NOTICE OF PRIVACY PRACTICES

THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL  INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

As a patient of Elemental Health, PLLC (“we,” “us,” “our,” or “Elemental Health”), you have legal rights concerning how we use or disclose medical information about you. We are required by the federal Health Insurance Portability and Accountability Act of 1996 and the Health Information Technology for Economic and Clinical Health Act, Public Law 111-005, and the regulations thereunder (“HIPAA”), and applicable Massachusetts state law, to maintain the privacy of your protected health information (“PHI”) and provide you with this Notice of Privacy Practices (this “Notice”).

For the purposes of this Notice, “Elemental Health” and the pronouns “we,” “us,” and “our” refer to Elemental Health, PLLC, its subsidiaries and affiliates under common ownership or operational control, and its contracted or employed care providers which may operate as a HIPAA single affiliated covered entity.

PHI is health information, including demographic information such as your name, address, telephone number, Social Security number, birth date, and gender, as well as past, present, or future information about your or your child’s physical, developmental, or mental health condition, and information about the services provided to you, including payment information, if any of that information may be used to identify you.

This Notice describes how we may use and disclose your PHI to carry out treatment, payment, or health care operations, and for other purposes permitted or required by state and federal law. As required by law, this Notice describes:

  • How we may use and disclose your PHI;

  • Your privacy rights with respect to your PHI; and

  • Our obligations concerning the use and disclosure of your PHI.

The terms of this Notice apply to all records containing your PHI that are created or received by Elemental Health. We are required by law to abide by the terms of the Notice currently in effect.

We reserve the right to revise or amend this Notice. Any revision or amendment will be effective for all PHI we have created or received in the past and for any PHI we may create or receive in the future. We will post a copy of our current Notice in our office and on our website. You may request a copy at any time by contacting our Privacy Officer.

We will make reasonable efforts to limit uses and disclosures of PHI to the minimum necessary to accomplish the intended purpose, except as otherwise permitted by law.

YOUR PRIVACY RIGHTS ARE IMPORTANT TO US. IF YOU HAVE QUESTIONS REGARDING THIS NOTICE OR OUR PRIVACY POLICIES, PLEASE CONTACT OUR PRIVACY OFFICER AT (617) 858-0313.

B. USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

We may use and disclose your PHI without your specific permission in the following circumstances:

  • Treatment. We may use and disclose your PHI to provide you with mental health treatment or services or to assist in the coordination, continuation, or management of your care and any related services, including treatment options. We may provide services via telehealth. While we take reasonable steps to protect your privacy, electronic communications may involve risks to confidentiality. By choosing telehealth services, you acknowledge and accept these risks. For example, we will record your health information to assist in diagnosis and care and may share information with other providers involved in your treatment.

  • Payment. We may use and disclose your PHI to bill and collect payment. For example, we may contact your insurer to determine eligibility or coverage.

  • Health Care Operations. We may use and disclose your PHI for operational purposes.

  • Business Associates. We may share PHI with third parties who perform services for us (e.g., electronic medical record vendors, billing providers), subject to legally required agreements to protect your information.

  • Communications. We may use and disclose your information to provide appointment reminders, leave a message on your answering machine, or leave a message with an individual who answers the phone at your residence. We may contact you to remind you about appointments. If you choose to communicate with us via email or text message, you acknowledge that such communications may not be secure and may be subject to unauthorized access. You may request alternative methods of communication.

  • Individuals involved in your care. We may disclose PHI to individuals involved in your care or payment of your care. If you are deceased, we may disclose medical information about you to a friend or family member who was involved in your medical care prior to your death, limited to information relevant to that person’s involvement, unless doing so would be inconsistent with your written wishes that you previously provided to us. If we disclose information to a family member, relative, or close friend, we will disclose only information that we believe is relevant to that person’s involvement with your health care or payment related to your health care. 

HIPAA permits Elemental Health to disclose to other health providers any PHI contained in the medical record about an individual for treatment, case management, and coordination of care and, with few exceptions, treats mental health information the same as other health information. HIPAA generally does not limit these disclosures except that Elemental Health must obtain individuals’ authorization to disclose separately maintained psychotherapy session notes for such purposes. LifeStance will abide by all applicable state law or professional practice standards that place additional limitations on disclosures of PHI related to mental health.

  • Personal Representative. We will treat a legally authorized personal representative as you.

  • Minors. We may disclose PHI of minor children to parents or guardians unless prohibited by law.

  • Limited Data Set. We may use or disclose limited data sets for research, public health, or operations.

In the context of mental health treatment, we will apply heightened sensitivity and may limit disclosures consistent with applicable federal and Massachusetts law.

C. SPECIAL CIRCUMSTANCES

We may use or disclose your PHI without authorization in the following circumstances:

  • Required by law

  • Public health activities

  • Health oversight activities

  • Legal proceedings

  • Law enforcement

  • Abuse, neglect, or domestic violence

  • Decedents

  • Organ and tissue donation

  • Research (with appropriate safeguards)

  • Serious threats to health or safety

  • Military and national security

  • Workers’ compensation

We may disclose PHI when necessary to prevent or lessen a serious and imminent threat to your health or safety or that of another person, consistent with applicable law.

D. USE AND DISCLOSURE REQUIRING YOUR AUTHORIZATION

The following uses and disclosures of your PHI can be made only with your written authorization:

  • Marketing (with limited exceptions)

  • Sale of PHI: Uses and disclosures which are a sale of protected health information.

  • Psychotherapy notes (with limited exceptions)

  • Mental Health, HIV, and Substance Use Information. Certain uses and disclosures of mental health information, HIV information and substance use information, except as may be otherwise required or permitted by law.

In particular, special rules and/or authorizations apply to psychotherapy notes and records of substance use disorder treatment. For example, substance use disorder treatment records received from programs subject to 42 CFR Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in federal law.

Substance use disorder records are subject to additional federal protections under 42 CFR Part 2, which may be more restrictive than HIPAA. Massachusetts law provides additional protections for certain types of health information, including mental health records, HIV/AIDS information, genetic testing information, and certain reproductive health information. Where state law is more protective than federal law, we will follow state law

You may revoke your authorization in writing at any time. 

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

E. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights:

  • Confidential Communications – Request alternative communication methods

  • Request Restrictions – Including the right to restrict disclosures to insurers if paid out-of-pocket in full. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. Except as noted above, we are not required to agree to your request. However, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.

  • Inspection and Copies – You have the right to inspect and obtain an electronic or paper copy of your PHI. You must submit a request in writing to the Privacy Officer in order to inspect and/or obtain a copy of your PHI. We may charge a reasonable, cost-based fee for the costs of copying, mailing, labor, and/Or supplies associated with the request. We have up to 30 days to provide you with your PHI

  • Amendment – You have the right to ask us to amend your health information. Such right shall extend for as long as the information is kept by or for Elemental Health. You must submit your request in writing to the Privacy officer. We will deny your request if you fail to submit your request in writing.

  • Accounting of Disclosures – You have the right to request an “accounting of disclosures.” To do so, you must submit your request in writing to the Privacy Officer. All requests must state the time period for disclosures in writing, and the period may not extend beyond six (6) years.

  • Paper Copy of Notice

  • Authorization Rights - We will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization you provide us regarding the use and disclosure of your PHI may be revoked at any time, except to the extent we have already relied upon your authorization in making a disclosure. Requests to revoke your authorization must be made to the Privacy Officer in writing. Once an authorization is revoked, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note we are required to retain records of your care.

  • Breach Notification – You will be notified of unsecured breaches as required by law

  • Complaints – If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. To file a complaint with us, contact the Privacy Officer at the address above. All complaints must be submitted in writing and should be submitted within one hundred eighty (180) days of when you knew or should have known that the alleged violation occurred. See the Office for Civil Rights website, www.hhs.gov/ocr/hipaa, for more information.

You will not be penalized or retaliated against for filing a complaint.

F. EFFECTIVE DATE

This Notice was published and originally became effective on March 17, 2026. This Notice was last updated on March 17, 2026.  Please note that changes in law affecting your privacy rights may take effect at different times. Please speak with the Privacy Officer if you have any questions.

G. CONTACT

If you have a question, need more information, or wish to file a complaint, please contact the Privacy Officer at  (617) 858-0313 or in writing at the address below:
Elemental Health, PLLC
56 Broad St.
Suite 51014
Boston, MA 02109