HIPAA Notice of Privacy Practices

Effective Date: October 2025
Evergreen Mind & Medicine – Logan, Utah

This Notice describes how your medical information may be used and disclosed, and how you can access that information. Please review it carefully.

Your privacy and trust are very important to us. Evergreen Mind & Medicine is required by law to maintain the privacy of your protected health information (PHI) and to provide you with this Notice of our legal duties and privacy practices.

How We May Use and Share Your Health Information

We may use or share your health information in the following ways, as permitted by law:

For Treatment

We may use and share your information to provide, coordinate, or manage your healthcare. For example, we may consult with another healthcare provider, pharmacy, or laboratory involved in your care.

For Payment

We may use your information to obtain payment for services rendered — for example, to send billing information to your insurer or process cash-pay receipts.

For Healthcare Operations

We may use your information for practice management activities such as quality improvement, scheduling, or training to ensure efficient and effective care.

As Required by Law

We may disclose information when required by federal, state, or local law — for example, to report suspected abuse, neglect, or certain infectious diseases.

For Public Health and Safety

We may share information to help prevent or control disease, report adverse medication events, or protect against serious threats to health or safety.

For Health Oversight Activities

We may disclose information to health oversight agencies for audits, investigations, or compliance with regulations.

For Legal or Administrative Proceedings

We may disclose information in response to a court order or subpoena when legally obligated to do so.

With Your Authorization

For any other uses or disclosures not described in this Notice, we will obtain your written authorization before sharing your information. You may revoke that authorization at any time in writing.

Your Rights Regarding Your Health Information

You have the right to:

  • Access Your Records: Request to view or receive a copy of your medical record.

  • Request Corrections: Ask us to correct or amend health information you believe is inaccurate or incomplete.

  • Request Restrictions: Request limits on how we use or share your information (though we may not be able to agree in all cases).

  • Request Confidential Communications: Ask that we contact you in a specific way (e.g., only by email, or at a certain phone number).

  • Receive an Accounting of Disclosures: Request a list of when your health information was shared for reasons other than treatment, payment, or operations.

  • Receive a Paper Copy of This Notice: You may request a printed copy of this Notice at any time.

To exercise any of these rights, please submit a written request to our privacy officer (see contact information below).

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information (PHI).

  • We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this Notice.

  • We will not use or share your information other than as described here unless you give us written permission.

Changes to This Notice

We may update this Notice at any time to reflect changes in our practices or the law. Updates will be posted on our website with a revised effective date.
You are entitled to the most current version of this Notice at any time.

Questions or Complaints

If you have questions about this Notice or believe your privacy rights have been violated, you may contact:

Evergreen Mind & Medicine
Attn: Privacy Officer
hello@evergreenmindandmedicine.com

You may also file a complaint directly with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) at:
🔗 www.hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

Commitment to Your Privacy

At Evergreen Mind & Medicine, we treat your health information with the same care and respect we bring to every aspect of your treatment. Protecting your privacy is not just a legal responsibility — it’s a core part of our values.