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HIPAA Privacy Policy Disclosure

Your Information. Your Rights. Our Responsibility.





Please read through this document carefully.


Please contact Megan Buckland, Privacy Officer, at for further questions and concerns.

This section will discuss and disclose how your medical information about you and your child may be used and disclosed and how you can get access to this information.

Your Rights.

  • You have the right to get a copy of the health and claims records that we have about your child. Please ask your therapist how you can access this information.

  • We can usually provide you with a copy within 30 days.

  • You have the right to ask Lively Therapy Services, LLC to correct health and claims records if you feel they are incorrect or incomplete. However, we may say "NO" to this request and, if so, we will provide you with a written notice within 60 days.

  • You can ask Lively Therapy Services, LLC to contact you in a specific way (for example home or office phone) or send mail to a different address.

  • We will consider all reasonable requests and must say "YES" if you or your child are in danger if we do not.

  • You can ask us not to use or share certain health information for treatment, payment or our operations.

  • We at Lively Therapy Services, LLC are not required to say "YES" and we may say "NO" if it would affect your care while at Lively Therapy Services, LLC.

  • We can share with you information of up to six years prior to the date you requested, who we shared it with, and why. With this we will include disclosures, except for those about treatment, payment and health care operations and certain other disclosures (any you have asked Lively Therapy Services, LLC) to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. You can ask and receive a list at any time with whom we have shared information.

  • You have the right to get a copy of your 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. Your paper copy will be provided within 5 business days.

  • If you have given someone medical power of attorney, or if someone is your legal guardian, that person is able to exercise your rights and make choices about your healthcare information. Lively Therapy Services, LLC will ensure this person has authority and can act for you before we take this action.

  • You can file a complaint at any point if you feel your rights are violated.

  • 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, DC 20201, or calling 1-877-696-6775, or by visiting We will not retaliate against you for filing a complaint.






Your Choices.

For some of your health information, you can chose what you want to share. If you have a clear and specific request of how you want us to share your information in the situations described below, please let Lively Therapy Services, LLC be aware and we will work with you accordingly.

  • You have the right and choice to tell us to share information with your family, close friends, or others who may be involved in payment of your care.

  • Share information in a disaster relief situation.

  • Contact you for fundraising events

    • In an event of fundraising you have the right to tell us not to contact you again.

  • If you are unable to tell us your preference (unconscious), we might go ahead and share your information if we believe it is in your best interests. We may also share your information if we believe at Lively Therapy Services, LLC it is in your best interest. We also may share your information when needed to lessen a serious and imminent threat to health or safety.

  • In the cases below we will NEVER share your information unless you give us written permission

    • Marketing purposes

    • Sale of your information

    • Most Psychotherapy notes


Our Uses and Disclosures - How do we typically share your health information? Please read below for details:

  • We can use your health information and share it with professionals who are treating you. Example:(social workers or other health related professionals)

  • We can use and disclose your information to run our organization and contact you when necessary. We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.

  • We can use and disclose your health information as we pay for your health services.

  • We may disclose your health information to your health plan sponsor for plan administration. Example: your company contracts with us to provide a health plan and we provide your company with certain statistics to explain the premiums we charge.


How else can we share or use your health information? We are allowed and required to share your information in other ways that are usually in ways to 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. For more information see

  • We can share your health information about you for certain situations such as:

    • preventing disease

    • helping with product recalls

    • reporting adverse reactions to medications

    • reporting suspected abuse, neglect, or domestic violence

    • preventing or reducing a serious threat to anyone's health or safety

  • Do research. We can use or share your information for health research.

  • Comply with the law. We will share information about you if the state or federal laws require it, which includes the Department of Health and Human Services if they want to see we are complying with federal privacy laws.

  • Respond to organ and tissue donation requests and work with medical examiner or funeral director. We can share health information about you with organ procurement organizations. We can share health information with a medical examiner, coroner, or funeral director if an individual dies.

  • Address Worker's compensation, law enforcement, and other government requests. We can use or share information about you:

    • For workers compensation claims

    • For law enforcement purposes or with a law enforcement official

    • With health oversight agencies for activities authorized by law

    • For special government functions such as military or national security

  • Responds to lawsuits and legal actions

    • We can share information about you in response to a court or administrative order if issued a subpoena.






Our Responsibilities.

  • By law, we are required to maintain privacy and security of your protected health information.

  • We will 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 document and provide you with a copy.

  • We will not use or share your information other than described, 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.


For further information see

Changes to the Terms of this Notice

We have the right to change this notice and the changes will apply to all information we have about you. The new notice will be available upon request and we will mail a copy to you.





Effective Date: April 2021
Last Updated: May 2022

This notice of Privacy Practices applies to the following organizations:

Lively Therapy Services

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