Notice of Privacy Practices
Your information. Your rights. Our responsibilities.
Effective Date: November 1st 2026
This Notice describes how medical information about you may be used and disclosed. It also describes how you can access this information. Please review it carefully.
In order to provide you care, Gaines Wellness, PLLC and Brianna Gaines, LCSW (“Provider”) must collect, create, and maintain health information about you. This includes individually identifiable information obtained from you or others that relates to your past, present, or future physical or mental health, the healthcare you have received, or payment for your healthcare.
Provider is required by law to maintain the privacy of this information. This Notice of Privacy Practices (“Notice”) describes how your health information may be used and disclosed and explains certain rights you have regarding this information.
How We Use and Disclose Your Health Information
Gaines Wellness protects your health information from inappropriate use and disclosure. Your health information will be used and disclosed only as permitted or required by applicable law.
Treatment, Payment & Healthcare Operations
Treatment & Care Management
We may use and disclose health information about you to provide treatment and to coordinate and manage your care with other healthcare providers.
Payment
We may use and disclose your health information for payment purposes. This may include determining insurance eligibility and benefits and obtaining payment from insurers or other entities responsible for your healthcare coverage.
Healthcare Operations
We may use and disclose health information to support healthcare operations, including care management, quality improvement, evaluating our performance, administrative activities, and addressing complaints or grievances.
Uses and Disclosures Without Your Authorization
In certain circumstances, your health information may be used or disclosed without your specific written authorization, as permitted or required by law. These circumstances may include:
As Required by Law — To comply with applicable federal, state, or local law.
Public Health Activities — For certain authorized public health activities, including preventing or controlling disease, injury, or disability and certain required reports.
Abuse, Neglect, or Domestic Violence — Information may be disclosed to an appropriate government agency when required or permitted by law.
Health Oversight Activities — Information may be disclosed to authorized federal or state agencies for audits, investigations, inspections, licensing activities, or other legally authorized oversight.
Judicial & Administrative Proceedings — Information may be disclosed in response to an appropriate court or administrative order.
Law Enforcement — Information may be disclosed for certain legally authorized law-enforcement purposes.
Deceased Individuals — Information may be disclosed to coroners, medical examiners, or funeral directors when necessary and authorized by law.
Organ or Tissue Donation — Information may be disclosed to appropriate organ procurement organizations or similar entities.
Research — Information may be used or disclosed for research when appropriate legal requirements and approval processes have been satisfied.
Health or Safety — Information may be disclosed when permitted by law to prevent or lessen certain threats to your health or safety or the health or safety of others.
Specialized Government Functions — Certain disclosures may be made for legally authorized government activities, including appropriate military or national-security purposes.
Workers' Compensation — Information may be disclosed as permitted under workers' compensation laws or similar programs.
Individuals Involved in Your Care — Information may be shared with a family member, relative, close friend, or other person involved in your care when permitted by law and appropriate under the circumstances.
Appointments, Information & Services — We may contact you regarding appointment reminders, treatment alternatives, or other health-related services.
Incidental Uses & Disclosures — Certain limited incidental uses or disclosures may occur as a result of an otherwise permitted use or disclosure.
Specially Protected Information
Uses Requiring Your Authorization
Your Rights Regarding Your Health Information
Certain types of health information may receive additional protection under federal or state law. This may include information related to mental health treatment, substance use disorder treatment, HIV/AIDS status, genetic information, and other specially protected health information.
When additional protections apply, Gaines Wellness will use and disclose the information only as permitted or required by applicable federal and state law, including HIPAA and the laws of the state in which services are provided
Certain uses or disclosures of your health information will be made only with your written authorization. This may include:
Certain uses or disclosures of psychotherapy notes;
Certain marketing purposes; and
Disclosures that constitute a sale of health information under applicable privacy rules.
Your health information will not be used or disclosed for purposes outside those permitted by this Notice unless we obtain the appropriate authorization from you or your legally authorized representative.
If you provide authorization, you may revoke it at any time, subject to applicable legal requirements and except to the extent action has already been taken in reliance on that authorization.
You have certain rights regarding your health information.
Right to Access Your Medical Record
You have the right to inspect or request a copy of health information maintained about you, subject to certain limitations permitted by law. You may be asked to specify the information you would like to receive and your preferred format.
Right to Request Changes
If you believe information in your record is incorrect or incomplete, you may request an amendment. If your requested change is not accepted, you will be notified and informed about how you may have your objection included in the record.
Right to an Accounting of Disclosures
You may request a list of certain disclosures of your health information. Some disclosures, including certain disclosures related to treatment, payment, healthcare operations, or those you specifically authorized, may not be included.
Right to Request Restrictions
You may request restrictions on certain uses and disclosures of your health information. Gaines Wellness may not be required to agree to every requested restriction.
As stated in your existing notice, certain requests involving disclosure to a health plan for services you have paid for in full may be subject to different requirements. Pasted markdown
Right to Request Confidential Communications
You may ask us to communicate with you in a particular way or at a different location. Your request should specify how or where you would prefer to be contacted.
Right to Receive Notification of a Breach
You have the right to receive notification following a breach of unsecured health information when notification is required by applicable privacy law.
Right to a Paper Copy
You may request a paper copy of this Notice of Privacy Practices at any time.
Questions, Requests & Complaints
If you would like to exercise one of the rights described in this Notice, have questions about our privacy practices, or believe your privacy rights have been violated, please contact:
Gaines Wellness, PLLC
Brianna Gaines, LCSW
Email: hello@gaineswellness.com
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services.
You will not be penalized or retaliated against for filing a privacy complaint.
Changes to This Notice
Gaines Wellness may change the terms of this Notice of Privacy Practices as permitted by law. If the Notice changes, the revised terms may apply to health information maintained by the practice, including information created or received before the change.
An updated Notice will be made available as appropriate.