Concierge Psychiatry
of Main Line Where Your Story Matters
of Main Line Where Your Story Matters
Your privacy is fundamental to the care we provide. This notice describes how medical information about you may be used and disclosed, and how you can access this information.
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.
Concierge Psychiatry of Main Line is committed to protecting your Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the HITECH Act, and all applicable state and federal regulations.
Effective Date: October 13, 2026
Last Updated: October 13, 2026
This Notice replaces our prior Notice dated January 1, 2025.
At Concierge Psychiatry of Main Line, we understand that the information you share with us during psychiatric care is deeply personal. Protecting the confidentiality of your health information is not only our legal obligation—it is fundamental to the therapeutic relationship and the trust you place in our practice.
This Notice of Privacy Practices ("Notice") describes how we may use and disclose your Protected Health Information (PHI) and explains your rights regarding your health information.
PHI includes any individually identifiable health information that we create, receive, maintain, or transmit electronically, on paper, or orally. This includes:
Treatment: We may use and disclose your PHI to provide, coordinate, or manage your psychiatric care. For example, we may share relevant information with your primary care physician, a consulting specialist, a hospital if you are admitted, or a pharmacy that fills your prescriptions.
Payment: We may use and disclose your PHI to bill you and obtain payment for services we provide, and, if you ask, to prepare documents you can submit to your health plan.
Healthcare Operations: We may use and disclose your PHI for our internal operations, such as quality assessment, training, licensing, accreditation, and business management activities.
Family and Friends: We may share information with a family member or friend involved in your care only if you agree, or do not object when given the chance, or, in an emergency or if you are unable to agree, if we believe it is in your best interest. You can tell us at any time whom we may speak with.
Federal law also permits or requires us to use or share your information in the situations below, subject to the conditions the law sets. Pennsylvania law gives mental health and substance use treatment records greater protection than federal law in several of these situations. Where it does, we follow Pennsylvania law.
Except as described above, we will not use or disclose your PHI without your written authorization. Uses and disclosures requiring your authorization include:
You may revoke an authorization at any time by submitting a written request, except to the extent that we have already taken action based on the authorization.
Psychotherapy notes—the private notes your clinician may take during or after sessions—receive additional protection under HIPAA. We will not disclose psychotherapy notes without your specific written authorization, except where the law specifically permits, such as to prevent a serious and imminent threat to someone's safety.
If you receive substance use disorder treatment from us, those records receive additional protection under federal law (42 CFR Part 2), and Pennsylvania law also gives drug and alcohol treatment records special protection. In general, we will not disclose these records without your written consent, with limited exceptions such as medical emergencies, a court order that meets Part 2 requirements, and required reporting of suspected child abuse.
We will not use or disclose substance use disorder records, or testimony about their content, in any civil, criminal, administrative, or legislative proceeding against you unless you give specific written consent or a court issues an order that meets Part 2 requirements. If you give a single consent for us to use your records for treatment, payment, and health care operations, we may use and disclose them as described in this Notice, as Part 2 allows. You may revoke your consent in writing at any time, except to the extent we have already acted on it.
Under HIPAA, you have the following rights:
Right to Access: You may inspect or receive a copy of your records, including in electronic form, usually within 30 days of your request. You may also ask us to send a copy to another person you choose. We may charge a reasonable, cost-based fee.
Right to Amend: You may request that we amend your health information if you believe it is incorrect or incomplete. We may deny the request in certain circumstances but must provide a written explanation.
Right to an Accounting of Disclosures: You may request a list of disclosures we have made of your PHI (excluding disclosures for treatment, payment, healthcare operations, and certain other exceptions).
Right to Request Restrictions: You may request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request unless you pay out of pocket in full and request that we not disclose to your health plan.
Right to Request Confidential Communications: You may request that we communicate with you in a certain way or at a certain location (for example, by mail to a specific address or by phone at a specific number).
Right to a Paper Copy of This Notice: You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Right to Choose Someone to Act for You: If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information.
Right to Be Notified of a Breach: We will notify you if a breach occurs that may have compromised the privacy or security of your information.
Right to Opt Out of Fundraising: If we ever contact you for fundraising, you may tell us not to contact you again, and we will honor that request.
We implement administrative, physical, and technical safeguards to protect your PHI, including:
When you visit our website:
We reserve the right to change this Notice at any time. Changes will apply to PHI we already have as well as new information. The current Notice will always be posted in our office and on our website, and we will give you a copy of any revised Notice at your next visit on request.
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
With Our Practice:
Concierge Psychiatry of Main Line
Privacy Officer
Email: info@cpoml.com
Phone: (610) 632-7781
With the Federal Government:
U.S. Department of Health and Human Services
Office for Civil Rights
Website: www.hhs.gov/ocr
File online: ocrportal.hhs.gov/ocr/complaint
Phone: 1-800-368-1019
We will not retaliate against you for filing a complaint.
For questions about this Notice or to exercise your rights, please contact:
Concierge Psychiatry of Main Line
Privacy Officer
Phone: (610) 632-7781
Email: info@cpoml.com
We're committed to protecting your privacy. Contact us if you have any questions about our privacy practices.