Bold Behavioral Health, PLLC
Effective date: October 16, 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
I understand that information about your health is personal. I am required by law to maintain the privacy and security of your protected health information (PHI), to give you this notice describing my legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How I May Use and Disclose Your Health Information
Treatment. I may use and share your information to provide and coordinate your care. For example, I may share information with your primary care provider, therapist, pharmacy or hospital so your treatment is safe and coordinated.
Payment. I may use and share your information to bill for services and collect payment. For example, I may send information to your insurance plan to confirm coverage or receive payment. If you pay out of pocket, I can provide a receipt (superbill) for you to submit to your insurer.
Health care operations. I may use and share your information to run my practice, such as quality review, training, legal and accounting services, and compliance. Vendors who help with these tasks must sign agreements to protect your information.
Other ways I may use or share information without your written authorization:
- When required by law
- For public health activities, such as reporting certain diseases or adverse medication reactions
- To report suspected abuse, neglect or domestic violence, as the law requires
- To prevent or lessen a serious and imminent threat to the health or safety of you or others
- For health oversight activities, such as audits or licensing board investigations
- In response to a court order, subpoena or other lawful legal process
- To law enforcement, as the law allows
- To coroners, medical examiners and funeral directors
- For workers’ compensation, military, national security and certain government functions, as the law allows
- To family members or others involved in your care, if you agree or do not object, or if I decide it is in your best interest and you cannot speak for yourself
- To send appointment reminders and treatment-related communications
Uses That Require Your Written Authorization
I will get your written permission before using or sharing your information for:
- Psychiatry notes, with limited exceptions allowed by law
- Marketing
- Sale of your health information
- Any other purpose not described in this notice
You may cancel an authorization at any time in writing, except where I have already acted on it. I do not use your information for fundraising.
Your Rights
You have the right to:
- Inspect and get a copy of your health record, including an electronic copy where available. Submit a written request to me. I may charge a reasonable, cost-based fee for copying and mailing. I may deny access in limited situations, such as when it could endanger someone’s safety, and you may ask for a review of that decision.
- Request an amendment if you believe information is incorrect or incomplete. Complete my Patient Amendment Request form. I may deny the request in certain cases and will explain why in writing.
- Receive an accounting of disclosures I made of your information in the past six years, with some exceptions.
- Request restrictions on how I use or share your information. I am not required to agree, except that I must agree if you ask me not to share information with your health plan about a service you paid for in full out of pocket.
- Request confidential communications, such as contact by a different phone number or method.
- Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
- Be notified of a breach of your unsecured health information.
- Choose someone to act for you, such as a health care power of attorney, and I will confirm that person’s authority before acting.
To use any of these rights, contact me using the details below.
Changes to This Notice
I may change this notice and the changes will apply to all information I hold. The current notice will be posted on my website and available on request, and the effective date will appear at the top.
Questions or Complaints
If you have questions or believe your privacy rights were violated, contact:
Privacy Contact: Scott Arno, PA-C
Bold Behavioral Health, PLLC
Phone: 515-207-9693
Email: contact@boldbehavioral.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
200 Independence Avenue SW, Washington, DC 20201
Phone: 1-877-696-6775
Website: hhs.gov/ocr/privacy/hipaa/complaints
I will not retaliate against you for filing a complaint.