Notice of Privacy Practices
Effective Date: November 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.
Your Information. Your Rights. Our Responsibilities. This Notice applies to Origins Psychiatry and describes our privacy practices concerning protected health information (PHI), including information related to psychiatric and mental health care. Federal and Michigan law may provide additional protections for certain records. Where a law provides greater privacy protection than HIPAA, we will follow the more protective law.
Your Choices…
In certain situations, you may tell us your preferences about sharing information, including sharing information with family, friends, or others involved in your care and sharing information in a disaster-relief situation. If you are unable to communicate your preference, we may share information when permitted by law and when we believe it is in your best interest.
For certain uses and disclosures, we will obtain your written authorization when required by law. Uses and disclosures of psychotherapy notes generally require written authorization except for limited circumstances permitted by law. We will obtain authorization for uses or disclosures of PHI for marketing or a sale of PHI when required. Origins Psychiatry does not sell PHI.
Your Rights…
Get an electronic or paper copy of your medical record: you may ask to inspect or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We will provide access as required by law, generally within the time limits established by HIPAA, and may charge a reasonable, cost-based fee when permitted.
Ask us to correct your medical record: you may ask us to correct health information you believe is incorrect or incomplete. We may deny the request in certain circumstances, but we will explain the reason in writing as required by law.
Request confidential communications: you may ask us to contact you in a specific way (for example, at a particular phone number or email address) or to send communications to a different address. We will accommodate reasonable requests as required by law.
Ask us to limit what we use or share: you may ask us not to use or disclose certain health information for treatment, payment, or health care operations. We generally are not required to agree, except where HIPAA requires us to do so. If you pay in full out of pocket for a service, you may ask us not to disclose information about that service to your health plan for payment or health care operations, and we will honor the request unless disclosure is required by law.
Your Rights Continued…
Get an accounting of disclosures: you may request a list of certain disclosures of your PHI made during the six years before your request. The accounting does not include certain disclosures, such as many disclosures for treatment, payment, or health care operations.
Get a copy of this Notice: you may request a paper copy at any time, even if you agreed to receive it electronically.
Choose someone to act for you: if a person has legal authority to act on your behalf, such as a health care power of attorney or legal guardian, that person may exercise your privacy rights as permitted by law.
File a complaint: you may complain to Origins Psychiatry if you believe your privacy rights have been violated. 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.
How We May Use and Disclose Your Information…
Treatment: We may use and disclose your PHI to provide, coordinate, or manage your care. For example, we may share relevant information with another clinician involved in your treatment.
Payment: We may use and disclose PHI to bill and collect payment for services and to perform payment-related activities. For a cash-pay practice, this may include processing your payment through a payment processor or providing documentation you request for reimbursement.
Health care operations: We may use and disclose PHI to operate the practice, such as for quality improvement, compliance, auditing, credentialing, legal services, and business management.
Business associates: We may share PHI with vendors that perform services for us when permitted by HIPAA. When required, we enter into business associate agreements requiring appropriate protection of PHI.
Required or permitted by law: We may use or disclose PHI when federal or state law requires or permits it, including certain public health and safety activities, health oversight activities, judicial or administrative proceedings, law enforcement purposes, workers' compensation matters, organ donation, certain research activities, and other purposes permitted by law.
Serious threat to health or safety: We may disclose information when permitted or required by law to prevent or lessen a serious and imminent threat to the health or safety of you or another person.
Abuse, neglect, or other mandatory reporting: We may make reports or disclosures required or permitted by applicable law, including mandatory reporting obligations.
Mental Health and Substance Use Disorder Information…
Mental health information may receive additional protection under Michigan law.
We will not disclose mental health treatment records when a specific authorization or other legal basis is required unless that requirement is satisfied.
Certain substance use disorder (SUD) records may also be protected by federal law, including 42 CFR Part 2. When those protections apply, we will use and disclose those records only as permitted by applicable law.
Records subject to 42 CFR Part 2 that are disclosed pursuant to a valid consent may be subject to restrictions on further use and disclosure as provided by federal law. Origins Psychiatry will comply with applicable HIPAA and Part 2 requirements.
Our Responsibilities…
We are required by law to maintain the privacy and security of your PHI.
We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your unsecured PHI.
We must follow the duties and privacy practices described in the Notice currently in effect.
We will not use or disclose your PHI other than as described in this Notice unless you authorize us in writing or another use or disclosure is permitted or required by law. You may revoke an authorization in writing, subject to legal limitations.
Changes to This Notice
We may change the terms of this Notice, and the changes may apply to all PHI we maintain. If we make a material change, the revised Notice will be available upon request, at our office, and on our website.
Questions or Complaints
Privacy Officer: Origins Psychiatry
Established patients may submit privacy-related questions, requests, or complaints through the secure patient portal. Others may contact Origins Psychiatry through the contact form available on this website.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Origins Psychiatry will not retaliate against you for exercising your privacy rights or filing a complaint.
Acknowledgment of Receipt
Patients will be asked to acknowledge receipt of this Notice. Your acknowledgment confirms receipt only and does not mean that you agree with every practice described in the Notice.
Let’s Start the Conversation
ACCEPTING NEW PATIENTS NOVEMBER 2026
Thank you for your interest in Origins Psychiatry.
Beginning psychiatric care is a personal decision, and finding the right fit matters. I offer a complimentary 15-minute consultation to learn about what you're looking for, answer questions, and explore whether Origins Psychiatry may be the right fit for your needs.
I personally review each inquiry and aim to respond within 1–2 business days.
Please note: Origins Psychiatry is a private-pay practice and does not bill insurance directly. Individuals with commercial insurance or without insurance are welcome to inquire. At this time, I am unable to accept Medicare or Medicaid beneficiaries for covered services.
Consultations do not include diagnostic evaluation or treatment and do not establish a physician-patient relationship. This service is not intended for emergencies. If you are experiencing an emergency, call 911 or visit the nearest emergency department.