NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MENTAL HEALTH AND MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
In the course of providing services to you, Maxwell Recovery Services, LLC (“Maxwell
Recovery Services”) and Henry Maxwell, BA, CAS, CRS, CAI, CPC, will obtain, record, and
use mental health and medical information about you that is considered Protected Health
Information, or “PHI.” PHI is defined as “individually identifiable health information” that is
created or received by a healthcare provider and which relates to past, present, or future health,
provision of healthcare, or payment for provision of healthcare and that either identifies the
individual or could be used to identify the individual. HIPAA and other laws regulate the use
and disclosure of PHI when it is transmitted electronically. This Notice describes Maxwell
Recovery Services’ policies related to the use and disclosure of your PHI.
Uses and Disclosures Not Requiring Consent
Providing treatment services, collecting payment and conducting healthcare operations are
necessary activities for quality care. State and federal laws allow me to use and disclose your
health information for these purposes. In most cases, I am limited to disclosing the minimum
information necessary to accomplish these purposes. To help clarify these terms, here are some
examples:
• Treatment is when I use and disclose health information to provide, coordinate or manage
your health care and other services related to your health care. If I decide to consult with another
licensed health care provider about your condition, I would be permitted to use and disclose your
personal health information, which is otherwise confidential, in order to assist me in the
diagnosis or treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard, because
physicians and other health care providers need access to the full record and/or full and complete
information in order to provide quality care. The word “treatment” includes, among other things,
the coordination and management of health care among health care providers or by a health care
provider with a third party, consultations between health care providers, and referrals of a patient
for health care from one health care provider to another.
• Payment is when I use and disclose health information to obtain reimbursement for your
healthcare. Examples of payment are when I disclose your PHI to your health insurer to obtain
reimbursement for your health care or to determine eligibility or coverage.
• Health Care Operations refers to the use and disclosure of health information for
activities that relate to the performance and operation of my practice. Examples of health care
operations are review of treatment procedures or business operations, quality assessment and
improvement activities, and staff training.
PLEASE NOTE: I, or someone from Maxwell Recovery Services acting with my authority, may
contact you to provide appointment reminders or information about treatment alternatives or
other health-related benefits and services that may be of interest to you. Your prior written
authorization is not required for such contact.
Uses and Disclosures Requiring Authorization
I may use or disclose PHI for purposes outside of treatment, payment, or health care operations
when your appropriate authorization is obtained. In those instances when I am asked for
information for purposes outside of treatment, payment or 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. These notes are given a greater
degree of protection than PHI. I will also obtain an authorization from you before using or
disclosing PHI in a way that is not described in this Notice. You may revoke all such
authorizations at any time, provided each revocation is in writing. You may not revoke an
authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization
was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to
contest the claim under the policy.
Uses and Disclosures with Neither Consent nor Authorization
I may use or disclose PHI without your consent or authorization in certain circumstances,
including, but not limited to:
• Child or At-Risk Adult Abuse: If I have reasonable cause to know or suspect that a child
has been subjected to abuse or neglect or an at-risk adult has been mistreated, self-neglected, or
financially exploited or is at imminent risk of mistreatment, self-neglect, or financial
exploitation, then I must report this to the appropriate authorities.
• Health Oversight Activities: If the Colorado state licensing board or an authorized
professional review committee is reviewing my services, I may disclose PHI to that board or
committee.
• Judicial and Administrative Proceedings: If you are involved in a court proceeding
where you are being evaluated for a third party or where the evaluation is court ordered, I may
disclose PHI to the court. You will be informed in advance if this is the case.
• Serious Threat to Health or Safety: If you communicate to me a serious threat of
imminent physical violence against a specific person or persons, including those identifiable by
association with a specific place, I have a duty to notify any person or persons specifically
threatened, as well as a duty to protect by taking other appropriate action. If I believe that you
are at imminent risk of inflicting serious harm on yourself, I may disclose information necessary
to protect you. In either case, I may disclose information in order to initiate hospitalization.
• Business Associates: Maxwell Recovery Services may enter into contracts with business
associates that are outside entities to provide billing, legal, auditing, and practice management
services. In those situations, protected health information will be provided to those contractors as
needed to perform their contracted tasks. Business associates are required to enter into an
agreement maintaining the privacy of the protected health information released to them.
• In Compliance with Other State/Federal Laws and Regulations: PHI may be disclosed
when the use and disclosure is allowed under other sections of Section 164.512 of the Privacy
Rule and the state’s confidentiality law. This includes certain narrowly-defined disclosures to
law enforcement agencies, to a health oversight agency (such as HHS), to a medical examiner,
for public health purposes relating to disease or FDA-regulated products, or for specialized
government functions (fitness for military duties, eligibility for VA benefits, etc.)
Client Rights
When it comes to your PHI, you have certain rights. This section explains your rights and some
of Maxwell Recovery Services’ responsibilities to help you.
• Right to Request Restrictions: You have the right to request restrictions on certain uses
and disclosures of protected health information regarding you. The request must be in writing,
and I am not required to agree to a restriction you request.
• Right to Receive Confidential Communications by Alternative Means and at Alternative
Locations: You have the right to request and receive confidential communications of PHI by
alternative means and at alternative locations. (For example, you may not want a family member
to know that you are seeing me. On your request, I will send your bills to another address.)
• 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. I may deny your access to PHI under certain circumstances, but in
some cases you may have this decision reviewed. On your request, I will discuss with you the
details of the request and denial process.
• 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. On your request, I will discuss with
you the details of the amendment process.
• Right to an Accounting: You generally have the right to receive an accounting of
disclosures of PHI. On your request, I will discuss with you the details of the accounting
process.
• 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.
• Right to Restrict Disclosures When You Have Paid for Your Care Out-of-Pocket: You
have the right to restrict certain disclosures of PHI to a health plan when you pay out-of-pocket
in full for my services.
Provider’s Duties
As a mental health provider, I have certain duties to you related to your PHI. These are
described below.
• 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 am required to notify you if: (a) there is a breach (a use or disclosure of your PHI in
violation of the HIPAA Privacy Rule) involving your PHI; (b) that PHI has not been encrypted to
government standards; and (c) my risk assessment fails to determine that there is a low
probability that your PHI has been compromised.
• 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 send a revised Notice of Privacy Practices
by mail or email to the address I have in your record.
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 the Privacy Officer,
Henry Maxwell, BA, CAS, CRS, CAI, CPC at 970-987-1525 or
henry@maxwellrecoveryservices.com.
If you believe that your privacy rights have been violated and wish to file a complaint with my
office, you may send your written complaint to Henry Maxwell, BA, CAS, CRS, CAI, CPC at
218th East Valley Road, Suite 104 #272, Carbondale, CO, 81623 or
henry@maxwellrecoveryservice.com. You may also send a written complaint to the Secretary of
the U.S. Department of Health and Human Services. 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, or email to OCRComplaint@hhs.gov. Maxwell
Recovery Services will not retaliate against you for exercising your right to file a complaint.
This Notice is effective December 2024.
For more information: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html