Notice of Privacy Practices

Effective Date: September 15, 2026

Amplify Your Narrative PLLC

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.

Our Responsibilities

Amplify Your Narrative PLLC is required by law to maintain the privacy and security of your protected health information (PHI), provide you with this Notice describing our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

We will not use or disclose your health information except as described in this Notice unless you authorize us in writing. If you provide written authorization, you may revoke that authorization in writing at any time, except to the extent that we have already acted in reliance on it.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities in helping you exercise them.

Get an Electronic or Paper Copy of Your Health Record

You may ask to see or obtain an electronic or paper copy of your health record and other health information we maintain about you.

We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee as permitted by law.

In limited circumstances, we may deny access to certain information as permitted by law.

Ask Us to Correct Your Health Record

You may ask us to correct health information about you that you believe is incorrect or incomplete.

We may deny your request in certain circumstances, but we will explain the reason for the denial in writing, generally within 60 days.

Request Confidential Communications

You may ask us to contact you in a specific way, such as by phone or email, or to send communications to a different address.

We will accommodate reasonable requests.

Ask Us to Limit What We Use or Share

You may ask us not to use or disclose certain health information for treatment, payment, or health care operations.

We are generally not required to agree to your request.

If you pay for a health care service in full out of pocket, you may ask us not to disclose information about that service to your health plan for payment or health care operations. We will honor that request unless disclosure is required by law.

Get a List of Disclosures

You may request an accounting of certain disclosures of your health information made during the six years before the date of your request.

The accounting will not include certain disclosures, such as disclosures made for treatment, payment, or health care operations or disclosures that you specifically authorized.

We will provide one accounting during any 12-month period at no charge. We may charge a reasonable, cost-based fee for additional requests during the same 12-month period.

Get a Copy of This Notice

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

An electronic copy is also available on the Amplify Your Narrative website.

Choose Someone to Act for You

If you have given someone medical power of attorney, or if someone is otherwise legally authorized to act on your behalf, that person may exercise your rights and make choices regarding your health information.

We will verify that the individual has appropriate authority before taking action.

File a Complaint

If you believe your privacy rights have been violated, you may file a complaint directly with Amplify Your Narrative PLLC using the contact information provided below.

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

Amplify Your Narrative PLLC will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your preferences about what we share.

If you have a clear preference about how we share information in the situations described below, please tell us what you want us to do. We will follow your instructions when permitted by law.

These situations may include:

• Sharing information with family members, close friends, or others involved in your care or payment for your care.

• Sharing information in a disaster relief situation.

• Contacting you regarding certain services or treatment alternatives.

If you are unable to tell us your preference, such as during an emergency, we may disclose information when we determine that doing so is in your best interest and is permitted by law.

Uses and Disclosures of Your Health Information

We may use and disclose your health information for certain purposes without obtaining your written authorization.

Treatment

We may use and disclose your health information to provide, coordinate, or manage your care.

For example, with appropriate legal authority, we may communicate with another health care professional involved in your treatment to coordinate your care.

Payment

We may use and disclose your health information for activities necessary to obtain payment for services.

For example, if you request documentation for out-of-network reimbursement, we may provide information necessary to support that process as authorized or permitted by law.

Health Care Operations

We may use and disclose your health information to operate the practice, improve services, and manage administrative activities.

For example, information may be used for quality assessment, compliance activities, business management, or professional consultation as permitted by law.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose your health information without your authorization when permitted or required by law. Depending on the circumstances, these may include:

Preventing or Reducing a Serious Threat to Health or Safety

We may disclose health information when necessary and permitted by law to prevent or reduce a serious and imminent threat to your health or safety or the health or safety of another person.

Reporting Abuse, Neglect, or Exploitation

We may disclose information when required or permitted by law regarding suspected abuse, neglect, exploitation, or other circumstances subject to mandatory reporting requirements.

Public Health and Safety Activities

We may disclose health information for certain public health activities when authorized or required by law.

Health Oversight Activities

We may disclose information to authorized agencies for legally permitted oversight activities, such as audits, investigations, inspections, licensing, or disciplinary proceedings.

Judicial and Administrative Proceedings

We may disclose health information in response to certain court or administrative orders, subpoenas, discovery requests, or other lawful processes when the requirements of applicable law have been satisfied.

Law Enforcement

We may disclose health information for certain law enforcement purposes when permitted or required by law.

Workers' Compensation

We may disclose health information as authorized by and to the extent necessary to comply with workers' compensation laws or similar programs.

When Required by Law

We may use or disclose your health information when federal, state, or other applicable law requires us to do so.

Uses and Disclosures Requiring Your Written Authorization

For uses and disclosures not otherwise permitted or required by law, we will obtain your written authorization.

We will obtain authorization when required by law before using or disclosing psychotherapy notes.

We will also obtain authorization when required for marketing purposes or for a sale of protected health information.

You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on that authorization.

Mental Health Information and Other More Protective Laws

Certain health information may receive additional protection under federal or state law, including some mental health records and other specially protected information.

When another applicable law provides greater privacy protection than HIPAA, Amplify Your Narrative PLLC will follow the more protective requirement.

Electronic Communications and Telehealth

Because Amplify Your Narrative PLLC provides virtual services, health information may be created, received, maintained, or transmitted electronically.

We use administrative, technical, and physical safeguards designed to protect electronic protected health information and use service providers that are intended to support applicable privacy and security requirements where required.

No method of electronic communication or data transmission can be guaranteed to be completely risk free.

Changes to This Notice

Amplify Your Narrative PLLC may change the terms of this Notice and its privacy practices.

Changes may apply to health information we already maintain as well as information we receive in the future.

When material changes are made, an updated Notice will be made available upon request and posted on the Amplify Your Narrative website.

Questions or Complaints

If you have questions about this Notice, would like to exercise your privacy rights, or believe your privacy rights have been violated, please contact:

Amplify Your Narrative PLLC
Attn: Privacy Officer, Trinity Perry, LPC
1500 N Grant St, Ste N
Denver, CO 80203
Phone: 983.218.2298
Email: trinity@amplifyyournarrative.com

You may also submit a complaint to:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775

Complaints may also be submitted through the U.S. Department of Health and Human Services Office for Civil Rights complaint process.

Amplify Your Narrative PLLC will not retaliate against you for filing a complaint.