NOTICE OF PRIVACY PRACTICES
Effective Date: August 20, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Root & Rise Brain Health is committed to protecting the privacy and security of your protected health information ("PHI"). This Notice describes how Root & Rise Brain Health may use and disclose your health information, your rights regarding that information, and the legal responsibilities of Root & Rise Brain Health under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and other applicable federal and state privacy laws.
This Notice applies to adult patients receiving psychiatric care through Root & Rise Brain Health in California and Arizona, as applicable.
YOUR RIGHTS
You have the right to:
Obtain a Copy of Your Health Record
You may request an electronic or paper copy of your medical record and other health information maintained about you.
Root & Rise Brain Health will provide access within the time required by applicable federal and state law and may charge a reasonable, legally permitted cost-based fee.
Ask Root & Rise Brain Health to Amend Your Health Record
You may request an amendment to health information that you believe is incorrect or incomplete.
Root & Rise Brain Health will review the request and may deny it when permitted by law, including when the information is believed to be accurate and complete.
If a request is denied, you will be informed of the denial and any applicable rights to submit a written statement of disagreement.
A request for amendment does not require Root & Rise Brain Health to alter accurate clinical documentation or change a provider's professional assessment, diagnosis, clinical judgment, or treatment recommendation solely because a patient disagrees with it.
When a correction is appropriate, it will be made in accordance with applicable law and recordkeeping standards, typically through an amendment, correction, or addendum that preserves the integrity of the original medical record.
Request Confidential Communications
You may ask Root & Rise Brain Health to contact you in a specific way or at a specific location.
Reasonable requests will be accommodated as required by law.
Ask Root & Rise Brain Health to Limit Certain Uses or Disclosures
You may request restrictions on certain uses or disclosures of your health information.
Root & Rise Brain Health is not required to agree to every requested restriction.
However, when you pay in full out of pocket for a specific health care service and ask that information about that service not be disclosed to your health plan for payment or health care operations, Root & Rise Brain Health will honor the request when required by law.
Obtain an Accounting of Disclosures
You may request a list of certain disclosures of your health information made during the period permitted by law.
The accounting generally does not include disclosures made for treatment, payment, health care operations, or disclosures made pursuant to your written authorization.
Obtain a Copy of This Notice
You may request a paper or electronic copy of this Notice at any time, even if you previously agreed to receive it electronically.
Choose Someone to Act for You
If you have given someone medical power of attorney or another person is legally authorized to act on your behalf, that individual may exercise your privacy rights as permitted by law.
Root & Rise Brain Health may verify that the individual has legal authority to act for you before releasing information or acting on a request.
File a Privacy Complaint
You may file a complaint with Root & Rise Brain Health if you believe your privacy rights have been violated.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
Root & Rise Brain Health will not retaliate against you for filing a complaint.
YOUR CHOICES
For certain health information, you may tell Root & Rise Brain Health your preferences regarding what may be shared.
When appropriate and permitted by law, you may indicate whether Root & Rise Brain Health may:
Share information with family members, friends, or others involved in your care.
Share information in a disaster-relief situation.
Contact you regarding certain health-related services.
If you are unable to communicate your preference, such as during an emergency, Root & Rise Brain Health may share information when doing so is reasonably believed to be in your best interest and is permitted by law.
Root & Rise Brain Health will obtain your written authorization before using or disclosing your PHI for purposes that require authorization under federal or applicable state law.
Root & Rise Brain Health does not sell protected health information.
HOW ROOT & RISE BRAIN HEALTH MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Treatment
Root & Rise Brain Health may use and disclose your health information to provide, coordinate, and manage your care.
For example, information may be shared with another physician, therapist, pharmacist, laboratory, hospital, or other health care professional involved in your treatment when permitted by law.
Payment
Root & Rise Brain Health may use and disclose health information to obtain payment for services, determine coverage, coordinate benefits, or communicate with an insurance company or authorized billing platform.
Health Care Operations
Root & Rise Brain Health may use and disclose health information for activities necessary to operate the practice, including quality improvement, compliance, credentialing, auditing, administrative functions, and practice management.
Business Associates
Root & Rise Brain Health may share PHI with vendors and service providers that perform functions on behalf of the practice when permitted by HIPAA.
When required, these organizations enter into agreements requiring them to appropriately safeguard PHI.
Appointment Reminders and Health-Related Communications
Root & Rise Brain Health may use your contact information to provide appointment reminders and other communications related to your care.
As Required by Law
Root & Rise Brain Health may use or disclose your health information when required or permitted by federal, state, or local law.
To Prevent or Reduce a Serious Threat to Health or Safety
When permitted or required by law, Root & Rise Brain Health may disclose information necessary to prevent or reduce a serious and imminent threat to your health or safety or the health or safety of another person.
Abuse, Neglect, or Other Mandatory Reporting
Root & Rise Brain Health may disclose health information when required by applicable mandatory-reporting laws.
Health Oversight Activities
Root & Rise Brain Health may disclose information to authorized health oversight agencies for activities such as audits, investigations, inspections, licensure matters, or other activities authorized by law.
Judicial, Administrative, and Law-Enforcement Matters
Root & Rise Brain Health may disclose PHI in response to a valid court order, subpoena, administrative process, or other lawful request when permitted or required by applicable law.
Workers' Compensation and Similar Programs
Root & Rise Brain Health may disclose health information as permitted or required for workers' compensation or similar programs established by law.
Coroners, Medical Examiners, and Certain Government Functions
Root & Rise Brain Health may make disclosures when permitted or required by law for these purposes.
MENTAL HEALTH INFORMATION
Because Root & Rise Brain Health provides psychiatric care, your records may contain particularly sensitive mental health information.
Federal and state laws may provide protections for mental health information that are more restrictive than HIPAA.
Root & Rise Brain Health will comply with applicable California or Arizona privacy law when those laws provide greater protection than HIPAA.
Specially protected mental health information will not be disclosed without authorization unless the disclosure is otherwise permitted or required by applicable law.
PSYCHOTHERAPY DOCUMENTATION
Root & Rise Brain Health may provide brief psychotherapy as part of psychiatric medication-management visits.
Documentation of brief psychotherapy, including relevant interventions, patient response, treatment progress, and other clinically appropriate information, may be included in the same clinical progress note as the medication-management service and is part of the patient's medical record.
Root & Rise Brain Health does not routinely create or maintain separate psychotherapy notes as that term is specifically defined under HIPAA.
If separate psychotherapy notes are ever created and maintained apart from the regular medical record, those notes will receive the additional privacy protections required by applicable law.
SUBSTANCE USE DISORDER RECORDS
Certain records relating to substance use disorder diagnosis, treatment, or referral may receive additional protection under federal law, including 42 CFR Part 2, when those protections apply.
Root & Rise Brain Health will use or disclose information protected by Part 2 only as permitted by applicable federal law.
Certain uses and disclosures may require your written consent.
When applicable, records protected by Part 2 may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you except as specifically permitted by federal law or pursuant to an appropriate court order when required.
TELEHEALTH AND ELECTRONIC COMMUNICATIONS
Root & Rise Brain Health provides telehealth services.
The privacy and confidentiality protections applicable to health care also apply to telehealth, subject to applicable law.
Telehealth services are provided in accordance with the laws and professional requirements applicable to the state in which the patient is physically located at the time of the encounter.
Electronic communications and patient information may be processed through secure technology vendors, electronic health record systems, patient portals, telehealth platforms, pharmacies, laboratories, billing platforms, and other services necessary for your care.
Root & Rise Brain Health uses reasonable administrative, physical, and technical safeguards to protect patient information. However, no electronic communication system can be guaranteed to be completely secure.
RESPONSIBILITIES OF ROOT & RISE BRAIN HEALTH
Root & Rise Brain Health is required to:
Maintain the privacy and security of your protected health information.
Provide you with this Notice describing legal duties and privacy practices.
Follow the privacy practices described in the Notice currently in effect.
Notify you following a breach of unsecured PHI when notification is required by law.
Comply with applicable federal and state privacy laws, including laws that provide greater privacy protections than HIPAA.
Root & Rise Brain Health will not use or disclose your information in a manner not described in this Notice unless you provide written authorization or the use or disclosure is otherwise permitted or required by law.
If you provide written authorization, you may revoke it in writing at any time, except to the extent that action has already been taken in reliance on the authorization.
CHANGES TO THIS NOTICE
Root & Rise Brain Health may revise this Notice.
A revised Notice may apply to information already maintained by Root & Rise Brain Health as well as information received in the future.
The current Notice will be available upon request and will be made available electronically and on the Root & Rise Brain Health website as required by law.
PRIVACY CONTACT
If you have questions about this Notice, wish to exercise your privacy rights, or wish to submit a privacy complaint, please contact:
Root & Rise Brain Health
Privacy Officer: Jill Mobley, PMHNP-BC
Phone: (480) 256-2867
Email: jill@rootandrisebrainhealth.com
Website: rootandrisebrainhealth.com
You may also file a privacy complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
Root & Rise Brain Health will not retaliate against you for exercising your privacy rights or filing a complaint.