MAGIC VALLEY BEHAVIORAL HEALTH, PLLC

Kelsie Hendrickson, Ph.D., ABPP
Licensed Psychologist

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NOTICE OF PRIVACY PRACTICES

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.

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I. MY DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)

I understand that health information about you and your care is personal. I am committed to protecting your protected health information (PHI). I create and maintain records of the care and services you receive from me. These records are necessary to provide quality care and to comply with legal requirements.

By law, I am required to:

• Maintain the privacy of your PHI.

• Provide you with this Notice of my legal duties and privacy practices.

• Follow the terms of the Notice currently in effect.

• Notify you in the event of a breach of unsecured PHI.

I reserve the right to revise this Notice at any time. Any revised Notice will apply to all PHI I maintain. The most current version will be available in my office and in the client portal.

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II. HOW I MAY USE AND DISCLOSE YOUR PHI

A. For Treatment, Payment, and Health Care Operations

I may use and disclose your PHI without your written authorization for:

Treatment – To provide, coordinate, or manage your psychological care, including consultation with other healthcare providers when clinically appropriate.

Payment – To obtain reimbursement for services provided.

Health Care Operations – For practice operations such as quality assessment, supervision, training, licensing, accreditation, and compliance activities.

For treatment purposes, the “minimum necessary” standard does not apply, as providers may need access to complete information to provide appropriate care.

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B. Uses and Disclosures Required or Permitted by Law

I may use or disclose your PHI without authorization when required or permitted by federal or state law, including:

• Reporting suspected child abuse, neglect, or abandonment as required by state law.

• Reporting suspected abuse, neglect, or exploitation of a vulnerable adult as required by state law.

• Preventing or reducing a serious and imminent threat to your health or safety or that of another person.

• Health oversight activities (audits, investigations, licensure actions).

• Judicial or administrative proceedings (court orders, subpoenas).

• Law enforcement purposes.

• Coroners or medical examiners.

• Workers’ compensation claims.

• Specialized government functions (military, national security).

• Research that complies with applicable law.

Under state law, if I determine that you present a serious risk of harm to yourself or others, I may disclose relevant information and take reasonable steps to protect those at risk.

Whenever feasible, I will attempt to obtain your authorization before disclosure unless legally prohibited.

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III. REPRODUCTIVE HEALTH CARE PRIVACY PROTECTIONS

I am prohibited from using or disclosing your PHI for the purpose of investigating or imposing liability for lawful reproductive health care.

I will not disclose your PHI to law enforcement or other parties for purposes related to investigating or prosecuting lawful reproductive health care.

In certain situations involving requests related to reproductive health care, I may be required to obtain a signed attestation from the requesting party confirming that the use or disclosure is not for a prohibited purpose.

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IV. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

A. Psychotherapy Notes

I maintain psychotherapy notes as defined by federal law. These notes receive special protection.

I will not use or disclose psychotherapy notes without your written authorization except:

• For my own treatment use.

• For training or supervision.

• To defend myself in legal proceedings brought by you.

• When required by law.

• For certain health oversight activities.

• To prevent a serious and imminent threat.

 

B. Marketing and Sale of PHI

I will not use or disclose your PHI for marketing purposes without your written authorization.

I do not sell your PHI.

You may revoke any written authorization at any time in writing, except to the extent action has already been taken.

 

V. USES AND DISCLOSURES WHERE YOU MAY OBJECT

I may share relevant PHI with a family member, friend, or other person involved in your care or payment for your care, unless you object.

For minor clients, parents or legal guardians generally have the right to access the minor’s PHI, except where state or federal law limits such access.

 

VI. TELEHEALTH SERVICES

If services are provided via telehealth, I take reasonable steps to protect the privacy and security of electronic communications in accordance with applicable state and federal law. However, no electronic system can be guaranteed to be completely secure.

 

VII. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights:

1. Right to Inspect and Receive a Copy

You have the right to inspect and obtain a copy of your PHI (excluding psychotherapy notes) in paper or electronic format. I will respond within 30 days of receiving your written request. A reasonable, cost-based fee may apply. You may request that I transmit a copy directly to another person or entity.

2. Right to Request an Amendment

If you believe your PHI is incorrect or incomplete, you may request an amendment. I may deny your request but will provide a written explanation within 60 days.

3. Right to an Accounting of Disclosures

You may request a list of disclosures made in the past six years (excluding treatment, payment, and health care operations disclosures). The first request in a 12-month period is free. Additional requests may incur a reasonable fee.

4. Right to Request Restrictions

You may request restrictions on certain uses and disclosures. I am not required to agree, except that if you pay in full out-of-pocket for a service, you may request that I not disclose information about that service to your health plan, and I must honor that request.

5. Right to Confidential Communications

You may request that I contact you in a specific way (e.g., specific phone number, email, mailing address). I will accommodate reasonable requests.

6. Right to a Paper Copy of This Notice

You may request a paper copy at any time, even if you agreed to receive it electronically.

 

VIII. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

Magic Valley Behavioral Health, PLLC
Kelsie Hendrickson, Ph.D., ABPP
493 Eastland Drive
Twin Falls 83301
Phone: 208-494-6824
Email: khendrickson@mvbh.org

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

You will not be retaliated against for filing a complaint.

 

EFFECTIVE DATE

This Notice is effective as of: February 16, 2026.

Version 2026.1

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ACKNOWLEDGMENT OF RECEIPT

By electronically signing below, I acknowledge that I have received a copy of this Notice of Privacy Practices.

Client Name: ___________________________
Signature (Electronic): ___________________________
Date: ___________________________