EleVolve PLLC
Notice of Privacy Practices
Effective Date: 8/18/25
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.
Our Legal Duties
We are required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice of Privacy Practices, and to notify you in the event of a breach of unsecured PHI. We are also required to abide by the terms of this Notice as currently in effect.
PHI is individually identifiable health information, including demographic information, that relates to your past, present, or future physical or mental health or condition and related healthcare services.
How We May Use and Disclose Health Information Without Your Authorization
The following categories describe different ways that we may use and disclose PHI without your prior written authorization. Examples are provided for clarity but do not include every possible use or disclosure.
1. Treatment
We may use and disclose PHI to provide, coordinate, or manage your healthcare and related services. For example, we may disclose information to another provider involved in your care, such as a psychiatrist, physician, or another therapist.
2. Payment
We may use and disclose PHI to obtain reimbursement for services. For example, your information may be shared with your insurance company for purposes of prior authorization or claims processing.
3. Healthcare Operations
We may use and disclose PHI for operations necessary to run our practice, ensure quality of care, and comply with legal obligations. Examples include supervision of clinicians, licensing activities, training, and quality assessment.
Other Uses and Disclosures Permitted by Law
We may also use or disclose your PHI in the following situations:
As Required by Law: When required by federal, state, or local law.
Public Health: To public health authorities to prevent or control disease, injury, or disability.
Communicable Diseases: To notify individuals at risk of contracting or spreading disease, as authorized by law.
Abuse, Neglect, or Domestic Violence: To appropriate authorities when required to report suspected child abuse, elder abuse, or domestic violence.
Health Oversight: To oversight agencies for activities such as audits, investigations, or inspections.
Legal Proceedings: In response to a court order, subpoena, or other lawful process.
Law Enforcement: For law enforcement purposes as required by law.
Coroners, Medical Examiners, Funeral Directors: To assist with identification, cause of death, or other authorized duties.
Organ and Tissue Donation: To organizations engaged in procurement or transplantation.
Research: Under certain conditions, if approved by an Institutional Review Board with privacy safeguards.
Serious Threats to Health or Safety: To prevent or lessen a serious and imminent threat to you or others.
Specialized Government Functions: For military, national security, protective services, or correctional institutions when legally permitted.
Workers’ Compensation: To comply with workers’ compensation and similar laws.
Uses and Disclosures Requiring Your Written Authorization
Certain uses of your PHI require your prior written authorization, including:
Most uses and disclosures of psychotherapy notes.
Uses and disclosures of PHI for marketing purposes.
Disclosures that constitute a sale of PHI.
Any other uses and disclosures not described in this Notice.
You may revoke an authorization at any time in writing, except to the extent that action has already been taken in reliance on it.
Special Protections: Reproductive Health Information
In accordance with the HHS Final Rule (effective December 23, 2024), we will not disclose PHI relating to reproductive healthcare for purposes of investigations or proceedings that could penalize an individual for seeking, obtaining, providing, or facilitating reproductive health services. Any request for such PHI must include a signed attestation that it is not for a prohibited purpose.
Your Rights Regarding Your PHI
You have the following rights, subject to certain limitations:
Right to Inspect and Copy: You may inspect and obtain a copy of your PHI maintained in a designated record set. Exceptions include psychotherapy notes and certain legal proceedings.
Right to Request Amendment: You may request an amendment of your PHI if you believe it is inaccurate or incomplete.
Right to Request Restrictions: You may request restrictions on the use or disclosure of PHI for treatment, payment, or operations. We are not required to agree, except you may restrict disclosures to your health plan when you pay in full out of pocket.
Right to Confidential Communications: You may request that we communicate with you in a certain way or at a certain location (e.g., by phone only, or at your work address). We will accommodate reasonable requests.
Right to an Accounting of Disclosures: You may request a list of certain disclosures of your PHI made by us in the past six years, excluding disclosures for treatment, payment, operations, and certain other exceptions.
Right to a Paper Copy: You may request a paper copy of this Notice, even if you previously agreed to receive it electronically.
Right to Breach Notification: You have the right to be notified in the event of a breach of your unsecured PHI.
Right to File a Complaint: You may file a complaint with us or with the U.S. Department of Health and Human Services (HHS) if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.
Safeguards and Security
We maintain administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of your PHI, including encryption and access controls, in compliance with the HIPAA Security Rule.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at:
Privacy Officer
EleVolve PLLC
1200 High Ridge Road, Suite #208
Stamford, CT 06902
Phone: 203-212-8910
Email: info@elevolve.co
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights (OCR):
Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Phone: 1-800-368-1019
We will not retaliate against you for filing a complaint.
Changes to This Notice
We reserve the right to change the terms of this Notice at any time. Any new Notice will apply to all PHI maintained at that time and will be available upon request and on our website. The effective date of this Notice is listed at the top of the first page.