Notice of Privacy Practices

Last updated February 19, 2026.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Two Rivers Neuropsychology LLC (“the Practice”) is required by federal law to protect the privacy of your Protected Health Information (“PHI”) and to provide you with this Notice describing our legal duties and privacy practices.

PHI includes information that identifies you and relates to your health condition, evaluation, treatment, or payment for services.

YOUR RIGHTS

You have the following rights regarding your PHI:

Right to Inspect and Receive a Copy

You may request a copy of your health information in paper or electronic form. A reasonable, cost-based fee may apply.

In limited circumstances, we may deny access (for example, if access would endanger you or another person). You may request a review of certain denials.

Right to Request an Amendment

If you believe information in your record is incorrect or incomplete, you may request an amendment in writing. We may deny the request if the information is accurate and complete or was not created by this Practice. You will receive a written explanation if denied.

Right to Request Confidential Communications

You may request that we contact you in a specific manner (e.g., at a certain phone number or address). We will accommodate reasonable requests.

Right to Request Restrictions

You may request restrictions on how your PHI is used or disclosed for treatment, payment, or operations. We are not required to agree to most restrictions.

However, if you pay for a service in full out-of-pocket, you may request that we not disclose information about that service to your health insurer, and we will comply unless required by law.

Right to an Accounting of Disclosures

You may request a list of certain disclosures of your PHI made outside of treatment, payment, and healthcare operations. One accounting per 12-month period is provided at no charge.

Right to a Copy of This Notice

You may request a paper copy of this Notice at any time.

Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with:

Two Rivers Neuropsychology LLC
6165 NW 86th St, Ste. 209
Johnston, IA 50131
Phone: 515-220-2747

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

We use and disclose PHI in the following ways:

1. Treatment

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

Example: Communicating with your referring physician regarding evaluation results.

2. Payment

We may use and disclose PHI to obtain payment for services, including submitting claims to insurance carriers or verifying benefits.

If you are self-pay, limited billing-related information may still be maintained for accounting and compliance purposes.

3. Healthcare Operations

We may use PHI to operate and improve the Practice, including:

  • Quality assurance

  • Professional consultation

  • Training

  • Legal compliance

  • Appointment reminders

4. Uses and Disclosures Required or Permitted by Law

We may disclose PHI without your authorization when required or permitted by law, including:

  • Public health reporting

  • Health oversight activities

  • Abuse or neglect reporting

  • Court orders or lawful subpoenas

  • Law enforcement requests permitted by law

  • Workers’ compensation claims

  • To prevent a serious and imminent threat to health or safety

5. Individuals Involved in Your Care

Unless you object, we may share relevant information with individuals involved in your care (e.g., a spouse assisting with scheduling or payment). You may restrict this at any time.

6. Business Associates

We use secure third-party service providers who perform services on our behalf (such as electronic health records, secure email, billing platforms, and website hosting). These entities are required by law to safeguard your information.

7. Uses Requiring Your Written Authorization

We will obtain your written authorization for:

  • Marketing communications not otherwise permitted

  • Sale of PHI

  • Most disclosures of psychotherapy notes

You may revoke an authorization in writing at any time.

PSYCHOTHERAPY NOTES

Psychotherapy notes, if maintained separately from the clinical record, receive special protection under federal law and are not disclosed without your specific written authorization, except in limited circumstances required by law.

OUR RESPONSIBILITIES

We are required by law to:

  • Maintain the privacy and security of your PHI

  • Provide you with this Notice

  • Abide by the terms of the Notice currently in effect

  • Notify you if a breach of unsecured PHI occurs

We reserve the right to revise this Notice. Revised versions will apply to all PHI we maintain and will be available upon request and on our website.

CONTACT INFORMATION

If you have questions about this Notice, please contact:

Two Rivers Neuropsychology LLC
6165 NW 86th St, Ste. 209
Johnston, IA 50131
Phone: 515-220-2747e website.