Notice of Privacy Practices

Effective Date: September 5, 2026

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Privacy Matters

Sycamore Mental Health & Wellness, PLLC (“Sycamore,” “we,” “our,” “us,” or “the Practice”) is committed to protecting your privacy. This Notice of Privacy Practices explains how your protected health information (PHI) may be used and disclosed, your privacy rights, and our legal responsibilities under the Health Insurance Portability and Accountability Act (HIPAA).

Please read this notice carefully. If you have questions, we are happy to discuss them with you.

How We May Use and Disclose Your Health Information

HIPAA permits us to use and disclose PHI without your written authorization for treatment, payment, and healthcare operations. We may use or disclose your health information without your written authorization for the following purposes:

Treatment

We may use your health information to provide psychiatric evaluation, diagnosis, medication management, treatment planning, and supportive therapeutic interventions.

When appropriate, we may communicate with:

  • Your pharmacy

  • Other healthcare providers involved in your care

  • Hospitals or emergency departments

  • Laboratories or diagnostic facilities

We generally will obtain your written authorization before sharing information with other providers for purposes beyond treatment, payment, or healthcare operations, unless disclosure is otherwise permitted or required by law.

Payment

We may use or disclose your health information to:

  • Submit claims to your insurance company

  • Verify insurance eligibility

  • Obtain prior authorization

  • Collect payment for services

  • Provide billing information related to your care

Healthcare Operations

We may use your information to:

  • Improve the quality of care we provide

  • Maintain accurate medical records

  • Manage appointments

  • Conduct internal quality improvement activities

  • Meet legal and regulatory requirements

  • Train staff or contractors who support our operations, when permitted by law and subject to appropriate confidentiality obligations

Uses Requiring Your Written Authorization

Except as otherwise permitted or required by law, we will obtain your written authorization before:

  • Sharing information with family members or friends who are not involved in your care

  • Releasing records to schools, employers, attorneys, or other third parties

  • Using or disclosing psychotherapy notes, if applicable

  • Using your information for marketing purposes where authorization is required

  • Selling your protected health information

You may revoke an authorization at any time in writing, except to the extent action has already been taken in reliance on your authorization.

Fundraising

Sycamore Mental Health & Wellness, PLLC does not use protected health information for fundraising communications.

Situations Where We May Be Required or Permitted to Share Information

Federal or state law may require or permit us to disclose health information without your authorization in certain circumstances, including:

  • Medical emergencies

  • To prevent or lessen a serious threat to your health or safety or the health or safety of another person

  • Suspected child abuse or neglect

  • Suspected abuse, neglect, or exploitation of a vulnerable or protected adult, when required by law

  • Certain public health activities

  • Court orders or other lawful legal processes

  • Law enforcement requests, when permitted by law

  • Workers' compensation claims

  • Health oversight activities

Telehealth Privacy

Telehealth appointments are conducted using secure technology designed to protect your privacy. We use reasonable administrative, technical, and physical safeguards; however, no electronic communication system can guarantee complete security. Patients should participate from a private location when possible, protect access to their devices and patient portal, and notify Sycamore if their contact preferences or location change.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose PHI without your authorization in the circumstances below when the applicable legal requirements are met. When the minimum-necessary rule applies, we will make reasonable efforts to limit the PHI used or disclosed to what is reasonably necessary for the purpose.

  • Public health and safety. To prevent or control disease; assist with product recalls; report adverse reactions to medications; report suspected abuse, neglect, or domestic violence; or prevent or lessen a serious and imminent threat to a person's health or safety.

  • Required by law and HHS oversight. When federal, state, or local law requires disclosure, including disclosure to the U.S. Department of Health and Human Services when it requests information to determine our compliance with federal privacy law.

  • Health oversight. For audits, investigations, inspections, licensure activities, and other legally authorized oversight of the healthcare system or government programs.

  • Judicial and administrative proceedings. In response to a court or administrative order, subpoena, discovery request, or other lawful process, subject to applicable legal protections.

  • Law enforcement. For law-enforcement purposes when permitted or required by law, including certain requests concerning a victim, suspect, missing person, crime, or death.

  • Workers' compensation. As authorized by workers' compensation laws or similar programs.

  • Specialized government functions. For military and veterans' activities, national-security and intelligence activities, protective services, and other specialized government functions authorized by law.

  • Organ and tissue donation. With organ-procurement organizations or other entities involved in donation and transplantation.

  • Coroners, medical examiners, and funeral directors. To assist them in carrying out legally authorized duties after an individual's death.

  • Research. For research approved or permitted under applicable privacy requirements, including when an institutional review board or privacy board has approved a waiver of authorization.

  • Correctional institutions and custodial situations. If you are an inmate or under lawful custody, to a correctional institution or law-enforcement official when permitted by law for healthcare, safety, security, or administration.

  • Business associates. To vendors and professionals who perform services for Sycamore, such as electronic health record, billing, technology, legal, accounting, or administrative services. We require appropriate privacy and security safeguards through written agreements when required by law.

Substance Use Disorder Records Protected by 42 C.F.R. Part 2

The following provisions apply only to the extent Sycamore maintains or receives substance use disorder patient records protected by 42 C.F.R. Part 2 ("Part 2 records"). Part 2 records receive additional federal confidentiality protections.

  • A valid patient consent may permit uses and disclosures of Part 2 records for treatment, payment, and healthcare operations. A HIPAA covered entity or business associate that receives Part 2 records pursuant to such consent may redisclose the records as permitted by HIPAA, subject to Part 2's additional restrictions.

  • SUD counseling notes that a clinician voluntarily maintains separately from the rest of the treatment and medical record require a separate written consent, as required by Part 2.

  • Each disclosure made with patient consent will include a copy of the consent or a clear explanation of its scope when required by Part 2.

  • Part 2 records, or testimony describing their contents, will not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you unless authorized by your written consent or by a Part 2-compliant court order accompanied by a subpoena or other legal requirement compelling disclosure.

  • You may revoke a consent as permitted by law by contacting Sycamore in writing. Revocation will not affect actions already taken in reliance on the consent.

  • Sycamore does not use Part 2 information for fundraising communications.

Your Privacy Rights

You have the right to:

Request Access

You may ask to see or obtain an electronic or paper copy of your medical record and other health information maintained by Sycamore Mental Health & Wellness, PLLC. We will generally provide a copy or summary within 30 days of receiving your request. We may charge a reasonable, cost-based fee as permitted by law.

Request Corrections

If you believe information in your record is inaccurate or incomplete, you may request an amendment. We may deny your request in certain circumstances, but we will explain the reason in writing, generally within 60 days.

Request Restrictions

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations. We are not required to agree to most requests. If we agree, we may still use or disclose the information when needed for emergency treatment or as otherwise required by law. If you pay for a service completely out of pocket and ask us not to disclose information about that service to your health plan for payment or healthcare operations, we will honor the request unless disclosure is required by law. You may ask us to limit disclosures to family members, friends, or others involved in your care or payment for your care.

Request Confidential Communications

You may ask us to contact you in a specific way, such as by phone, email, or patient portal, or to send mail to a different address. We will accommodate reasonable requests.

Receive an Accounting of Disclosures

You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.

Receive a Paper or Electronic Copy

You have the right to receive a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

Choose Someone to Act for You

If a person has legal authority to act as your personal representative, such as a legal guardian or someone holding an appropriate healthcare power of attorney, that person may exercise your privacy rights. We will verify the person’s authority before taking action.

File a Complaint

You may complain to Sycamore if you believe your privacy rights have been violated by contacting the Privacy Officer listed at the end of this Notice. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201; calling 1-877-696-6775; or visiting www.hhs.gov/hipaa/filing-a-complaint. Sycamore will not retaliate against you for filing a complaint.

Our Responsibilities and Commitment to You

We are required by law to:

  • Maintain the privacy and security of your protected health information.

  • Provide you with this Notice of Privacy Practices.

  • Follow the privacy practices described in this notice.

  • Notify you if a breach occurs that may have compromised the privacy or security of your information, as required by law.

Sycamore Mental Health & Wellness reserves the right to update this Notice of Privacy Practices.

Any revised notice will apply to all protected health information maintained by the practice. The current Notice will be available upon request and posted at www.sycamoremh.com/notice-of-privacy-practices.

Questions or Concerns

If you have questions about this Notice or believe your privacy rights have been violated, please contact Sycamore Mental Health & Wellness, PLLC.

Privacy Officer: Julie Harris
Sycamore Mental Health & Wellness, PLLC
P.O. Box 602
Mabelvale, AR 72103
Phone: 501-604-6355
Email: info@sycamoremh.com

You may file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by writing to 200 Independence Avenue SW, Washington, DC 20201; calling 1-877-696-6775; or visiting www.hhs.gov/hipaa/filing-a-complaint. Filing a complaint will not affect your care or result in retaliation.

Thank you for trusting Sycamore Mental Health & Wellness, PLLC with your care.

We are committed to protecting your privacy while providing compassionate, evidence-based psychiatric treatment.