MindFlow Mental Health, LLC
Phone: (458) 488-1000
Fax: (458) 488-1010
This notice went into effect on 11/01/2024
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NOTICE OF PRIVACY PRACTICES
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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION:
MindFlow Mental Health (MMH) understands that health information about you and your health care is
personal. We are committed to protecting health information about you. MindFLow Mental Health creates
a record of the care and services you receive from us. This record is needed to provide you with quality
care and to comply with certain legal requirements. This notice applies to all of the records of your care
generated by MindFlow Mental Health. This notice will tell you about the ways in which MMH may use
and disclose health information about you. It also describes your rights to the health information kept
about you and describes certain obligations MMH has regarding the use and disclosure of your health
information. MindFlow Mental Health is required by law to:
Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of our legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.
The terms of this Notice can be changed, and such changes will apply to all information we have about
you. The new Notice will be available upon request, in the office, and on the website.
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II. Special Considerations for YOUTH CONSENT: In Oregon, youth are able to make decisions about
their mental health in an outpatient setting without parental consent starting at 14-years-old (ORS
109.675). While youth can access mental health services without parental consent, in most cases
providers have to attempt to engage the youth's adult(s) before the end of treatment, if it is determined
that it is in the best interest of the child. MindFlow Mental Health will encourage all patients age 14-17 to
sign a release of information form for parents to allow information exchange, unless determined to not be
in the best interest of the child. Patients aged 18 or older who have parents involved in their care, a release
of information is required.
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III. HOW MINDFLOW MENTAL HEALTH MAY USE AND DISCLOSE HEALTH
INFORMATION ABOUT YOU: The following categories describe different ways that MMH use and
disclose health information. For each category of uses or disclosures we will explain what this means and
try to give some examples. Not every use or disclosure in a category will be listed. However, all of the
ways MMH is permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care
providers who have direct treatment relationship with the patient/client to use or disclose the
patient/client’s personal health information without the patient’s written authorization, to carry out the
health care provider’s own treatment, payment or health care operations. We may also disclose your
protected health information for the treatment activities of any health care provider. This too can be done
without your written authorization. For example, if a clinician were to consult with another licensed
health care provider about your condition, we would be permitted to use and disclose your personal health
information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of
your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists
and other health care providers need access to the full record and/or full and complete information in
order to provide quality care. The word “treatment” includes, among other things, the coordination and
management of health care providers with a third party, consultations between health care providers and
referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, MMH may disclose health information in
response to a court or administrative order. We may also disclose health information about your child in
response to a subpoena, discovery request, or other lawful process by someone else involved in the
dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting
the information requested.
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IV. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes. Some but not all mental health providers at MindFlow Mental Health keep
“psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such
notes requires your authorization unless the use or disclosure is:
a. For use in treating you.
b. For use in training or supervising mental health practitioners to help them improve their skills in
group, joint, family, or individual counseling or therapy.
c. For use in defending MindFlow Mental Health or one of its employees, contractors, or other
individual engaged by MMH, in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the
psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.
Marketing Purposes. As a provider of mental health care, MindFlow Mental Health will not use or
disclose your PHI for marketing purposes.

Sale of PHI. As a provider of mental health care, MindFlow Mental Health will not sell your PHI in the
regular course of business.
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V. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.
Subject to certain limitations in the law, MMH can use and disclose your PHI without your Authorization
for the following reasons:
When disclosure is required by state or federal law, and the use or disclosure complies with and is limited
to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or
preventing or reducing a serious threat to anyone’s health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order.
For law enforcement purposes, including reporting crimes occurring on my premises.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one
form of therapy versus those who received another form of therapy for the same condition.
Specialized government functions, including, ensuring the proper execution of military missions;
protecting the President of the United States; conducting intelligence or counter-intelligence operations;
or, helping to ensure the safety of those working within or housed in correctional institutions.
For workers’ compensation purposes. MindFlow Mental Health may provide your PHI in order to comply
with workers’ compensation laws.
10 Appointment reminders and health related benefits or services. MMH may use and disclose your
PHI to contact you to remind you that you have an appointment with me. We may also use and disclose
your PHI to tell you about treatment alternatives, or other health care services or benefits offered.
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VI. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO
OBJECT.
Disclosures to family, friends, or others. MMH may provide your PHI to a family member, friend, or
other person that you indicate is involved in your care or the payment for your health care, unless you
object in whole or in part. The opportunity to consent may be obtained retroactively in emergency
situations.
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VII. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask MindFlow
Mental Health not to use or disclose certain PHI for treatment, payment, or health care operations
purposes. MMH is not required to agree to your request, and may say “no” if believed that it would affect
your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to
request restrictions on disclosures of your PHI to health plans for payment or health care operations
purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-
of-pocket in full.
The Right to Choose How MindFlow Mental Health Sends PHI to You. You have the right to ask MMH
to contact you in a specific way (for example, home or office phone) or to send mail to a different
address, and we will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to
get an electronic or paper copy of your medical record and other information that we have about you.
MMH will provide you with a copy of your record, or a summary of it, if you agree to receive a summary,
within 30 days of receiving your written request, and may charge a reasonable, cost-based fee for doing
so.
The Right to Get a List of the Disclosures MindFlow Mental Health Has Made. You have the right to
request a list of instances in which MMH has disclosed your PHI for purposes other than treatment,
payment, or health care operations, or for which you provided me with an authorization. We will respond
to your request for an accounting of disclosures within 60 days of receiving your request. The list you will
be given will include disclosures made in the last six years unless you request a shorter time. MMH will
provide the list to you at no charge, but if you make more than one request in the same year, you will be
charged a reasonable cost-based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a
piece of important information is missing from your PHI, you have the right to request the existing
information be corrected or add the missing information. We may say “no” to your request, but we will
tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this
notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to
receive this notice via e-mail, you also have the right to request a paper copy of it.
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Acknowledgement of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights
regarding the use and disclosure of your protected health information. By checking the box below, you are
acknowledging that you have been offered or received access to a copy of HIPAA Notice of Privacy
Practices. NOTE: you can ask for a copy of this at any time.