Privacy Notice

HIPAA – Privacy Notice Effective 06-01-2021


Protecting the privacy and confidentiality of patients’ personal information is important to the providers and staff at Balanced Mind Integrative Care, LLC (BMIC “the Practice). Every member of our team must abide by our commitment to privacy in handling personal information and are informed about the importance of privacy according to The Health Insurance Portability and Accountability Act of 1996 (HIPAA). Our Notice of Privacy Practices applies to the personal health information (PHI) of all patients that receive care and services from BMIC.

This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you, relating to your past, present, or future physical or mental health or condition and related health care services.

Identifying purposes: We ask and collect information to establish a relationship to serve your mental health needs. We obtain most of your information about you directly from you or from your referring physician, whom you have authorized to disclose information.

You have the right to determine how your personal health information is used and disclosed. For most healthcare purposes, your consent is implied because you consent to treatment. However, in all circumstances, express consent must be written. Your written consent will be forwarded to the Privacy Officer, who will document the request in the patient’s medical records and notify the appropriate healthcare providers and their supporting staff. We will obtain your consent if we wish to use your information for other purposes.

Personal Health Information permits certain collections, uses, and disclosures of your PHI, despite the consent directive; healthcare providers may override the consent directive in certain circumstances, such as emergencies, and the consent directive may result in delays in receiving health care.

Uses and Disclosures of Protected Health Information

Your Protected Health Information may be used and disclosed by your clinician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the practice, and any other use required by law.

Treatment: We will use and disclose your Protected Health Information to provide, coordinate, or manage your health care and any related services. This includes coordinating or managing your health care with a third party. For example, your protected health information may be provided to a physician or nurse practitioner to whom you have been referred to ensure that the healthcare professional has the necessary information to diagnose or treat you.

Payment: We may use or disclose your Protected Health Information as needed to obtain payment for health care services. For example, we may provide relevant information to an insurance company or its administrators to process and pay your claims and collect payment for the services provided to you or a third-party payer for the rendering of services by us. We may disclose your PHI to establish your insurance eligibility benefits. We may also provide you PHI to our business associates, such as billing companies, claims processing companies, and others that process our health care claims.

Healthcare Operations: We may use or disclose your Protected Health Information as needed to support the business activities of Balanced Mind Integrative Care. These activities include but are not limited to quality assessment activities, employee review activities, and conducting or arranging for other business activities. We may also provide your PHI to accountants, attorneys, consultants, and others to make sure we comply with the laws that govern us. In addition, we may use or disclose your PHI as necessary to contact you to remind you of your appointment. We may call your home phone, or cell phone, send a text message, or leave a message (either on your answering machine or with the person answering the phone) to remind you of an upcoming appointment, the need to schedule a new appointment, request additional information for your appointment, or to call our office. We may also mail to your home or other location designated by you any items that assist the Practice in carrying out healthcare operations. We may email you at the email address you provided us with for our records. We may email any items that assist the practice in carrying out healthcare operations, such as appointment reminders, telehealth links, patient statements, and informational items. We may disclose your PHI if you require emergency treatment or are unable to communicate with us or to family, friends, or other people you identified as involved with your care or payment for care unless you object.

We may use or disclose your protected health information in the following situations without your authorization. These situations include:

  • Required by Law: Abuse or Neglect, Subpoena, Serious Threat to Health or Safety
  • Public Health: Communicable diseases
  • Health Oversight Activities: 
  • Research 
  • Worker’s Compensation
  • Specialized Government Activities: Military or Veteran activities, National Security, Law Enforcement, Criminal Activity, Legal Proceeding
  • Organ Donation
  • Coroners, Medical Examiners, Funeral Directors
  • Disaster Relief

Under the law, we must disclose to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with HIPAA requirements.

Disclosures Requiring Written Authorization

Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization, or Opportunity to Object unless required by Law.

Your Rights

Right to Receive a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice upon request.

Right to Access PHI: You have the right to inspect and copy your PHI for as long as we maintain your medical record. You must make a written request for access to the Privacy Officer at the address listed at the end of this Notice. We may charge you a reasonable fee for processing your request and copying your medical record. In certain circumstances, we may deny your request to access your PHI, and you may request that we reconsider our denial. Depending on the reason for the denial, another licensed healthcare professional chosen by us may review your request and the denial.

Right to Request Restrictions: You have the right to request a restriction on the use or disclosure of your PHI for the purpose of treatment, payment, or healthcare operations, except in the case of an emergency. You also have the right to request a restriction on the information we disclose to a family member or friend who is involved with your care or the payment of your care. However, we are not legally required to agree to such a restriction.

Right to Restrict Disclosure for Services Paid by You in Full: You have the right to restrict the disclosure of your PHI to a health plan if the PHI pertains to health care services for which you paid in full directly to us.

Right to Request Amendment. You have the right to request that we amend your PHI if you believe it is incorrect or incomplete for as long as we maintain your medical record. We may deny your request to amend if:

  1. We did not create the PHI.
  2. Is not information that we maintain.
  3. Is not information that you are permitted to inspect or copy (such as psychotherapy notes).
  4. We determine that the PHI is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures of PHI made by us (other than those made for treatment, payment, or health care operations purposes) during the 6 years prior to the date of your request. You must make a written request for an accounting, specifying the time period for the accounting, to the Privacy Officer at the address listed at the end of this Notice.

Right to Confidential Communications. You have the right to request that we communicate with you about your PHI by certain means or at certain locations. For example, you may specify that we call you only at your home phone number and not your work number. You must make a written request specifying how and where we may contact you to the Privacy Officer at the address listed at the end of this Notice.

Right to Notice of Breach. You have the right to be notified if one of our business associates, or we become aware of your unsecured PHI breach.

Changes to this Notice

We reserve the right to change this Notice at any time in accordance with applicable law. Prior to a substantial change to this Notice related to the uses of disclosures of your PHI, your rights, or our duties, we will revise and distribute this Notice, or you can obtain an updated HIPPA privacy notice on our website or request a copy at any time.

Acknowledgment of Receipt of Notice: We will ask you to sign an acknowledgment that you received this Notice.

Questions and Complaints: If you would like more information about our privacy practices or have questions or concerns, don’t hesitate to contact us. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made regarding the use, disclosure, or access to your PHI; you may submit a complaint to us by contacting the Privacy Officer at the address and phone number at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file such a complaint upon request.

We encourage you to contact us with any questions or concerns you might have about your privacy. We will investigate and respond to your concerns about any aspect of handling your information.

Privacy Officer
Balanced Mind Integrative Care, LLC
3440 Hollywood Boulevard, Suite 415
Hollywood, FL 33021

About Us

Balanced Mind Integrative Care's vision is to empower individuals to attain mental, emotional, and physical well-being through accessible, quality mental health care.

Serving Florida and Maryland.


954‍‍-295-7116 (FL)
301-450-6803 (MD)



3440 Hollywood Blvd., Ste 415
Hollywood, FL 33021

10411 Motor City Drive, Ste 750
Bethesda, MD 20817


Mon. - Thurs.: 6 p.m. to 10 p.m.
Friday: 9 a.m. to 3 p.m.
Sunday (Every other): 11 a.m. to 3 p.m.

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