Notice Of Privacy Practices
Effective Date: September 15, 2026
This notice describes how medical and mental health information about you may be used and disclosed and how you can obtain access to that information.
Please review it carefully.
Commonwealth Center for Behavioral Medicine, PLLC (“CCBM”) is required by law to maintain the privacy of protected health information (“PHI”), provide you with this Notice of Privacy Practices, and follow the privacy practices described in the notice currently in effect.
This Notice applies to PHI created or maintained by CCBM in connection with your clinical care.
Your Rights
You have the right to:
Obtain a copy of your health information
You may request access to your health information and may request a paper or electronic copy, subject to applicable law and certain limited exceptions.
Request correction
You may ask us to correct health information that you believe is inaccurate or incomplete. We may deny a request in certain circumstances, but we will provide a written explanation if we do so.
Request confidential communications
You may ask us to contact you in a particular way or at a particular location.
For example, you may request that we contact you by telephone rather than email or communicate with you at an alternative mailing address.
We will accommodate reasonable requests as required by law.
Request restrictions
You may ask us to limit how we use or disclose your health information.
We are not required to agree to every request.
However, if you pay for a service completely out of pocket and request that we not disclose information concerning that service to your health plan for payment or health care operations, we generally must honor that request unless disclosure is required by law.
Receive an accounting of certain disclosures
You may request a list of certain disclosures of your health information made by CCBM during the preceding six years, subject to exceptions provided by law.
Obtain a copy of this Notice
You may request a paper copy of this Notice at any time.
The current version will also be available on the CCBM website.
Choose someone to act for you
If another person has legal authority to act on your behalf, that person may exercise your privacy rights as permitted by law.
File a complaint
You may file a complaint with CCBM if you believe your privacy rights have been violated.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
CCBM will not retaliate against you for filing a privacy complaint.
How We May Use and Disclose Your Health Information
We may use and disclose PHI without your written authorization when permitted by HIPAA and applicable law.
Treatment
We may use or disclose your health information to provide, coordinate, or manage your care.
For example, with appropriate authorization or as otherwise permitted by law, we may communicate with another healthcare professional involved in your treatment.
Payment
We may use and disclose information as necessary to obtain payment for services.
Because CCBM operates as an out-of-network provider, this may include providing information necessary for you or an insurer to process an out-of-network claim or reimbursement request.
Health Care Operations
We may use and disclose PHI for activities necessary to operate our practice, improve services, conduct quality-related activities, maintain records, and perform other permitted health care operations.
Required by Law
We may disclose health information when federal, state, or local law requires us to do so.
Public Health
We may disclose information for public health activities when permitted or required by law.
Abuse, Neglect, or Domestic Violence
We may disclose information to appropriate authorities when required or permitted by law concerning suspected abuse, neglect, or domestic violence.
Health Oversight
We may disclose information to appropriate government agencies for activities authorized by law involving oversight of healthcare systems or providers.
Judicial and Administrative Proceedings
We may disclose health information in response to appropriate legal proceedings or orders when permitted by law.
Law Enforcement
We may disclose information to law enforcement in circumstances permitted or required by applicable law.
Serious Threats to Health or Safety
We may use or disclose information when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, when permitted by law.
Specialized Government Functions
We may disclose information for certain specialized government functions when permitted by law.
Workers' Compensation
We may disclose health information as necessary to comply with workers' compensation laws and other similar programs.
Uses and Disclosures Requiring Your Authorization
Except as otherwise permitted or required by law, CCBM will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice.
For example, your authorization generally will be required for:
Most uses and disclosures of psychotherapy notes
Certain uses or disclosures for marketing
Sale of PHI
Other uses or disclosures not otherwise permitted by law
You may revoke an authorization in writing at any time, except to the extent CCBM has already relied upon it.
Mental Health and Psychotherapy Information
Mental health information receives important protections under federal and Massachusetts law.
Psychotherapy notes maintained separately from the rest of your clinical record generally receive additional protection under HIPAA and may not be disclosed without your authorization except in limited circumstances permitted by law.
Other information contained in your clinical record may be used or disclosed as permitted by HIPAA and applicable law.
Massachusetts law also recognizes confidentiality protections for patient records and communications.
Minors and Personal Representatives
When CCBM provides services to children or adolescents, privacy rights and authority to access information may depend on the minor's age, the nature of the service, applicable Massachusetts law, and the circumstances of treatment.
CCBM will follow applicable federal and Massachusetts requirements concerning parental access, confidentiality, consent, and personal representatives.
Because these rules can vary based on the circumstances, CCBM will address questions about a minor's records and confidentiality individually rather than applying a blanket rule to all adolescents.
Our Responsibilities
CCBM is required to:
Maintain the privacy and security of your PHI
Provide you with this Notice describing our legal duties and privacy practices
Follow the terms of the Notice currently in effect
Notify affected individuals as required by law following a breach of unsecured PHI
Comply with applicable federal and state privacy requirements
CCBM will not use or disclose your PHI other than as described in this Notice or as otherwise permitted or required by law unless you provide written authorization.
Massachusetts Privacy Protections
CCBM is based in Massachusetts and is subject to applicable Massachusetts privacy and confidentiality requirements in addition to federal HIPAA requirements.
Massachusetts regulations also establish standards for safeguarding certain personal information, including administrative, technical, and physical safeguards designed to protect against unauthorized access and use.
Where Massachusetts law provides greater protection than federal law, CCBM will comply with the applicable legal requirements.
Changes to This Notice
CCBM may revise this Notice from time to time.
If we materially change our privacy practices, we will update this Notice and make the revised version available as required by law.
The current Notice will be posted on the CCBM website.
Questions or Privacy Complaints
If you have questions about this Notice or believe your privacy rights have been violated, you may contact:
Privacy Contact
Commonwealth Center for Behavioral Medicine, PLLC
29 N. Main St., Ste. 3 #3
Sherborn, MA 01770
(617)-299-9224
crutt@ccbmed.com
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
HHS Office for Civil Rights Complaint Information
CCBM will not retaliate against you for filing a complaint.