Privacy Policy | Prairie Psychiatric

NOTICE OF PRIVACY PRACTICES

Prairie Mental Health Associates

(Prairie Psychiatric LLC and Core 4 Balance LLC)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective Date: 03/05/2026

1. WHO THIS NOTICE APPLIES TO

Prairie Mental Health Associates is the public-facing name used at the shared office location. Care is provided by two separate practices:

A. Prairie Psychiatric LLC

B. Core 4 Balance LLC

Your clinician’s practice (Prairie Psychiatric LLC or Core 4 Balance LLC) is responsible for your care and for complying with privacy laws. Because the practices operate in a shared setting and may use shared systems and administrative support, some limited sharing of information may occur for permitted purposes such as scheduling, care coordination, records management, billing support coordination, and other lawful health care operations.

Administrative and operational support services may be provided through a separate management services organization, Nelson Operations and Consulting LLC, and or through contracted vendors (for example EHR, IT support, billing support). When these parties receive protected health information to perform services, they are required to protect it under HIPAA and applicable agreements.

2. OUR LEGAL DUTIES

We are required by law to:

Maintain the privacy and security of your protected health information (“PHI”).
Provide you with this Notice of Privacy Practices (“Notice”).
Follow the terms of this Notice currently in effect.
Notify you following a breach of unsecured PHI as required by law.

We may change this Notice from time to time. The changes will apply to information we already have about you as well as new information created after the change. You may request a copy of the current Notice at any time.

3. WHAT INFORMATION IS PROTECTED

Protected health information (“PHI”) includes information that identifies you and relates to your past, present, or future physical or mental health condition, the health care services you receive, or payment for those services.

Some information may also be subject to additional federal protections for substance use disorder records under 42 CFR Part 2, described in Section 8 below.

4. HOW WE MAY USE AND DISCLOSE YOUR PHI

HIPAA allows us to use and disclose PHI for certain purposes without your written authorization in most cases.

A. Treatment

We may use and disclose PHI to provide, coordinate, or manage your treatment and related services.Examples: sharing information with another treating provider for referral or continuity of care, coordinating medication management, or consulting with other providers involved in your care.

B. Payment

We may use and disclose PHI to bill and collect payment for services and to obtain payment authorization when required.Examples: submitting claims to your insurance, responding to audits, or providing information needed for payment and collections.

C. Health Care Operations

We may use and disclose PHI for operations necessary to run the practice and improve quality and safety.Examples: quality improvement, compliance reviews, training, internal audits, credentialing, licensing support, business planning, risk management, and record retention.

D. Appointment Reminders and Communications

We may contact you about appointments, scheduling, billing, or care coordination. We may communicate by phone, voicemail, text, email, patient portal, or mail unless you request restrictions or a different method. We will accommodate reasonable requests for confidential communications.

E. Individuals Involved in Your Care

We may share relevant PHI with a family member, friend, or other person involved in your care or payment for your care if you agree, do not object after being given the chance, or if you are unable to agree or object and we determine it is in your best interest.

F. Business Associates and Vendors

We may disclose PHI to vendors who perform services on our behalf (for example EHR, IT support, billing support coordination, legal, accounting, shredding). These parties must protect PHI and may use it only to perform services for us.

G. Required by Law

We may disclose PHI when required by federal, state, or local law.

H. Public Health and Safety

We may disclose PHI for public health activities such as reporting, preventing disease, reporting adverse reactions, or reporting abuse, neglect, or domestic violence as required or permitted by law.

I. Health Oversight Activities

We may disclose PHI to oversight agencies for audits, inspections, investigations, licensure, and other oversight functions authorized by law.

J. Legal Proceedings and Law Enforcement

We may disclose PHI in response to a valid court order, subpoena, or lawful process as required by law. We may disclose limited PHI for law enforcement purposes when permitted or required by law.

K. Serious Threat to Health or Safety

We may disclose PHI if needed to prevent or lessen a serious and imminent threat to a person’s health or safety or the public, consistent with applicable law.

L. Workers’ CompensationWe may disclose PHI for workers’ compensation claims as authorized by law.

5. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

We will not use or disclose your PHI for purposes outside those described in this Notice without your written authorization, except as otherwise permitted or required by law.

Written authorization is generally required for:
Most uses and disclosures of psychotherapy notes (as defined by HIPAA), with limited exceptions
Marketing disclosures where HIPAA requires authorization
Sale of PHI (we do not sell PHI)

You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

6. YOUR RIGHTS

You have the right to:

A. Get a copy of your records

You may request to inspect or obtain a copy of your PHI, including electronic copies when available. We may charge a reasonable, cost-based fee as permitted by law.

B. Request a correction

You may request that we correct your PHI if you believe it is incorrect or incomplete. We may deny your request in certain circumstances and will provide a written explanation.

C. Request confidential communications

You may ask us to contact you in a specific way or at a specific location (for example only by mail or only at a certain phone number). We will accommodate reasonable requests.

D. Request restrictions

You may ask us not to use or disclose certain PHI for treatment, payment, or operations. We are not required to agree, but if we do agree, we will follow the restriction except in emergencies.If you pay for a service out of pocket in full, you may request that we not share information about that service with your health plan, and we will comply unless a law requires disclosure.

E. Get an accounting of disclosures

You may request a list of certain disclosures of your PHI made in the last six (6) years, excluding disclosures for treatment, payment, and operations and certain other disclosures permitted by law.

F. Get a copy of this Notice

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

G. File a complaint

You may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

7. OUR SHARED SETTING AND BUSINESS STRUCTURE

Because Prairie Psychiatric LLC and Core 4 Balance LLC operate at the same location under the Prairie Mental Health Associates name, limited information sharing may occur as necessary for lawful treatment, payment, and health care operations, including scheduling, records management, and operational support.

To protect privacy and reduce confusion:

Your treating clinician’s practice is the primary custodian of your clinical record for your care.
Billing is handled by a billing company who is contracted with your provider (Prairie Psychiatric LLC or Core 4 Balance LLC), unless a specific written arrangement states otherwise.
Any shared access is limited to the minimum necessary and subject to confidentiality and security requirements.

8. IMPORTANT NOTICE ABOUT SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)

Some records relating to substance use disorder (“SUD”) diagnosis, treatment, or referral may be subject to additional federal confidentiality protections under 42 CFR Part 2, depending on the type of services provided and the circumstances.

If 42 CFR Part 2 applies to your information:

Part 2 may limit certain disclosures even when HIPAA would otherwise permit them.
Part 2 may require more specific consent language for certain disclosures.
Part 2 generally restricts use of SUD records in civil, criminal, administrative, or legislative proceedings unless permitted by your consent or a court order meeting Part 2 requirements.

Redisclosure notice:

Information disclosed under this Notice may be re-disclosed by the recipient and may no longer be protected by HIPAA. If Part 2 applies, additional redisclosure restrictions may apply, and recipients may be prohibited from re-disclosing Part 2 protected information except as allowed by law.If you have questions about whether your information is subject to 42 CFR Part 2 protections, please contact us using the information in Section 10.

9. FUNDRAISING AND MARKETING

We do not sell PHI. We will not use your PHI for marketing in a way that requires authorization without your written consent.

10. CONTACT INFORMATION

For questions, requests, restrictions, or complaints about this Notice, contact:

Privacy Contact:

Connie R. Nelson, APRN-NP, Prairie Psychiatric LLC

Amy Golter, APRN-NP, Core 4 Balance LLC

8055 O Street, Suite 119A

Lincoln, NE 68510

Phone: 402-413-5448

Fax: 402-858-2121

Email: office@prairiepsych.com

11. ACKNOWLEDGMENT OF RECEIPT

You may be asked to sign an acknowledgment that you received this Notice. Signing acknowledges receipt only and does not mean you agree with the uses and disclosures described.