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me at:
henry@maxwellrecoveryservices.com

If you believe that your privacy rights have been violated and wish to file a complaint with me, you may send your written complaint to me at my office address. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.

Effective Date: December 2024

For more information: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html