Effective Date: January 1, 2026

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.

About This Practice and This Notice

Wildflower Peaks Mental Health, led by January Sadler, MSN, APRN, PMHNP-BC, provides psychiatric medication management and psychotherapy services by telehealth. This Notice explains how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, and healthcare operations, and describes categories of information — such as psychotherapy notes and controlled-substance prescribing records — that carry additional legal protection beyond the rest of your medical record.

How we may use and disclose your health information How We May Use and Disclose your Health Inforamation

For Treatment:

• Conducting psychiatric evaluations, prescribing and adjusting medications, and monitoring your response to treatment.
• Providing individual psychotherapy and coordinating your medication management and therapy care.
• Consulting with your pharmacy, laboratory, or other treating providers involved in your care.
• Consulting with another qualified professional for case consultation or coverage during a provider absence.

For Payment

• Billing you or your insurance company for services rendered.
• Verifying insurance eligibility and benefits.
• Providing invoices or superbills for out-of-network reimbursement.

For Healthcare Operations:

• Quality assessment and improvement activities.
• Licensing, credentialing, and accreditation activities.
• Business planning, audits, and administrative functions.

Medication Management – Additional Disclosure (Arizona Law)

When prescribing controlled substances, Arizona law (A.R.S. § 36-2606) requires us to report prescription information to, and in many cases to check, the Arizona Controlled Substances Prescription Monitoring Program (CSPMP), a state-run database. This means limited prescription information is disclosed to and may be accessed through this state system as required by law, independent of your authorization. We may also share medication information directly with your pharmacy to process prescriptions.

Psychotherapy Notes – Special Protection

If you receive psychotherapy from us, we may keep separate, more detailed notes from your therapy sessions (“psychotherapy notes”) apart from the rest of your medical record. These notes do not include medication information, session start/stop times, treatment plans, test results, or diagnosis — those remain part of your regular record. Psychotherapy notes receive stronger protection under HIPAA than the rest of your record:

• We will not disclose psychotherapy notes for any purpose — including to other providers involved in your treatment — without your specific written authorization.
• Limited exceptions apply: to defend ourselves in a legal action you bring against us, if required by law, for oversight of the originating provider, to avert a serious and imminent threat to your safety or someone else’s, or as needed to meet a mandatory reporting duty (such as suspected abuse or neglect).
• Neither you nor a parent or guardian generally has a right under HIPAA to inspect or obtain a copy of psychotherapy notes, though we may choose to share clinically appropriate information directly with you as part of your care.

Other Permitted or Required Disclosures

We may also disclose PHI, without your authorization, when:

• Required by federal, state, or local law.
• Needed for public health activities, such as reporting to public health authorities.
• We suspect abuse, neglect, or domestic violence.
• Needed for health oversight activities, such as audits, investigations, or licensing actions.
• In response to a valid court order, subpoena, or other lawful process.
• Requested by law enforcement under narrow, legally specified circumstances.
• Necessary to avert a serious and imminent threat to the health or safety of you or another identifiable person.
• Requested by a coroner or medical examiner, as required.
• Related to workers’ compensation, to the extent authorized by law.
• Required for the Arizona CSPMP, as described above.

Any use or disclosure not described in this Notice will only be made with your written authorization, which you may revoke in writing at any time, except to the extent we have already relied on it.

Additional Confidentiality Protections Under Arizona Law

Arizona law (A.R.S. § 36-509) provides behavioral health records with confidentiality protections beyond HIPAA. In particular:

• When you are present and able to take part in the decision, we will share your information with a family member or support person only with your verbal or written agreement, or if you do not object when given the chance to.
• If you are not present or unable to make this decision, we will share only information that is directly relevant, and only when doing so is determined to be in your best interest based on your treatment history and any known risk of harm.
• We keep a record of the name and contact information of anyone to whom information is released under this provision.

Minor Clients

If treatment is provided to a minor, Arizona law (A.R.S. § 36-2272) generally requires the written or oral consent of a parent or legal guardian before mental health screening or treatment may be provided, except in an emergency necessary to prevent serious injury or to save the minor’s life. Where consent is given by telehealth, we will verify the identity of the consenting parent or guardian.

Your Rights Regarding Your Health Information

• Right to Inspect and Copy — you may request to see or receive a copy of your health record; this does not extend to psychotherapy notes.
• Right to Request Amendment — you may ask us to correct information you believe is incomplete or inaccurate.
• Right to Request Restrictions — you may ask us to limit certain uses or disclosures of your information; we are not required to agree, except that we must honor a request not to disclose to your health plan information about a service you paid for in full out of pocket.
• Right to Request Confidential Communications — you may ask us to contact you in a specific way or at a specific location.
• Right to an Accounting of Disclosures — you may request a list of certain disclosures we have made of your information.
• 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.
• Right to Choose Someone to Act for You — if someone has medical power of attorney for you or is your legal guardian, they may exercise these rights on your behalf.
• 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 File a Complaint — if you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health & Human Services Office for Civil Rights. We will not retaliate against you in any way for filing a complaint.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this Notice and provide you a copy of it.
• We will not use or share your information other than as described here unless you tell us in writing that we can; you may revoke that permission in writing at any time, except to the extent we have already relied on it.
• We reserve the right to change the terms of this Notice. Any changes will apply to information we already have as well as information we receive in the future. If we make a material change, we will make the updated Notice available to you.

Contact & Complaints

Wildflower Peaks Mental Health
January Sadler, MSN, APRN, PMHNP-BC
P: (480) 779-0474
E: info@wildflowerpeaksmentalhealth.com

U.S. Department of Health & Human Services, Office for Civil Rights
200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201
Phone: (800) 368-1019
Complaint portal: ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf