Privacy Practices

This notice describes how information about you may be used and disclosed and how you can receive access to this information. In this notice, your health information means your mental health or substance use disorder patient record. Please review it carefully.

Introduction

At Professional Services Group (PSG) we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective as of January 16, 2026, and applies to all protected health information as defined by federal regulations.

Each time you have contact with PSG, a record of your visit is made. Typically, this record contains your symptoms, diagnoses, treatment notes, and a plan for future care or treatment. Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Substance Use Disorder Records (42 CFR Part 2)

Some of your health information is protected by a federal law called 42 CFR Part 2. This law applies to records related to substance use disorder diagnosis, treatment, or referral for treatment and provides privacy protections that are more stringent than HIPAA.

In general, we may not use or disclose Part 2-protected records without your written consent unless permitted or required by law. When disclosure is permitted, it is limited and subject to additional safeguards.

Your Rights:

You have the right to:

• Consent to most uses and disclosures of your protected health information (PHI).
  • You may provide a single consent for all future uses or disclosures for treatment, payment, and health care operations purposes.
  • Additional uses and disclosures of your PHI will only be made with your written authorization. You have the right to revoke your authorization at any time.
• Ask us to correct your medical record.
  • You can ask us to correct health information about you that you think is incorrect or incomplete. As us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.
• Ask us to limit the information we share.
  • You can ask us not to use or share certain health information for treatment, payment, or our health care operations after you have provided consent for all those purposes. We are not required to agree to your request, and we may say “no” if, for example, it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our health care operations with your health insurer. We will say “yes” unless a law requires us to share that information.
• Request confidential communication.
  • You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.
• Get a copy of this privacy notice.
  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
• Discuss this notice with someone in our program.
  • You can ask questions or obtain more information about this notice and our privacy practices by calling or emailing the contact person at the top of this notice.
• Get a list of those with whom we’ve shared information.
  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
• Get a list of health care providers who have received your information through certain third parties.
• File a complaint if you believe your privacy rights have been violated.
  • You can complain if you feel we have violated your rights by contacting us.
  • You can file a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
  • We will not retaliate against you for filing a complaint.
• Choose someone to act for you.
  • If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
• Inspect and receive a copy of your medical record.
  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Your Rights Regarding Part 2 Records

In addition to your rights under HIPAA, you have the right to:

• Decide whether to give consent for most uses and disclosures of Part 2-protected records.
• Revoke your consent at any time, except to the extent we have already relied on it.
• Receive an accounting of disclosures when required by law.

Your Choices:

With your consent, we can use and share your information as we:

• Treat you
  • We can use your health information and share it with other professionals who are treating you.
  • We may use or disclose Part-2 protected records for treatment, payment, and health care operations only with your written consent, except where otherwise permitted by law.
  • Example: A doctor treating you for a chronic condition asks a doctor at our program about your mental health condition and medications you are taking, to avoid complications.
• Run our organization
  • We can use and share your health information to run our program, improve your care, and contact you when necessary
• Bill for our services
  • We can use and share your health information to bill and get payment from health plans or other entities
• Fulfill your requests to share information with your consent
• Prevent multiple program enrollments
• Report about court-ordered treatment
• Report to prescription drug monitoring programs

Our Uses and Disclosures:

We are allowed or required to share your information in certain ways without your consent – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. We may use and share your information without your consent as we:

• Communicate within our program and with our contractors
  • We can share your information within our program, with an organization that has administrative control over our program, and with contractors who help us run our program.
• Help with medical emergencies
  • We can share your information during a bona fide medical emergency with the personnel and health care providers responding to your emergency, even when you are unable to consent because of the emergency.
  • We can also share your identifying information to assist the federal Food and Drug Administration in notifying you or your doctor about unsafe products you may be using.
• Help with public health
  • We can share health information that does not identify you for certain situations such as preventing disease and reporting adverse reactions to medications.
• Report crimes (and threats of crimes) on our premises and suspected child abuse and neglect
  • We will only report the information required by law regarding child abuse and neglect. We may report to law enforcement when a patient commits or threatens to commit a crime within our program or against our staff.
• Aid scientific research
  • We can use or share your information to conduct or help with health research. Researchers cannot include any patient identifying information in their reports about the research.
• Respond to audits and evaluations of our program
  • We can use or share your information to improve the quality of our services, obtain needed credentials, and cooperate with oversight agencies for activities authorized by law, as long as those who view or receive the information agree to destroy or return the information when they are finished and agree not to use it against you.
• Assist cause of death inquiries
• Respond to court orders

In these circumstances, we must protect your information and limit how we use and share it.

Redisclosure According to HIPAA

When you consent to uses and disclosures for all future treatment and payment purposes and to run our business, we may share your information with other substance use disorder treatment programs, doctors’ offices, and health care businesses for those activities. If the person who receives it is subject to HIPAA, then they are allowed to use and share your information again without your consent for the purposes that HIPAA allows. Your information still cannot be used in legal proceedings against you unless (1) you consent or (2) based on a Part 2 court order and a subpoena (or similar legal requirement).

Prohibition on Redisclosure

Federal law restricts recipients of Part 2-protected information from redisclosing that information unless permitted by 42 CFR Part 2. Once disclosed with your consent, some recipients may be permitted to use and redisclose the information in accordance with HIPAA; however, part 2 restrictions on legal proceedings continue to apply.

Legal Proceedings and Court Orders

We must follow certain procedures before using or sharing your information for investigations and legal proceedings.

• We will not use or share your information or provide testimony about your information in any civil, administrative, criminal, or legislative proceedings against you without your written consent or a court order.
• We will only respond to a court order to use or share your health information if it is accompanied by a subpoena or other similar legal mandate requiring us to comply.
• We will only use or share your information in proceedings against you based on a court order after we have received notice and an opportunity to be heard or you tell us that you have received notice.
• We may use or share your information to respond to legal proceedings against our program based on a court order and you may not be notified in advance. You have the right to seek to overturn or change the court order after you learn about it.
• Records protected by 42 CFR Part 2, and any testimony relaying the content of such records, may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order that meets federal requirements.

Our Responsibilities

• We are required to obtain your consent for most uses and sharing of your information.
• We are required by law to maintain the privacy and security of your information.
• We must let you know 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 and give you a copy of it.
• We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We are required to follow the terms of this notice that are currently in effect.  We can change the terms of this notice, and the changes will apply to all information we have about you.  The new notice will be available upon request in our office and on our web site.

For More Information or to Report a Problem

If you have questions or would like additional information, you may contact PSG’s Privacy Officer, Leah Featherstone, Psy.D. at (262) 652-2406.

If you believe your rights have been violated, you can file a complaint with the practice’s Grievance Specialist, Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Grievance Specialist, Privacy Officer or the Office for Civil Rights.

Office for Civil Rights

U.S. Department of Health and Human Services 200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C. 20201