Effective Date: October 5, 2026
Maine ADHD Clinic, PLLC
PO Box 462, Southwest Harbor, ME 04679
207-656-4539
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
Maine ADHD Clinic, PLLC is committed to protecting the privacy of your protected health information (PHI). PHI includes information that identifies you and relates to your mental health care, treatment, or payment for services. We create a record of the care and services you receive from us in order to provide quality care and comply with certain legal requirements. This notice applies to all records of your care generated by this practice.
We are required by law to:
- Keep your PHI private
- Provide this notice of our legal duties and privacy practices
- Follow the terms of the notice currently in effect
- Provide adequate notice of your rights and our legal duties if we create or maintain records protected by 42 C.F.R. Part 2
We may change the terms of this notice at any time. Changes will apply to all information we have about you. The updated notice will be available upon request and on our website.
How We May Use and Disclose Your Health Information
For Treatment, Payment, or Health Care Operations
We may use and disclose your PHI without written authorization to carry out treatment, payment, and health care operations. For example, we may consult with another licensed health care provider about your condition, share information for care coordination, or use your information for billing and quality assurance purposes.
If your records are protected under 42 C.F.R. Part 2, certain uses and disclosures permitted by HIPAA are materially limited by the stricter standards of those regulations. Information disclosed pursuant to these rules may be subject to redisclosure by the recipient and may no longer be protected by federal privacy standards.
Telehealth & Secure Communications
Care is provided through HIPAA-compliant secure telehealth platforms and electronic health records. The patient portal is encrypted and is the required and safest method of communication. Email is not considered secure and should only be used for limited non-sensitive communication.
Lawsuits and Disputes
We may disclose your PHI in response to a court or administrative order, subpoena, or other lawful process. For records protected by 42 C.F.R. Part 2, such records shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide specific written consent or a court order is issued in accordance with 42 C.F.R. Part 2.
Uses and Disclosures Requiring Your Authorization
Psychotherapy Notes
We maintain psychotherapy notes as defined in 45 CFR § 164.501. Any use or disclosure of such notes requires your written authorization unless the use or disclosure is:
- For treatment purposes
- For training or supervising mental health practitioners
- For defending against legal proceedings instituted by you
- Required by the Secretary of Health and Human Services
- Required by law
- Required by a coroner performing duties authorized by law
- Required to avert a serious threat to health or safety
Marketing and Sale of PHI
We will not use or disclose your PHI for marketing purposes or sell your PHI in the regular course of business.
Uses and Disclosures That Do Not Require Your Authorization
We may use and disclose your PHI without authorization for the following:
- When required by state or federal law
- For public health activities including reporting suspected child, elder, or dependent adult abuse or preventing a serious threat to 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
- To coroners or medical examiners performing duties authorized by law
- For research purposes
- For specialized government functions
- For workers compensation purposes
- For appointment reminders and information about treatment alternatives or health care services
Uses and Disclosures Requiring You to Have the Opportunity to Object
Disclosures to Family, Friends, or Others
We may provide your PHI to a family member, friend, or other person involved in your care or payment for your care unless you object. The opportunity to consent may be obtained retroactively in emergency situations.
Your Rights Regarding Your PHI
Right to Request Limits You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We are not required to agree if we believe it would affect your care.
Right to Request Restrictions for Out-of-Pocket Expenses 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 service you paid for out of pocket in full.
Right to Choose How We Contact You You have the right to ask us to contact you in a specific way or send mail to a different address and we will agree to all reasonable requests.
Right to Access Your Records Other than psychotherapy notes and SUD counseling notes, you have the right to get an electronic or paper copy of your medical record. We will provide a copy or summary within 30 days of receiving your written request and may charge a reasonable cost-based fee.
Right to an Accounting of Disclosures You have the right to request a list of disclosures we have made for purposes other than treatment, payment, or health care operations. We will respond within 60 days. The list will include disclosures made in the last six years. We will provide this at no charge for the first request each year. Additional requests in the same year may incur a reasonable fee.
Right to Request Corrections If you believe there is a mistake or missing information in your PHI, you have the right to request a correction. We may deny your request but will explain why in writing within 60 days.
Right to a Paper or Electronic Copy of This Notice You have the right to receive a paper or electronic copy of this notice at any time upon request.
Our Responsibilities
We must:
- Keep your PHI private
- Provide this notice and follow its terms
- Notify you of any breach of unsecured PHI
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Maine ADHD Clinic, PLLC or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.
Contact
Maine ADHD Clinic, PLLC
PO Box 462, Southwest Harbor, ME 04679
207-656-4539
office@maineadhdclinic.com