Notice of Privacy Practices
Effective Date: August 01, 2025
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 Responsibilities
We are 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
Notify you if a breach occurs involving your unsecured PHI
Follow the terms of this Notice until it is replaced
How We May Use and Disclose Your PHI Without Your Authorization
We may use and share your PHI for certain purposes without your written permission, including:
Treatment – To provide, coordinate, or manage your health care (e.g., consultation with another provider).
Payment – To bill and collect payment for services provided.
Health Care Operations – For practice management, quality assessment, training, and accreditation.
Required by Law – If mandated by federal, state, or local laws.
Public Health and Safety – To report abuse, neglect, or domestic violence; prevent or lessen a serious threat to health or safety.
Judicial and Administrative Proceedings – If ordered by a court or required for legal proceedings.
Law Enforcement – In limited situations such as identifying a suspect, fugitive, witness, or missing person.
Specialized Government Functions – For national security, military, or protective services.
Coroners, Medical Examiners, and Funeral Directors – As needed for identification or determining cause of death.
Uses and Disclosures That Require Your Authorization
Any other uses or disclosures of your PHI will be made only with your written permission. Examples include:
Marketing communications
Disclosures for purposes other than treatment, payment, or health care operations
You may revoke your authorization at any time in writing, except to the extent we have already acted on it.
Your Rights Regarding Your PHI
You have the right to:
Access Your Records – Receive a copy of your PHI in paper or electronic format (fees may apply).
Request an Amendment – Ask us to correct your PHI if you believe it is incorrect or incomplete.
Request Restrictions – Ask us to limit how we use or disclose your PHI (we may not be able to agree to all requests).
Request Confidential Communications – Ask that we contact you in a specific way (e.g., at home, at work, or via secure messaging).
Receive an Accounting of Disclosures – Get a list of certain disclosures we have made in the past six years.
Receive a Paper Copy of This Notice – Even if you agreed to receive it electronically.
Breach Notification
We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
Colorado State Law Considerations
Under Colorado law, mental health records may have additional protections. This includes more stringent requirements for releasing psychotherapy notes and special rules regarding the disclosure of substance use disorder treatment information.
Changes to This Notice
We may change the terms of this Notice at any time. Changes will apply to all PHI we maintain. The new Notice will be available upon request, in our office, and on our website.
Contact for Questions or Complaints
If you have any questions about this Notice or believe your privacy rights have been violated, you may contact:
Therapy With A Dog
Gavyn Baxa, LCSW
Email: gavyn@therapywithadog.com
Phone: 720-466-3112
Website: www.therapywithadog.com
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
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not retaliate against you for filing a complaint.