HIPAA Notice of Privacy Practices

Effective: 10/22/2025

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.

Purpose of This Form

Bloom Therapy Collective is committed to safeguarding your child’s health information and complies with the Health Insurance Portability and Accountability Act (HIPAA) and applicable state laws, including those specific to Colorado. Please read the following policy to understand how your child’s Protected Health Information (PHI) will be used, disclosed, and protected during their treatment with us.

I. Protected Health Information (PHI)

PHI refers to any information related to your child’s health, treatment, or payment for healthcare services that can be used to identify them. This includes medical records, treatment plans, therapy notes, and any other personal information.

II. Use and Disclosure of PHI

We will use and disclose your child’s PHI for the following purposes:

  • Treatment: To coordinate care with other healthcare providers.

  • Payment: To process payments or for billing purposes. 

  • Healthcare Operations: For administrative tasks, quality improvement, and legal compliance.

We will not disclose PHI to any third party without your written authorization, except where required or allowed by law, including emergency situations or mandated reporting.  Other situations where information may be shared without your written authorization include disclosures to certain Business Associates (as more fully described below), health oversight activities, or to avert a serious and imminent threat of harm to your child.

III. Your Rights Regarding PHI

You have the right to:

  • Access your child’s PHI: You can request and/or inspect a copy of the records we maintain about your child.

  • Accounting of disclosures: You may request to receive an accounting of all disclosures of your child’s PHI.

  • Request amendments: If you believe any PHI is inaccurate or incomplete, you can request that it be amended.

  • Request restrictions: You can ask that we limit how we use or disclose your child’s PHI. While we are not required to agree to all restrictions, we will consider them carefully.

  • Revoke authorization: You may revoke the authorization to use or disclose your child’s PHI.  As stated above regarding any restrictions you may request, we may not be able to agree to any revocations where disclosure is required by law, judicial order, or for your child’s imminent safety.

  • Confidential communications: You may request we contact you using alternative methods.

IV. Security and Safeguarding of PHI

We employ various safeguards to ensure the privacy and security of your child’s PHI, including:

  • Physical safeguards: Secured offices, locked files, and restricted access.

  • Administrative safeguards: Staff training, regular audits, and privacy protocols.

  • Technical safeguards: HIPAA compliant digital records via Google Workspace (BAA signed), password protections, and secure servers.

V. Retention of PHI

Your child’s PHI will be stored for the duration of their treatment with us and for a period of 7 years following the conclusion of treatment. After this period, PHI will be securely disposed of or anonymized in accordance with applicable regulations.

VI. Employee Training and Privacy Practices

All employees and contractors of Bloom Therapy Collective are required to complete HIPAA privacy training. This includes training on the handling of PHI, confidentiality requirements, and procedures for reporting any violations. Training is conducted annually to ensure compliance with current HIPAA regulations and best practices.

VII. Colorado-Specific Laws

In addition to federal HIPAA regulations, Colorado law has specific privacy protections for health information:

  • Colorado Consumer Protection Act: We are required to notify patients if there is a breach of personal information, including health data.

  • Colorado’s Health Information Privacy Law: This law imposes stricter standards on the handling of health information and ensures that patients have additional rights in accessing and controlling their health data.

We ensure that our practices comply with all relevant state regulations in Colorado, providing you with the highest level of privacy protection.

VIII. Complaints

You have the right to file a complaint with Bloom Therapy Collective and to the Secretary of the U.S. Department of Health and Human Services regarding the handling of your child’s PHI.  Please send all complaints directed to Bloom Therapy Collective to the following address:

Attn: Hannah Pereira

Bloom Therapy Collective
PO Box 1402

Arvada, CO 80001

hannah@bloom-therapycollective.com

IX. Notice of Privacy Practices (NPP)

You have the right to a copy of our Notice of Privacy Practices (NPP), which provides a detailed explanation of how your child’s PHI will be used and your rights under HIPAA and Colorado law. By signing below, you acknowledge receipt of the NPP and consent to the use of your child’s PHI for treatment, payment, and healthcare operations.

X. Contact

For further information, please contact our practice at:

Bloom Therapy Collective
PO Box 1402

Arvada, CO 80001

Email: info@bloom-therapycollective.com

Phone: 720-340-8440