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10432 Balls Ford Road Ste 300 Manassas, Virginia 20109
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Galaxy Behavioral Health

Notice of Privacy Practices

Galaxy Behavioral Health
10432 Balls Ford Road, Ste 300, Manassas, VA 20109
Effective Date: June 1, 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.

  1. Our Commitment to Your Privacy

We understand that your health information is personal. We are required by law to maintain the privacy of your Protected Health Information (PHI), to provide you with this notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI.

  1. How We May Use and Disclose Your Health Information

We may use and share your health information for the following purposes without your express written authorization:

  • Treatment: We use your PHI to provide, coordinate, or manage your mental health care. For example, your provider may consult with another specialist or your primary care physician.
  • Payment: We use your PHI to bill and collect payment from you, an insurance company, or another third party. This includes determining eligibility for benefits.
  • Health Care Operations: We use your PHI to run our practice and ensure you receive quality care. Examples include quality assessment, internal audits, and staff evaluations.
  • Required by Law: We will disclose PHI when required by federal, state, or local law.
  • Public Safety & Health: We may disclose PHI to prevent a serious threat to your health and safety or the safety of the public. Under Virginia law, if you communicate a specific and immediate threat of serious bodily injury or death to an identified person, we have a duty to protect/warn.
  • Abuse and Neglect: We are mandated reporters under Virginia law for suspected child abuse, neglect, or elder abuse.
  1. Uses That Require Your Written Authorization

For any use or disclosure not described above, we must obtain your written authorization. Specifically:

  • Psychotherapy Notes: Most uses and disclosures of psychotherapy notes require your authorization.
  • Marketing: We will not use or sell your PHI for marketing purposes without your permission.
  1. Your Rights Regarding Your PHI
  • Right to Inspect and Copy: You have the right to inspect and obtain a copy of your mental health and billing records, usually within 30 days. We may charge a reasonable, cost-based fee.
  • Right to Amend: If you feel the information we have is incorrect, you may ask us to amend it. We may deny this request if the information is accurate or was not created by us, but we will provide a written explanation.
  • Right to an Accounting of Disclosures: You can ask for a list of times we shared your PHI for reasons other than treatment, payment, or operations.
  • Right to Request Restrictions: You can ask us not to use or share certain PHI for treatment or payment. We are not required to agree, except if you pay for a service out-of-pocket in full and request we not share that info with your health insurer.
  • Right to Confidential Communications: You can ask us to contact you in a specific way (e.g., home phone only) or at a specific address.
  1. Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

CONTACT INFORMATION

For questions about this notice or to exercise your privacy rights, please contact our designated Privacy Officer:

Privacy Officer
Galaxy Behavioral Health
10432 Balls Ford Road Ste 300
Manassas, VA
Phone: 571-279-8264
Fax: 571-376-6540
Email: [email protected]