NOTICE OF PRIVACY PRACTICES

At the Crossroads Therapy
Effective Date: March 03, 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 LEGAL DUTY

At the Crossroads Therapy is required by law to:

• Maintain the privacy of your Protected Health Information (PHI)

• Provide you with this Notice of our legal duties and privacy practices

• Abide by the terms of this Notice currently in effect

• Notify you in the event of a breach of your unsecured PHI

Protected Health Information (PHI) includes information that identifies you and relates to your past, present, or future physical or mental health condition and related healthcare services.

HOW WE MAY USE AND DISCLOSE YOUR PHI

We may use and disclose your PHI for the following purposes:

1. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare treatment.
Example: Consulting with another healthcare provider involved in your care.

2. Payment

We may use and disclose PHI to obtain payment for services.
Example: Submitting claims to your insurance provider.

3. Healthcare Operations

We may use and disclose PHI for practice operations.
Examples include:

• Quality assessment

• Staff supervision

• Licensing and accreditation

• Administrative functions

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

We will obtain your written authorization for:

• Most disclosures of psychotherapy notes

• Marketing communications

• Sale of PHI

• Any use or disclosure not described in this Notice

You may revoke an authorization at any time in writing.

SITUATIONS WHERE WE MAY DISCLOSE PHI WITHOUT AUTHORIZATION

Under certain circumstances, we may disclose PHI without your written consent, including:

• When required by law

• Suspected abuse or neglect reporting

• Serious threat to health or safety

• Court orders or legal proceedings

• Public health reporting

• Law enforcement purposes (as permitted by law)

• Workers’ compensation claims

We comply with all federal and state laws regarding mandatory reporting.

YOUR RIGHTS REGARDING YOUR PHI

You have the right to:

1. Inspect and Obtain a Copy

You may request access to your records (with limited exceptions). We may charge a reasonable fee.

2. Request an Amendment

If you believe information in your record is incorrect, you may request a correction.

3. Request an Accounting of Disclosures

You may request a list of certain disclosures made over the past six years.

4. Request Restrictions

You may request limits on how we use or disclose your PHI. We are not required to agree, except in limited circumstances.

5. Request Confidential Communications

You may request we contact you in a specific way (e.g., only by email or at a specific phone number).

6. Receive a Paper Copy

You may request a paper copy of this Notice at any time.

ELECTRONIC COMMUNICATIONS

If you choose to communicate with us via email, text, or online forms, please understand that electronic communication carries some risk of confidentiality breach. We use reasonable safeguards but cannot guarantee absolute security.

MINORS

In most cases, parents or legal guardians have rights to access a minor’s records. However, certain state laws may limit parental access in specific situations.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice at any time. Any revised Notice will apply to all PHI we maintain and will be available on our website and at our office.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

At The Crossroads Therapy LLC

Nancy Atchue

[email protected]

877-962-7255

At the Crossroads Therapy LLC

PO Box 20244

Bullhead City, AZ 86439

United States

You may also file a complaint with:

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
www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be retaliated against for filing a complaint.

CONTACT INFORMATION

If you have questions about this Notice, please contact:

Privacy Officer
At the Crossroads Therapy
[email protected]

877-962-7255

At the Crossroads Therapy LLC PO Box 20244 Bullhead City, AZ 86439

United States