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.
Effective date: October 14, 2026
This is a summary of our privacy practices. A paper copy of the full notice is available at the clinic on request, and we will give you one at your first visit.
What this notice covers
Kiyla Mental Clinic, LLC protects patients’ medical, psychiatric, behavioral health, and substance use disorder information in accordance with HIPAA, applicable Kentucky BHSO/AODE requirements, and 42 CFR Part 2 where it applies.
Protected information includes identifying details, diagnoses, treatment plans, medications, laboratory results, clinical notes, insurance, and billing records.
Substance use disorder records carry stricter protection than HIPAA alone. 42 CFR Part 2 limits when they can be disclosed, including to family, employers, and law enforcement, and generally requires your specific written consent.
How your information is used and disclosed
Information may be used or disclosed for treatment, payment, health care operations, or as otherwise permitted or required by law.
Written authorization, or Part 2 consent, is obtained where it is required — including for certain sensitive records, for marketing, and for psychotherapy notes. You can withdraw an authorization in writing at any time.
Your rights
- Request access to your records, and a copy of them
- Request an amendment if you believe something is wrong
- Ask us to communicate with you confidentially — a different phone number or address, for instance
- Request restrictions on certain disclosures
- Receive an accounting of applicable disclosures
- Receive a paper copy of the full notice
- Be notified if your information is involved in a breach
Our duties
The clinic maintains safeguards for your information, limits access to authorized personnel, retains records as legally required, and provides breach notification where that is required. We are required to abide by the terms of the notice currently in effect.
Complaints
You may file a privacy complaint with the clinic, and you will not be retaliated against for doing so. Contact the Privacy Officer below.
You may also complain to the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr/complaints.
Privacy Officer
Pascaline Jumbuin, PMHNP-BC
Phone: (859) 303-5794
Email: pjumbuin@kiylamc.com
A note about this website
This website does not collect health information. The contact form asks only for your name, contact details, and when you would like to be called. Please do not send symptoms, diagnoses, medications, or other health details through the form or by email — neither is a secure channel.