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Notice of health information privacy practices

Last updated: March 24, 2023




About Us 


In this Notice, we use terms like “we,” “us” or “our” or “Foresight Mental Health” to refer to Foresight Mental Health, PLLC, Foresight Mental Health (a California professional corporation), Foresight Mental Health Group NJ LLC, and M Telemedicine of New York, PLLC. We may share your protected health information to provide you with health care services, to treat you, to pay for your care, and to conduct our business operations (e.g., quality assurance, compliance, and utilization review). 


What is “Protected Health Information” or “PHI?” 


“Protected Health Information,” or “PHI” for short, is information that identifies who you are and relates to your past, present, or future physical or mental health condition, the provision of health care to you, or past, present, or future payment for the provision of health care to you. 


Our Privacy Obligations


In the course of providing healthcare services, we gather and maintain PHI about our members. We respect the privacy of your PHI and understand the importance of keeping this information confidential and secure. We are required by law to maintain the privacy of your PHI and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. 

We are also required by law to notify you in the event of a breach of your unsecured PHI. 


Types of Use and Disclosure of PHI We May Make Without Your Authorization 


We are also allowed by law to use and disclose your PHI without your authorization for the following purposes:


Treatment. Federal and state law allow us to use and disclose your PHI in order to provide treatment or other health care services to you. For example, we may use your PHI to provide clinical mental health counseling or prescribe medications. We may also use or disclose your PHI to recommend to you treatment alternatives, to inform you about health-related benefits and services that we offer, or to contact you to remind you of your appointments. We may also disclose PHI to other providers involved in your treatment.


Payment. Federal and state law allows us to use and disclose your PHI to obtain payment for health care services that we provide to you. For example, we may use your PHI to claim and obtain payment from your health insurer, HMO, or other company or program that arranges or pays the cost of your health care or to verify that your payor will pay for the health care.  We may also disclose PHI to your other health care providers when such PHI is required for them to receive payment for services they render to you.


Health Care Operations. Federal and state law also allow us to use and disclose your PHI as necessary in connection with our health care operations. For example, we may use your PHI to review the quality of care provided or for resolution of any grievance or appeal that you file if you are unhappy with the care you have received. We may use your PHI to perform certain business functions and disclose your PHI to our business associates, who must also agree to safeguard your PHI as required by law. 


As Required by Law. In some circumstances, we are required by federal or state laws to disclose certain PHI to others, such as public agencies for various reasons.


For Public Health Activities. We may disclose your PHI (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability, (2) to report child abuse and neglect to a government authority authorized by law to receive such reports, (3) to report information about products under the jurisdiction of the U.S. Food and Drug Administration, (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, and (5) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.


To Government Authorities Authorized to Receive Reports of Abuse, Neglect, or Domestic Violence. We may disclose your PHI if we are required to make such reports because we reasonably believe you are a victim of abuse, neglect, or domestic violence.


For Health Oversight Activities. We may disclose your PHI to governmental agencies that oversee the health care system and are charged with responsibility for ensuring compliance with the rules of government health programs, such as Medicare or Medicaid.


Judicial and Administrative Proceedings. We may disclose your PHI in connection with a judicial or administrative proceeding in response to a legal order or other lawful process agencies.


Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials as required by law or in compliance with a court order.


Decedents. We may disclose your PHI to coroners, medical examiners, or funeral directors as authorized by law to assist them in performance of their legal duties.


Organ and Tissue Procurement. We may disclose your PHI to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.


Research. We may use and disclose your PHI for research purposes pursuant to a valid authorization from you or when an institutional review board or privacy board has waived the authorization requirement.  Under certain circumstances, your Protected Health Information may be disclosed without your authorization to researchers preparing to conduct a research project, for research of decedents or as part of a data set that omits your name and other information that can directly identify you.


Health or Safety. We may use or disclose your PHI to avert or lessen a serious threat to the health or safety of you or other members of the public. 


Specialized Government Functions. We may use and disclose your PHI Such as disclosures to units of the government with special functions, such as the Department of Defense to determine eligibility for veteran benefits or for other national security purposes


Workers’ Compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with state law relating to workers’ compensation or other similar programs. 


Uses and Disclosures Requiring You to Have the Opportunity to Agree or Object 


Before we make certain uses and disclosures of your PHI without your written authorization, we must provide you with an opportunity to agree or object. We may disclose your PHI to your family members or other persons if they are involved in your care or payment for that care. We may disclose your PHI to notify and assist disaster relief organizations in their relief efforts. We will provide you with the opportunity to agree or object prior to these disclosures. If you cannot agree or object because you are incapacitated or not present at the time of disclosure, we will use our professional judgment. 


Special Rules for Highly Confidential PHI 


Some types of highly confidential PHI, such as HIV/AIDS status or test results, substance abuse treatment documentation, or mental health information, are protected by state or federal laws that are more responsive to patient rights of confidentiality than HIPAA. However, in order for us to disclose any such PHI for a purpose other than those permitted by law, we must obtain your written authorization. 


Uses and Disclosures Requiring Your Authorization 


We must obtain your written authorization prior to the following uses and disclosures of your PHI: 


Marketing. We must obtain your written authorization in order to use your PHI for purposes that are marketing under the HIPAA privacy rules. However, no authorization is required for the following communications so long as we do not accept any payments from other organizations or individuals in exchange for the communication: (1) information relating to your treatment, including case management, care coordination or recommendation of treatment alternatives; (2) refill reminders or other communications about drugs that are currently prescribed for you; (3) information about health-related products or services. In addition, we may market to you during a face-to-face communication; and give you promotional gifts of nominal value without obtaining your authorization. 


Psychotherapy Notes. With very limited exceptions, we must obtain your authorization in order to disclose any notes recorded by a mental health professional about you in a counseling session. 


Sale of PHI. We will not make any disclosure of PHI that is a sale of PHI without your written authorization.


Other Uses and Disclosures


All other uses and disclosures of your PHI that are not described in this Notice require your written authorization. If you need an authorization form, we will send you one for you or your personal representative to complete. When you receive the form, please fill it out and send it to the following address: Foresight Mental Health, P.O. Box 530077, Atlanta, GA 30353-0077. 3. You may revoke or modify your authorization at any time by writing to us at the same address. Please note that your revocation or modification may not be effective in some circumstances, such as when we have already taken action relying on your authorization. 


Notification of Your Rights Regarding Your PHI 


Right to Access Your PHI. You may request to inspect and obtain a copy of your PHI that we maintain in medical and billing records, for as long as we maintain such records. If you wish to access your PHI, please provide a detailed written description of the PHI you wish to review at the address given below. If you would like a copy of the information we have, please request a record release form from us and submit the completed form to us at the address given below address. If we provide you with a copy of your PHI, we may charge a reasonable administrative fee for copying your PHI to the extent permitted by applicable law. In limited circumstances, we may deny your request to inspect or obtain copies of your PHI. 


Right to Amend Your PHI. You have the right to request amendments to your PHI for so long as the information is maintained in our medical and billing records. If you wish to have your PHI corrected or updated, please write to us and tell us what you want changed and why. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply. 


Right to Receive an Accounting of Disclosures of Your PHI. You have the right to request an accounting of certain disclosures that we make of your PHI. An accounting lists disclosures we have made during the six-year period prior to the date of your request. You can request an accounting by writing to us. Please note that certain disclosures need not be included in the accounting we provide to you, such as disclosures made for treatment, payment or health care operations. If you request an accounting more than once during a twelve (12) month period, we may charge you a reasonable fee for the accounting statement. 


Right to Receive a Paper Copy of This Notice. You have the right to request and receive a paper copy of this Notice, even if you have agreed to receive the Notice electronically. You may contact us for a copy, and one will be provided to you at no charge. 


Right to Request Restrictions. You have the right to request restrictions on how we use and disclose your PHI for (1) our treatment, payment, and health care operations (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. All requests must be made in writing. Upon receipt, we will review your request and notify you whether we have accepted or denied your request. Please note that we are not required to accept your request for restrictions, except that we are required, based on your written request, to restrict disclosure of your PHI to a health plan if (a) the purpose of the disclosure is to carry out payment or health care operations, (b) the disclosure is not otherwise required by law, and (c) the PHI pertains solely to a health care item or service for which you or someone other than the health plan have paid in full without any contribution from your health plan. 


Right to Confidential Communications. You have the right to request, and we will accommodate, any reasonable request to provide your PHI to you in a confidential manner. For example, you may request that we send your PHI by an alternate means (e.g., sending by a sealed envelope, rather than a postcard) or to an alternate address (e.g., calling you at a different telephone number, or sending a letter to you at your office address rather than your home address). 


Right to File a Complaint. We must follow the privacy practices set forth in this Notice while in effect. If you have any questions about this Notice, wish to exercise your rights, or file a complaint, please contact us at: 


Phone: 800-539-2495


Address: P.O. Box 530077, Atlanta, GA 30353-0077


You also have the right to directly file a complaint with the Office for Civil Rights Secretary of the United States Department of Health and Human Service by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting We will not retaliate against you for filing a complaint against us. 


Changes to this Notice 


We reserve the right to revise this Notice consistent with law and make it applicable to all of your PHI that we maintain, regardless of when it was received or created. If we make material or important changes to our privacy practices, we will promptly revise our Notice. Unless the changes are required by law, we will not implement material changes to our privacy practices before we revise our Notice. You may request a copy of the Notice currently in effect at any time or you may access it by visiting


Effective Date 


The effective date of this Notice is March 24, 2023

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