Effective Date: March 2026 • Sage and Sol Therapy LLC
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Sage and Sol Therapy LLC is committed to protecting the privacy of your protected health information (PHI). We are required by the Health Insurance Portability and Accountability Act (HIPAA) to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices.
We may use and disclose your PHI to provide, coordinate, or manage your mental health treatment and related services. For example, we may share information with other healthcare providers involved in your care, with your written authorization.
We may use and disclose your PHI to obtain payment for services rendered. This may include submitting claims to insurance companies or other payers.
We may use and disclose your PHI for our internal operations, including quality assessment, training, and administrative purposes necessary to run our practice.
We will obtain your written authorization before using or disclosing your PHI for purposes other than those described above, including:
You may revoke your authorization at any time in writing, except to the extent that we have already taken action in reliance on it.
We may disclose your PHI without your authorization in the following circumstances:
You have the right to inspect and obtain a copy of your PHI maintained in our records, with limited exceptions. Requests must be made in writing.
You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. We may deny your request under certain circumstances.
You have the right to request a list of certain disclosures we have made of your PHI in the past six years.
You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to your request in all cases.
You have the right to request that we communicate with you about your health matters in a certain way or at a certain location.
You have the right to obtain a paper copy of this notice at any time, even if you have agreed to receive it electronically.
We reserve the right to change this notice and to make the revised notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our website and make it available upon request.
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be retaliated against for filing a complaint.
For questions about this notice or to exercise your rights, please contact: