Notice of Privacy Practices
Effective Date: August 20, 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.
Our Commitment to Your Privacy
Ayr Mental Health PLLC ("we," "us," "our," or "the Practice") is committed to protecting the privacy of your protected health information ("PHI"). In providing psychiatric mental health services, we create and maintain records about you and the care and services we provide to you.
We are required by law to maintain the privacy of your PHI, provide you with this Notice describing our legal duties and privacy practices with respect to your PHI, and notify affected individuals following a breach of unsecured PHI as required by law.
This Notice applies to PHI maintained by Ayr Mental Health PLLC in connection with the healthcare services we provide, including services provided by telehealth to patients located in Washington and Arizona.
How We May Use and Disclose Your Health Information
We may use and disclose your PHI without your written authorization for the following purposes, as permitted by applicable law:
For Treatment. We may use and disclose your PHI to provide, coordinate, or manage your psychiatric care and related services. This may include communicating with other healthcare providers involved in your care or making referrals for services we do not provide.
For Payment. We may use and disclose your PHI to obtain payment for services we provide. This may include billing your insurance carrier, verifying insurance coverage, determining eligibility, or obtaining prior authorization when applicable.
For Healthcare Operations. We may use and disclose your PHI for healthcare operations necessary to operate our practice, such as quality assessment, compliance activities, licensing, credentialing, staff training, and business planning.
Appointment Reminders and Health-Related Communications. We may contact you by phone, text message, email, or mail regarding appointments, treatment, or other health-related services, as permitted by applicable law.
Individuals Involved in Your Care or Payment. We may disclose limited PHI to a family member, friend, or other person involved in your care or payment for your care when you agree to the disclosure or when otherwise permitted by law, including when we exercise professional judgment in certain circumstances.
Uses and Disclosures That Require Your Written Authorization
Except as described in this Notice or otherwise permitted or required by law, we will obtain your written authorization before using or disclosing your PHI.
Certain uses and disclosures generally require your written authorization, including:
Psychotherapy notes, if we maintain psychotherapy notes separately from the rest of your medical record, except as otherwise permitted by law.
Uses or disclosures for marketing purposes, except as otherwise permitted by law.
Sale of PHI, except as otherwise permitted by law.
If you provide a written authorization, you may revoke it in writing at any time, except to the extent we have already relied upon the authorization.
Other Permitted or Required Uses and Disclosures Without Authorization
We may use or disclose your PHI without your written authorization when permitted or required by applicable law, including:
When required by federal, state, or local law
For certain public health activities
To report suspected abuse, neglect, or domestic violence when required or permitted by law
For health oversight activities, such as audits, investigations, or licensing activities
In response to a court order, subpoena, or other lawful process when the applicable legal requirements are satisfied
For certain law enforcement purposes, as permitted by law
To coroners, medical examiners, or funeral directors when necessary for their legally authorized duties
For certain research purposes, subject to applicable legal protections
To prevent or lessen a serious and imminent threat to the health or safety of a person or the public, when permitted by law
For certain specialized government functions, when applicable
For workers' compensation purposes, as authorized by applicable law
Substance Use Disorder Treatment Records
Some records we receive about you may come from a substance use disorder (SUD) treatment program covered by federal confidentiality rules at 42 CFR Part 2 ("Part 2 records"). These records have additional protections beyond HIPAA. When Part 2 rules are stricter than this Notice, we follow the stricter rules.
Your Consent. We generally use or share Part 2 records only with your written consent. You may sign one consent that covers our use and sharing of these records for your treatment, payment, and healthcare operations. Once you sign that consent, we may use and further share the records for those purposes as HIPAA allows, except as described under Legal Proceedings below.
Limited Exceptions. Without your consent, we may use or share Part 2 records only in narrow situations allowed under 42 CFR Part 2, such as a medical emergency, certain research, audits or program evaluations, disclosure of de-identified information for public health purposes, or a court order that meets Part 2 requirements.
Legal Proceedings. Part 2 records, and any testimony describing their contents, will not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you unless you give specific written consent or a court issues an order that meets the requirements of 42 CFR Part 2. A subpoena alone is not sufficient.
Revoking Your Consent. You may revoke your consent in writing at any time. Revoking it does not undo any use or sharing that took place while your consent was in effect.
Fundraising. We do not use or share Part 2 records for fundraising.
Complaints. If you believe your rights regarding Part 2 records were not respected, you may submit a complaint to us or to the U.S. Department of Health and Human Services, as explained under Right to File a Complaint in this Notice. We will never retaliate against you for making a complaint.
Your Rights Regarding Your Health Information
You have the following rights regarding the PHI we maintain about you:
Right to Request Restrictions. You may ask us to restrict how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request except in circumstances where applicable law requires us to do so. For example, we must generally agree to a request not to disclose PHI to a health plan for payment or healthcare operations purposes when you have paid for the service in full out of pocket and the disclosure is not otherwise required by law.
Right to Request Confidential Communications. You may ask us to communicate with you about your health information in a specific way or at a specific location. For example, you may request that we contact you only at a particular telephone number or email address. We will accommodate reasonable requests.
Right to Access. You have the right to inspect and obtain a copy of PHI maintained about you in a designated record set, subject to limited exceptions under applicable law. We may charge a reasonable, cost-based fee where permitted by law.
Right to Amend. You may request that we amend PHI that you believe is incorrect or incomplete. We may deny your request in certain circumstances permitted by law. If we deny your request, you have the right to submit a written statement of disagreement.
Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of your PHI made by us, subject to exceptions provided by law. Certain disclosures, including many disclosures for treatment, payment, and healthcare operations, are generally excluded from the accounting requirement.
Right to a Copy of This Notice. You have the right to receive a paper or electronic copy of this Notice at any time.
Right to Choose Someone to Act on Your Behalf. If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make decisions regarding your PHI to the extent permitted by law.
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with Ayr Mental Health PLLC or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
HHS Office for Civil Rights — HIPAA Complaints
Telehealth
Ayr Mental Health PLLC provides psychiatric mental health services through telehealth. Your PHI may be transmitted and maintained through electronic health record, scheduling, telehealth, billing, and other technology platforms used to provide and administer your care.
We select and use vendors that provide appropriate safeguards for protected health information and enter into Business Associate Agreements with vendors when required by HIPAA and applicable law.
State-Specific Privacy Protections
Washington. Washington law provides additional privacy protections for certain types of health information, including certain mental health records and information relating to services that may be provided without parental consent under applicable Washington law. We will comply with applicable Washington privacy and confidentiality requirements in addition to federal law.
Arizona. Arizona law may provide additional protections regarding the confidentiality of behavioral health information and certain healthcare records. We will comply with applicable Arizona privacy and confidentiality requirements in addition to federal law.
Nothing in this Notice is intended to limit any privacy rights or protections available to you under applicable federal or state law.
Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice applicable to PHI we already maintain as well as PHI we create or receive in the future, as permitted by law.
We will post the current version of this Notice on our website and make it available upon request. The effective date of the current Notice will appear at the beginning of the Notice.
Contact Us
If you have questions about this Notice of Privacy Practices, you may contact us at:
Privacy Officer: Stacey Velimesis, MSN, APRN, PMHNP-BC, FNP-C | P 425) 300-1333 | F (206) 339-1621 | Mailing address: 2027 196th Street SW, Suite A205, Lynnwood, WA 98036 | hello@ayrmentalhealth.com