HIPAA Notice

Effective Date: 08/03/2026

At Beacon Psychological Services, LLC, we understand that seeking psychological services requires trust. Protecting your privacy is an important part of that trust. This Notice explains how your Protected Health Information (PHI) may be used and disclosed, your rights regarding your health information, and our responsibilities under the Health Insurance Portability and Accountability Act (HIPAA).

Additional information about HIPAA is available from the U.S. Department of Health and Human Services at www.hhs.gov.

Your Rights

You have important rights regarding your PHI.

Access Your Records

You have the right to inspect or request a paper or electronic copy of your clinical record, subject to applicable federal and Colorado law.

Requests are generally fulfilled within 30 days. In certain situations, a reasonable cost-based fee may apply.

A Note About Psychological Testing Records

If you receive psychological assessment services, your record may include an evaluation report as well as raw test data and standardized test materials.

Evaluation reports are provided to you and may be released according to your written authorization. Standardized test materials, including test questions, protocols, and manuals, are protected by copyright and by professional standards governing test security, and may be withheld or released only in accordance with applicable law, publisher requirements, and professional standards regarding test security.

Raw test data may be released to you or to another qualified professional you designate, consistent with applicable law and professional standards. We are happy to discuss these distinctions with you at any point during the assessment process.

Request a Correction

If you believe information in your record is inaccurate or incomplete, you may request that it be corrected.

While we will carefully review every request, federal law allows us to deny certain requests. If this occurs, you will receive a written explanation.

Request Confidential Communication

You may request that we communicate with you in a specific way, such as:

  • Calling only a particular phone number

  • Sending mail to a different address

  • Communicating through an agreed-upon secure method

We will accommodate all reasonable requests whenever possible.

Request Restrictions

You may ask us to limit how your PHI is used or disclosed.

Although we are not required to agree to every request, we will carefully consider your preferences.

If you pay for services entirely out-of-pocket, you may request that we not disclose information about those services to your health insurance company unless disclosure is otherwise required by law.

Request an Accounting of Disclosures

You may request a list of certain disclosures of your PHI made during the previous six years.

One accounting per year is provided at no cost. Additional requests may involve a reasonable fee.

Receive a Copy of This Notice

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

Designate a Personal Representative

If another individual has legal authority to make healthcare decisions on your behalf (such as through a medical power of attorney or legal guardianship), that individual may exercise your rights regarding your PHI.

File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with Beacon Psychological Services, LLC.

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

You will never be penalized or retaliated against for filing a complaint.

How Your Information May Be Used

Your PHI is used only as necessary to provide quality psychological care and operate our practice responsibly.

Examples include:

Treatment and Assessment

We may use or disclose your information to provide psychotherapy or psychological assessment services, and to coordinate your care with other healthcare professionals when appropriate and with your authorization or as otherwise permitted by law.

Payment

We may disclose necessary information to process payment for services. If you elect to use insurance benefits, this may include disclosing information required to submit and process claims.

Healthcare Operations

We may use your information for activities such as quality improvement, scheduling, record keeping, licensing, accreditation, and practice management.

Other Uses and Disclosures

Federal and state laws permit or require certain disclosures without your authorization, including:

  • When required by law

  • To report suspected abuse or neglect

  • To prevent a serious threat to health or safety

  • For certain public health activities

  • In response to court orders or subpoenas

  • For health oversight activities

  • For workers’ compensation claims when applicable

Whenever possible, Beacon Psychological Services, LLC limits disclosures to the minimum necessary information.

Uses Requiring Your Written Authorization

Except where permitted or required by law, we will not disclose your information without your written authorization.

This includes:

  • Marketing purposes

  • Sale of PHI

  • Most disclosures of psychotherapy notes

  • Release of assessment reports to schools, employers, attorneys, or other third parties

  • Other uses not described in this Notice

You may revoke your authorization at any time in writing unless action has already been taken based on your previous authorization.

Our Responsibilities

Beacon Psychological Services, LLC is committed to safeguarding your information.

We are required by law to:

  • Maintain the privacy and security of your PHI.

  • Provide you with this Notice of Privacy Practices.

  • Follow the privacy practices described in this Notice.

  • Notify you without unreasonable delay, and in no case later than 60 days following discovery, if a breach occurs that may compromise the privacy or security of your unsecured PHI.

  • Comply with all applicable federal and Colorado privacy laws.

We do not sell your PHI.

Changes to This Notice

We reserve the right to revise this Notice as laws or practice policies change.

Any revised Notice will apply to all PHI maintained by Beacon Psychological Services, LLC and will be available in our office and on our website.

Questions

If you have questions regarding this Notice or your privacy rights, please contact:

Beacon Psychological Services, LLC 7222 Commerce Center Drive, Suite 255, Colorado Springs, CO 80919 (719) 492-5556 keithkutnarpsyd@gmail.com