HIPAA Notice of Privacy Practices

Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
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Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.

Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures. One accounting per year is free; additional requests may incur a reasonable, cost-based fee.

Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority before taking any action.

File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us using the information listed below.
You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your Choices
For certain health information, you can tell us your choices about what we share.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situationInclude your information in a hospital directory
- Contact you for fundraising efforts
If you are not able to tell us your preference, we may share your information if we believe it is in your best interest or to lessen a serious and imminent threat to health or safety.
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We never share your information without your written permission for:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes

Our Uses and Disclosures
We typically use or share your health information in the following ways:
Treatment - We can use your health information and share it with other professionals who are treating you.
Healthcare operations - We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Billing and payment - We can use and share your health information to bill and receive payment from health plans or other entities.

Other Permitted and Required Uses
We may also use or share your health information to:
- Help with public health and safety issues
- Conduct health research
- Comply with state or federal laws
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits or legal actions

Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will notify you promptly if a breach occurs that may compromise your information.
- We must follow the duties and privacy practices described in this notice and provide you with a copy.
- We will not use or share your information other than as described unless you authorize us in writing.

Changes to This Notice
We may change the terms of this notice, and the changes will apply to all information we have about you. The updated notice will be available on our website and upon request.

Contact Information
‍Shine Behavioral Health, LLC
📍 541 Benfield Rd, Suite A, Severna Park, MD, 21146
📞 (410) 513-4513
✉️ ccallahan@shinemaryland.com
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Download
You may download the full HIPAA Notice of Privacy Practices (PDF) below:
👉 Download HIPAA Notice of Privacy Practices