Effective Date: July 1, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Who Follows This Notice
This Notice describes the privacy practices of Black Psychiatry LLC and Christopher Black, APRN, PMHNP-BC (together, "we," "us," or "our"). We are required by law to protect the privacy of your health information, to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.
Our Pledge Regarding Your Health Information
"Protected health information" (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related care. We are committed to protecting your PHI and will use or disclose it only as described in this Notice or as otherwise permitted or required by law.
How We May Use and Disclose Your Health Information
We may use and disclose your PHI without your written authorization for the following purposes:
Treatment. We may use your PHI to provide, coordinate, or manage your care, and we may disclose it to other providers, pharmacies, laboratories, or specialists involved in your treatment. For example, we may share information with a lab performing testing we order, or with another provider we consult about your care.
Payment. We may use and disclose your PHI to obtain payment for services, such as billing your health insurer (for example, Cigna or Aetna) or verifying coverage and benefits.
Health Care Operations. We may use and disclose your PHI for operations such as quality assessment, care review, scheduling, and general administration of the practice.
Other Uses and Disclosures Permitted or Required by Law
Subject to legal requirements, we may use or disclose your PHI without your authorization:
When required by federal, state, or local law;
For public health activities, such as reporting communicable disease or adverse events;
To report suspected abuse, neglect, or domestic violence as permitted or required by law;
For health oversight activities authorized by law;
In connection with judicial or administrative proceedings, in response to a lawful order or subpoena;
For law enforcement purposes as permitted by law;
To coroners, medical examiners, or funeral directors as permitted by law;
To avert a serious and imminent threat to the health or safety of you or others;
For specialized government functions, such as military or national security activities; and
For workers' compensation as authorized by law.
Uses and Disclosures Requiring Your Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, including:
Most uses and disclosures of psychotherapy notes;
Uses and disclosures for marketing purposes; and
Any sale of your PHI.
You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
Additional Protections for Certain Information
Some of your health information may be subject to additional protection under state or federal law, including certain mental health and substance use disorder information. Where such laws apply, we will follow the more protective requirement.
Minor Patients
We provide care to patients under the age of 18 only with the consent of a parent or legal guardian. In most cases, a parent or guardian may exercise the rights described in this Notice on behalf of a minor patient. In certain situations defined by Utah and federal law, a minor may control the privacy of specific health information; where that is the case, we will follow the applicable law.
Your Rights Regarding Your Health Information
You have the right to:
Request access to and obtain a copy of your health records, subject to certain limited exceptions;
Request that we amend health information you believe is incorrect or incomplete;
Receive an accounting of certain disclosures we have made of your PHI;
Request restrictions on how we use or disclose your PHI (we are not required to agree to all requests);
Request that we communicate with you by alternative means or at an alternative location (for example, a specific phone number or email);
Receive a paper copy of this Notice upon request, even if you agreed to receive it electronically; and
Be notified in the event of a breach of your unsecured PHI.
To exercise any of these rights, contact us using the information below.
Our Duties
We are required by law to maintain the privacy of your PHI, to provide this Notice describing our duties and privacy practices, to follow the terms of the Notice currently in effect, and to notify you if a breach of your unsecured PHI occurs.
Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as information we receive in the future. The current Notice will be posted on our website with its Effective Date.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us by contacting Christopher Black, APRN, PMHNP-BC using the information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.
For More Information / To Contact Us
Christopher Black, APRN, PMHNP-BC
Black Psychiatry LLC
Provo, Utah
Phone: (801) 361-2255
Email: chris@black-psychiatry.com