NOTICE OF PRIVACY PRACTICES
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.
This Notice applies to Compass Cognition, LLC and Hannah Buck, Psy.D., HSPP (“we,” “us,” or “the practice”). Effective date: July 1, 2026
We are required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice describing our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.
How We May Use and Disclose Your Health Information Without Your Written Authorization
The following categories describe ways we may use and disclose your health information without first obtaining your written authorization. Not every permitted use or disclosure is listed.
Treatment: We may use and disclose your health information to provide, coordinate, or manage your evaluation and related care, including sharing information with health care providers involved in your care when permitted by law. This may include sharing your evaluation report with your referring physician or surgeon as described in your Informed Consent.
Payment: We may use and disclose your health information to obtain payment for services, including submitting claims to Medicare, responding to health-plan requests related to payment or coverage, providing information needed for out-of-network reimbursement, and communicating with billing or collection services as permitted by law.
Health Care Operations: We may use and disclose your health information for activities necessary to operate the practice, such as quality assessment, professional review, staff training, licensing or accreditation activities, compliance activities, and business planning.
Business Associates: We may disclose PHI to business associates that provide services on our behalf, including electronic health record, billing, administrative, or documentation-support services. When required by HIPAA, we maintain written agreements requiring these business associates to appropriately safeguard PHI.
Persons Involved in Your Care or Payment for Your Care: When permitted by law, we may share relevant health information with a family member, personal representative, or other person involved in your care or payment for your care. When appropriate, we will give you an opportunity to agree or object to the disclosure.
As Required by Law: We may disclose your health information when required to do so by federal, state, or local law.
Public Health and Safety: We may disclose health information to authorized public health authorities for activities such as preventing or controlling disease, injury, or disability. We may also make reports concerning suspected abuse, neglect, or other matters when required or permitted by law.
Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, or licensing actions.
Judicial and Administrative Proceedings: We may disclose your health information in connection with a judicial or administrative proceeding when the requirements of applicable law are satisfied, including in response to certain court orders, subpoenas, or other lawful processes.
Law Enforcement: We may disclose health information to law enforcement officials when permitted or required by law and when applicable legal requirements are satisfied.
To Avert a Serious Threat to Health or Safety: We may use or disclose your health information when permitted by law and reasonably necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Workers’ Compensation: We may disclose your health information as authorized by and to the extent necessary to comply with workers’ compensation laws or similar programs.
Appointment Reminders and Practice Communications: We may contact you to provide appointment reminders or information related to your care, treatment alternatives, health-related services, or practice policies.
Other Permitted or Required Disclosures: When permitted or required by law, we may also use or disclose health information for other purposes, including certain research activities, disclosures to coroners or medical examiners, organ or tissue donation purposes, and certain specialized government functions.
Uses and Disclosures Requiring Your Written Authorization
Uses and disclosures of your health information that are not otherwise permitted or required by law will be made only with your written authorization.
Written authorization is generally required for most uses and disclosures of psychotherapy notes, uses of PHI for marketing purposes, and disclosures that constitute a sale of PHI, when those provisions apply.
If you provide written authorization, you may revoke it in writing at any time, except to the extent that we have already acted in reliance on the authorization.
Your Rights Regarding Your Health Information
Right to Request Restrictions: You may ask us to restrict certain uses or disclosures of your health information for treatment, payment, or health care operations. We are generally not required to agree to a requested restriction.
However, if you pay in full out of pocket for a health care service and request that we not disclose information about that service to your health plan for payment or health care operations, we will honor the restriction when required by law.
Right to Request Confidential Communications: You may ask us to communicate with you about your health information in a specific way or at a specific location, such as through a particular telephone number or mailing address. We will accommodate reasonable requests as required by law.
Right to Inspect and Copy: You have the right to inspect or obtain a copy of protected health information maintained in your designated record set, subject to certain exceptions provided by law. We may require requests for access to be submitted in writing and may verify your identity before releasing records.
Certain information may be subject to different access rules, including psychotherapy notes and information prepared for certain legal proceedings. Psychological test data may be included in records subject to your right of access. Psychological test materials may be subject to additional legal, ethical, proprietary, or test-security restrictions.
We may charge a reasonable, cost-based fee as permitted by applicable law and will inform you of any applicable fee before processing your request.
Right to Amend: You may ask us to amend health information in your record if you believe it is incorrect or incomplete. Requests must be submitted in writing. We may deny a request under circumstances permitted by law and, when required, will provide a written explanation of the denial.
Right to an Accounting of Disclosures: You may request an accounting of certain disclosures we have made of your health information. The accounting generally does not include disclosures for treatment, payment, or health care operations, disclosures made directly to you, or disclosures made pursuant to your written authorization, as provided by law.
Right to a Paper 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.
Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with Compass Cognition, LLC or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
Our Responsibilities
We are required by law to maintain the privacy of your protected health information and to provide you with this Notice.
We are required to follow the terms of the Notice currently in effect.
We reserve the right to change the terms of this Notice and to make a revised Notice effective for all PHI we maintain, including information created or received before the change.
If we make a material change to our privacy practices, an updated Notice will be made available as required by law.
We will notify you following a breach of unsecured PHI when notification is required by law.
Questions or Complaints
If you have questions about this Notice or wish to file a privacy complaint, please contact:
Hannah Buck, Psy.D., HSPP
Privacy Officer
Compass Cognition, LLC
70 E 91st Street, Suite 100
Indianapolis, IN 46240
317-348-6590
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, through its complaint process.