NOTICE OF PRIVACY PRACTICES

Effective Date: December 10, 2025 

Provider: UTAH CENTER FOR PSYCHOLOGICAL SERVICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS FORMATION. PLEASE REVIEW IT CAREFULLY.

Utah Center for Psychological Services (UCPS) is committed to protecting your medical information as required by law. This is our notice of privacy practices. If you have any questions about anything within this document, you are encouraged to contact UCPS’s Privacy Officer by using the email address, telephone number or physical address set forth below. 

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Obtain an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. 

• We will provide a copy or a summary of your health information and billing information, usually within 30 days of your request. We may charge a reasonable, cost-based fee as allowed by law.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. You may ask us how to do this.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. 

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. 

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care.

• Share information in a disaster relief situation.

• Contact you for fundraising efforts.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes.

• Sale of your information.

Psychotherapy Notes

• Specific Authorization Required: Most uses and disclosures of "Psychotherapy Notes" require your specific written authorization. Psychotherapy notes are notes recorded (in any medium) by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session, and that are separated from the rest of your medical record.

USES AND DISCLOSURES OF YOUR INFORMATION

How do we typically use or share your health information? We typically use or share your health information in the following ways:

Requests made by you

You can direct us to share your information with others by signing a written authorization to release your health or billing information to others, with family and friends, in an emergency, for religious preferences and for other similar reasons.

If you authorize us to share your health information but later change your mind, you can change your authorization by notifying us in writing that you revoke the authorization. We will honor your revocation, but we will not be able to get back the health information that you previously authorized disclosed.

Treating you

• We can use your health information and share it with other professionals who are treating you.

• Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Running our organization

• We can use and share your health information to run our practice, improve your care, and contact you when necessary.

• Example: We use health information about you to manage your treatment and services.

Billing for services

• We can use and share your health information to bill and get payment from health plans or other entities.

• Example: We give information about you to your health insurance plan so it will pay for your services.

Quality improvement

• We can use and share your health information to improve the care we deliver

• Example: We may contact you to understand what you thought of our care and to learn how to improve our services we provide to you.

Other disclosures to third parties

How else can we use or share your health information? We are allowed or required to share your information in other ways authorized or required by law, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. 

In many cases, Utah law mandates specific reporting requirements that we must obey. These include:

Business Associates

• We are allowed to disclose your information to business associates who we contract with to perform services for us, provided they agree to protect your health information and obey the same privacy laws that we do.

Preventing a Serious Threat to Health or Safety (Duty to Warn)

• Under Utah law, if a client communicates to us an actual threat of physical violence against a clearly identified or reasonably identifiable victim, we are required by law to take reasonable precautions. This may include disclosing information to law enforcement and the potential victim.

Reporting Abuse or Neglect

• Under Utah law, we are required to report any suspected abuse or neglect of a child to the Division of Child and Family Services (DCFS) or law enforcement. We are required by Utah law to report any suspected abuse, neglect, or exploitation of a vulnerable adult to Adult Protective Services (APS).

Treatment of Minors

• Generally, parents or legal guardians have the right to access the medical records of their minor children. However, under Utah law, if a minor is legally able to consent to their own mental health treatment (such as in cases where parental involvement would be harmful), we may not disclose records to the parent without the minor's consent.

Public Health and Safety Issues

• We can share health information about you for certain situations such as:

• Preventing disease (including reporting communicable diseases to the health department as required by Utah law)

• Reporting adverse reactions to medications.

• Reporting suspected criminal injuries, such as gunshot or stab wounds, to law enforcement as required by Utah law.

Compliance with the law

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law or other applicable laws.

Work with a medical examiner or funeral director

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies in accordance with applicable law.

Workers’ compensation, law enforcement, and other government requests

• We can use or share health information about you:

• For workers’ compensation claims.

• For law enforcement purposes or with a law enforcement official.

• With health oversight agencies for activities authorized by law.

• For special government functions such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena issued and authorized under relevant laws.

OUR RESPONSIBILITIES

We have a number of responsibilities, including the following:

• We are required by law to maintain the privacy and security of your protected health information as required by law and subject to the exceptions noted in this Policy.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information, as required by federal and state law.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of This Notice 

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

To file a complaint if you feel your rights are violated. 

COMPLAINTS

You can file a complaint by contacting the Practice using the following information:
Utah Center for Psychological Services
6787 S Redwood Rd., West Jordan, UT 84084
Casey Mangnall, PsyD
Tel: (801) 839-5360

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.