This Notice describes how Behavior Momentum ("BXMO," "we," "us," or "our") may use and disclose your protected health information (PHI) to carry out treatment, payment, and health care operations, and about your rights to that information. PHI is information about you that can identify you and relates to your physical or mental health, the care you receive, or payment for that care. 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.
How We May Use and Disclose Your Health Information
The following categories describe ways we use and disclose PHI without your written authorization:
- For treatment. To provide, coordinate, or manage your care and related services. Example: sharing information with your service coordinator or other providers involved in your care.
- For payment. To bill and collect payment for the services we provide. Example: submitting claims to a regional center or funding source.
- For health care operations. For business and administrative activities, such as quality review, training, and care coordination.
- Appointment reminders & service communications. To remind you of appointments or service-related needs, including by phone, text, or email.
- As required by law. When a law requires us to disclose information.
- Public health & abuse/neglect reporting. To report suspected abuse, neglect, or domestic violence, as required or permitted by law (see our Notices & Disclosures page).
- Health oversight activities. To a health oversight agency for audits, investigations, inspections, and licensure.
- Judicial & administrative proceedings. In response to a court or administrative order, or a subpoena, discovery request, or other lawful process.
- Law enforcement. To a law enforcement official as required or permitted by law.
- Coroners, medical examiners & funeral directors. To identify a deceased person or determine cause of death.
- Workers' compensation. As authorized by law for work-related injury or illness claims.
- Family & caregivers. To a family member, friend, or caregiver involved in your care, when you do not object or in an emergency where it is in your best interest.
Uses Requiring Your Written Authorization
We will obtain your written authorization before using or disclosing your PHI for purposes other than those described above (except where permitted or required by law). Uses and disclosures of psychotherapy notes, and most uses and disclosures for marketing purposes and the sale of your PHI, require your authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.
Your Rights Regarding Your Health Information
- Right to inspect and copy. You may request to see and obtain a copy of your PHI in a designated record set.
- Right to amend. You may ask us to amend information you believe is incorrect or incomplete.
- Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your PHI.
- Right to request restrictions. You may ask us to limit what we use or disclose, though we are not required to agree to all requests (we will agree to restrict disclosure to a health plan for items you pay for out of pocket in full).
- Right to request confidential communications. You may ask us to communicate with you in a certain way or at a certain location.
- Right to a paper copy of this Notice. You may request a paper copy at any time.
- Right to be notified of a breach. You have the right to be notified if a breach of your unsecured PHI occurs.
To exercise any of these rights, contact us using the information at the bottom of this page. We may charge a reasonable, cost-based fee for the cost of copying and mailing.
Our Responsibilities
- Maintain the privacy and security of your PHI.
- Notify you following a breach of your unsecured PHI, as required by law.
- Provide you with this Notice and follow its terms.
- Reserve the right to change this Notice; the revised Notice will apply to PHI we already hold, and we will post the updated version on this page.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us and with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.
- File with HHS OCR: www.hhs.gov/ocr/privacy/hipaa/complaints or 1-877-696-6775
- File with us: Info@bx-mo.com · (661) 373-0284
Contact
For more information about this Notice or our privacy practices, contact us:
Email: Info@bx-mo.com
Phone: (661) 373-0284
This Notice is provided for informational purposes and is not legal advice. It is provided in accordance with 45 CFR §164.520.