A Mindful Transformation, Inc

This Notice describes how health information about you may be used and disclosed, how you can access this information, and your rights regarding your information. Please review it carefully.

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A Mindful Transformation, Inc. (“AMT,” “we,” “our,” or “us”) is committed to protecting the privacy, dignity, and confidentiality of adults served by our organization. AMT currently provides adult-focused psychoeducation, recovery support, prevention, education, consultation, and related services. This Notice of Privacy Practices explains how AMT may use and disclose your Protected Health Information (“PHI”) or other confidential service-related information, your rights regarding that information, and AMT’s legal duties to protect your privacy.

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A Mindful Transformation, Inc. Responsibilities

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AMT is required by law to maintain the privacy and security of your Protected Health Information (“PHI”) and to provide you with this Notice describing our privacy practices. AMT protects PHI in accordance with applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R. Parts 160 and 164, applicable substance use disorder confidentiality protections under 42 C.F.R. Part 2 when they apply, and applicable Florida confidentiality and mandatory reporting laws. AMT is required to follow the terms of the Notice currently in effect.

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If there is a breach of unsecured PHI that may compromise your privacy or security, AMT will notify you as required by law.

AMT will use and disclose your health information only as permitted or required by federal and state law, including applicable confidentiality protections for behavioral health and substance use disorder records. We will make reasonable efforts to use, disclose, and request only the minimum necessary information needed to accomplish the intended purpose, unless a broader disclosure is authorized by you or otherwise permitted by law.

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How AMT May Use and Disclose Your Health Information

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AMT Personnel

AMT personnel may use and share your health information as needed to provide psychoeducation, recovery support, prevention, education, consultation, service coordination, documentation, supervision or consultation related to service quality, billing and payment activities, compliance, quality improvement, required recordkeeping, and program operations. Access is limited to workforce members who need the information to perform their assigned duties.

 

Business Associates

AMT may disclose limited health information to business associates that perform services on our behalf, such as billing, technology support, records management, legal, accounting, compliance, or other administrative services. AMT requires each business associate that creates, receives, maintains, or transmits protected health information on AMT’s behalf to enter into a written Business Associate Agreement. The Business Associate Agreement requires the business associate to appropriately safeguard protected health information and to use or disclose it only as permitted by the agreement and applicable law.

 

Telehealth and Electronic Platforms

AMT provides services through a 100% telehealth model. AMT may use secure electronic platforms, including CarePatron, Zoom for Healthcare, and FormHippo, to support scheduling, documentation, electronic forms, communication, billing-related activities, and virtual service delivery. AMT maintains Business Associate Agreements with CarePatron, Zoom for Healthcare, and FormHippo when these platforms create, receive, maintain, or transmit protected health information or confidential service-related information on AMT’s behalf. Clients are encouraged to participate in telehealth services from a private location and to use a secure internet connection whenever possible.

 

Crimes and Threats of Crimes at Home; Reporting Abuse

AMT may disclose information when required or permitted by Florida or federal law to report suspected abuse, neglect, abandonment, exploitation, domestic violence, or threats of serious harm. Because AMT currently serves adults age 18 and older, this includes required reporting related to vulnerable adults, elderly persons, or other adults protected by law. Reports may be made to the Florida Abuse Hotline, the Florida Department of Children and Families, law enforcement, protective services, or other legally authorized agencies. AMT may also disclose information when necessary to prevent or lessen a serious and imminent threat to the health or safety of you, another person, or the public.

 

Court Orders; Warrants; Subpoenas; Legal Proceedings

AMT may disclose health information in response to a valid court order, warrant, subpoena, discovery request, administrative order, or other lawful process when the disclosure is required or permitted by law. When appropriate, AMT may seek assurances that you have been notified of the request or that a protective order is in place before releasing information.

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Medical Emergencies; Individual Health; Public Health/Safety Purpose

AMT may use or disclose health information in a medical emergency or when necessary to support your health and safety. AMT may also disclose information for public health and safety purposes, such as reporting certain diseases, injuries, threats, abuse, neglect, exploitation, or other circumstances required by law. Disclosures will be limited to the information necessary for the specific purpose.

 

Secretary of U.S. Department of Health and Human Services; State Agencies

AMT may disclose health information to the Secretary of the U.S. Department of Health and Human Services when required to determine AMT’s compliance with federal privacy laws. AMT may also disclose information to authorized state agencies for oversight, licensing, audits, investigations, inspections, program monitoring, or other activities permitted or required by law.

 

Research, Audit, and Evaluation Purposes

AMT may use or disclose information for research, audit, program evaluation, quality assurance, or outcome measurement purposes when permitted by law and subject to applicable privacy safeguards. When possible, AMT will use de-identified information or information that does not directly identify you. Identifiable information will be used or disclosed only when legally permitted, authorized by you, or approved through appropriate privacy protections.

 

Uses and Disclosures Requiring Written Authorization

AMT will obtain your written authorization before using or disclosing your information for purposes not otherwise permitted or required by law. Written authorization may be required for certain disclosures of substance use disorder information, psychotherapy notes if such notes are ever created, marketing communications that require authorization, sale of protected health information, or other uses and disclosures requiring specific permission under federal or state law.

 

Revocation of Authorization

You may revoke a written authorization at any time by submitting a written revocation to AMT. Revocation will not affect any use or disclosure that AMT already made in reliance on your authorization before receiving the revocation.

 

Substance Use Disorder Confidentiality Protections

If AMT creates, receives, or maintains records related to substance use disorder education, prevention, recovery support, referral, or other covered services, those records may receive additional confidentiality protections under federal law, including 42 CFR Part 2 when applicable. AMT will not use or disclose Part 2-protected information except as permitted by law, with your valid written consent when required, or pursuant to another legally recognized exception. AMT will also follow applicable restrictions on redisclosure of protected substance use disorder information.

 

Adult-Only Services

AMT currently provides services only to adults age 18 and older. This Notice does not describe minor consent, parental access, or confidentiality rules for services to individuals under age 18 because AMT does not currently serve minors.

Your Rights Regarding Your Health Information

You have rights regarding your health information. Some rights may be subject to legal limits, clinical restrictions, verification of identity, reasonable processing time, or applicable fees allowed by law.

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of certain health information maintained by AMT. Requests must be submitted in writing. If AMT maintains the information electronically, you may request an electronic copy when available and permitted by law. AMT may charge a reasonable, cost-based fee for copies as permitted by law. In limited circumstances, AMT may deny access, and you may have the right to request a review of the denial.

 

Right to Amend

If you believe information in your record is incorrect or incomplete, you may request an amendment in writing. AMT may deny the request in certain circumstances, such as when the information was not created by AMT, is not part of the record maintained by AMT, is not available for inspection, or is accurate and complete. If denied, you may submit a written statement of disagreement as permitted by law.

 

Right to Request Restrictions

You may request that AMT restrict certain uses or disclosures of your health information for treatment, payment, or health care operations. AMT is not required to agree to every requested restriction unless required by law. If AMT agrees to a restriction, we will follow it except in an emergency or as otherwise permitted by law.

If you pay out of pocket in full for a service and request that AMT not disclose information about that service to a health plan for payment or health care operations, AMT will honor the request when required by law.

 

Right to Request Confidential Communications

You may request that AMT communicate with you in a specific way or at a specific location, such as by phone, mail, or another address. AMT will accommodate reasonable requests when possible. Your request should be made in writing and should clearly explain how or where you wish to be contacted.

 

Right to an Accounting of Disclosures

You may request a list, or accounting, of certain disclosures of your health information made by AMT. This accounting does not include all disclosures, such as disclosures for treatment, payment, health care operations, disclosures made to you, disclosures made with your authorization, or disclosures otherwise excluded by law. Requests must be submitted in writing.

 

Right to Notice

You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically. AMT will make this Notice available to individuals served and will post it as required by applicable law.

 

Personal Representatives

AMT may treat a legally authorized personal representative as having the same rights as you with respect to your health information, unless AMT determines that doing so is not permitted by law or may create a risk of harm, abuse, neglect, or exploitation.

 

Changes to the Notice of Privacy Practices

AMT reserves the right to change the terms of this Notice and to make the revised Notice effective for all health information we maintain, including information created or received before the change. When AMT makes a material change to this Notice, we will update the effective date and make the revised Notice available as required by law. AMT will make the current Notice available upon request and, when applicable, will post the current Notice on AMT’s website.

 

Complaints and Report Violations

If you believe your privacy rights have been violated, you may file a complaint with AMT either by mail or email. Complaints should be submitted in writing to AMT at:

A Mindful Transformation, Inc.,

P.O. Box 772402, Ocala, FL 34474.

Email: info@amindfultransformation.org.

Website: www.amindfultransformation.org.

 

You may also file a health information privacy, security, or confidentiality complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Written complaints may be mailed to:

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.

AMT will not retaliate against you for filing a complaint or reporting a privacy concern.

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Important Note: This Notice is intended to summarize AMT’s privacy practices and individual rights in clear language. If state or federal law provides greater privacy protections than described here, AMT will follow the stricter applicable requirement.