Legal · HIPAANotice of Privacy Practices
How medical and mental health information about you may be used and disclosed by PIL Behavioral Health Associates, LLC and how you can access that information.
Effective Date: 06/04/2026
Columbia, South Carolina
Notice of Privacy Practices
PIL Behavioral Health Associates, LLC is required by law to protect the privacy and security of your protected health information, give you this Notice of Privacy Practices, follow the duties and privacy practices described in this Notice, and notify you if a breach occurs that may have compromised the privacy or security of your information.
This Notice: describes how medical and mental health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Contact Information
PIL Behavioral Health Associates, LLC
1320 Main Street, Suite 300, Columbia, SC 29201
Phone / Fax: 803-893-8884
Privacy Contact: Ashley M. Dais, LPC, CEO [or insert designated Privacy Officer]
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get a copy of your medical record
You may ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary of your health information, usually within the time required by law. We may charge a reasonable, cost-based fee.
Ask us to correct your record
You may ask us to correct health information about you that you believe is incorrect or incomplete. We may deny your request, but we will explain the reason in writing.
Request confidential communication
You may ask us to contact you in a specific way, such as at a specific phone number, email address, or mailing address. We will accommodate reasonable requests.
Ask us to limit what we use or share
You may ask us not to use or share certain health information for treatment, payment, or health care operations. We are not always required to agree, but we will consider your request. If you pay for a service fully out of pocket, you may ask us not to share that information with your health plan for payment or operations purposes, and we will agree unless the law requires otherwise.
Get a list of disclosures
You may ask for a list of certain times we have shared your health information, who we shared it with, and why. This is called an accounting of disclosures. This list will not include all disclosures, such as disclosures made for treatment, payment, health care operations, or disclosures you authorized.
Get a copy of this notice
You may ask for a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person may be able to exercise your rights and make choices about your health information. We will verify that the person has authority before taking action.
File a complaint
You may file a complaint if you believe your privacy rights have been violated. You may contact us directly using the contact information in this Notice. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you may tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk with us. We will follow your instructions when we are able and when legally permitted.
You have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care.
Share information in a disaster relief situation.
Contact you for appointment reminders, scheduling, follow-up, or care coordination.
If you are not able to tell us your preference, such as if you are unconscious or in crisis, we may share your information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.
We will not use or share your information for the following purposes unless you give us written permission:
Marketing purposes, except as permitted by law.
Sale of your health information.
Most sharing of psychotherapy notes, if psychotherapy notes are maintained separately from the medical record.
You may revoke an authorization in writing at any time, except to the extent we have already relied on it.
Our Uses and Disclosures
We typically use or share your health information in the following ways:
Treatment
We may use and share your health information to provide, coordinate, or manage your care. Example: We may share information with another mental health or medical provider involved in your treatment, with your permission when required.
Payment
We may use and share your health information to bill and receive payment from health plans, EAP programs, or other responsible payers. Example: We may provide information to your insurance company so it will pay for services.
Health Care Operations
We may use and share your health information to run the practice, improve care, train staff, conduct quality review, complete documentation audits, manage business operations, and contact you when needed. Example: We may use information from your record to review quality of services or improve practice operations.
Other Ways We May Use or Share Your Information
We are allowed or required to share your information in other ways, usually in ways that contribute to public health, safety, legal compliance, or oversight. We must meet legal requirements before doing so.
To help with public health and safety issues, such as preventing disease, reporting suspected abuse or neglect, or preventing or reducing a serious threat to health or safety.
To comply with federal, state, or local law.
For health oversight activities, such as audits, investigations, inspections, licensing, credentialing, and compliance reviews.
For workers’ compensation claims when permitted or required by law.
For law enforcement purposes or with a law enforcement official when permitted or required by law.
To respond to court or administrative orders, subpoenas, discovery requests, or other lawful processes, when legally required or permitted.
For specialized government functions, such as military, national security, or protective services when applicable and legally permitted.
Mental Health, Substance Use, and Sensitive Information
Mental health information is sensitive. We use additional care when handling information related to mental health treatment, trauma history, substance-related concerns, HIV/AIDS status, minors, reproductive health, and other sensitive information. Some information may receive additional protection under federal or state law.
If services or records are subject to additional confidentiality laws, such as 42 CFR Part 2 for certain substance use disorder treatment records, we will follow those requirements when they apply. Not all substance-related counseling or screening information is automatically subject to 42 CFR Part 2. Applicability depends on the nature of the program, services, funding, and records involved. Please ask us if you have questions about whether additional confidentiality protections apply to your records.
Psychotherapy Notes
Psychotherapy notes, if maintained separately from the medical record, receive special protection under HIPAA. We generally may not use or disclose psychotherapy notes without your written authorization, except in limited situations permitted by law, such as for our own training, to defend ourselves in a legal action or proceeding brought by you, for health oversight activities, or when required by law.
Progress notes, treatment plans, diagnosis information, appointment history, billing records, and other information kept as part of the medical record are not the same as psychotherapy notes.
Telehealth and Electronic Communication
PIL Behavioral Health Associates, LLC provides telehealth services. We use reasonable safeguards to protect privacy and security during telehealth services and electronic communication. However, no electronic system can be guaranteed to be completely secure.
Clients are responsible for participating in telehealth sessions from a private, safe location and for using appropriate devices and internet connections. You should not use general email, website forms, or voicemail for emergencies or for highly sensitive clinical information unless instructed to do so through a secure method.
Minors and Personal Representatives
We may provide services to minors with appropriate consent from a parent, guardian, or legally authorized representative as required by law. Parents, guardians, or other representatives may have rights to access a minor’s records depending on applicable law, consent, clinical circumstances, and the minor’s legal rights. We will follow applicable federal and state law when handling requests involving minors or personal representatives.
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 give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you give us permission, you may change your mind at any time by telling us in writing.
Changes to This Notice
We may change the terms of this Notice. The changes will apply to all information we have about you. The new Notice will be available upon request, in our office if applicable, and on our website if we post it there.
Acknowledgment of Receipt
You may be asked to sign an acknowledgment that you received this Notice. Signing the acknowledgment does not mean you agree to any special use or disclosure of your information. If you decline to sign, we will document that the acknowledgment was not obtained.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, please contact:
PIL Behavioral Health Associates, LLC — Attention: Privacy Contact
1320 Main Street, Suite 300, Columbia, SC 29201
Phone / Fax: 803-893-8884
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Client Acknowledgment
I acknowledge that I have received or been offered a copy of the Notice of Privacy Practices for PIL Behavioral Health Associates, LLC.
Client Name
Client / Representative Signature
Relationship to Client, if applicable
Date
Draft template for review. This document should be reviewed for alignment with PBHA policies, informed consent, state law, HIPAA requirements, and any applicable payer or substance-use confidentiality rules before publishing or client use.