🩺 Notice of Privacy Practices

Effective Date: 12/01/2025

Coastal Peaks Psychiatry PLLC
Serving patients in Colorado & Florida

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.

1. Our Commitment to Your Privacy

Your privacy is important to us. We are legally required to maintain the privacy of your health information and to provide you with this Notice of our legal duties and privacy practices. We must follow the privacy practices described in this Notice while it is in effect.

2. How We May Use and Disclose Health Information

We may use and disclose your protected health information (“PHI”) for the following purposes, as permitted by law:

A. Treatment

We may use and share your information to provide, coordinate, or manage your healthcare and related services.
Example: sharing necessary information with your therapist, primary care physician, or pharmacy.

B. Payment

We may use and disclose your PHI to bill and collect payment for your treatment and services.
Example: sending information to your insurance company for reimbursement.

C. Healthcare Operations

We may use your PHI to conduct business operations such as quality assessment, staff training, licensing, or accreditation.
Example: reviewing patient records to ensure quality of care.

D. Business Associates

We may share information with trusted vendors that perform services on our behalf (such as electronic health record providers, billing services, or secure communication platforms). These parties are bound by Business Associate Agreements (BAAs) to protect your information under HIPAA.

E. Appointment Reminders and Communication

We may contact you through secure messaging, phone, or email to remind you of appointments or provide information about treatment alternatives. We will use reasonable safeguards to protect your privacy.

F. As Required by Law

We may disclose your PHI when required by federal, state, or local law.

3. Other Uses and Disclosures Permitted or Required by Law

We may also disclose your PHI in the following limited circumstances:

  • To avert a serious threat to health or safety

  • To report suspected abuse or neglect of a child, elder, or vulnerable adult

  • For public health activities (e.g., reporting communicable diseases)

  • For health oversight agencies (e.g., audits, compliance reviews)

  • For judicial or administrative proceedings (e.g., court orders, subpoenas)

  • For law enforcement purposes (when required by law)

  • To coroners, medical examiners, or funeral directors as necessary

  • For research with proper authorization or waiver of consent

All other uses and disclosures require your written authorization, which you may revoke at any time in writing.

4. Your Rights Regarding Your Health Information

You have the following rights under HIPAA:

A. Right to Access

You may request to inspect or obtain copies of your medical record, in paper or electronic form. Requests must be submitted in writing. Reasonable fees may apply for copying or mailing.

B. Right to Request Amendment

If you believe information in your record is inaccurate or incomplete, you may request an amendment in writing. We may deny your request if the record is accurate and complete, but you will receive a written explanation.

C. Right to an Accounting of Disclosures

You may request a list of certain disclosures of your PHI made by us in the past six years, excluding those made for treatment, payment, or healthcare operations.

D. Right to Request Restrictions

You may ask us not to use or disclose certain information for treatment, payment, or operations. While we are not required to agree, we will comply when legally permissible.

E. Right to Confidential Communications

You may request that we contact you at a specific address, phone number, or email to protect your privacy.

F. Right to a Paper Copy

You may request a paper copy of this Notice at any time, even if you have received it electronically.

G. Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or directly with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).
You will not be penalized or retaliated against for filing a complaint.

5. Use of Artificial Intelligence (AI) in Documentation

Coastal Peaks Psychiatry PLLC may use HIPAA-compliant artificial intelligence (AI) tools, such as MD Hub, to assist with documentation and note organization. These tools operate under signed Business Associate Agreements (BAAs) and are used solely for administrative support — never for diagnosis, decision-making, or external data training.
All information is reviewed and finalized by a licensed clinician.

6. How We Protect Your Information

We use physical, technical, and administrative safeguards to protect your data, including:

  • HIPAA-compliant electronic health record systems

  • Encrypted telehealth and email communication

  • Access controls and ongoing staff training

  • Regular audits and review of privacy practices

7. Changes to This Notice

We reserve the right to change the terms of this Notice at any time. Any revised Notice will be posted on our website and available in electronic or printed form upon request. The new Notice will apply to all PHI we maintain.

8. Contact Information

If you have questions or wish to exercise any of your rights under this Notice, please contact:

Privacy Officer
Coastal Peaks Psychiatry PLLC
871 Venetia Bay Blvd., Suite 201, Venice, FL, 34285
Phone: (941) 202-6126
Email: owner@coastalpeakspsych.com

You may also contact:
U.S. Department of Health and Human Services, Office for Civil Rights (OCR)
Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/

Acknowledgment of Receipt

Patients are asked to sign an acknowledgment form confirming they have received and reviewed this Notice of Privacy Practices.