Moonlit Mental
Health
Moonlit Mental Health Privacy Policy
Effective Date: 7/1/2026
Moonlit Mental Health, LLC ("Moonlit Mental Health," "we," "our," or "us") is committed to protecting your privacy and safeguarding your personal information. This Privacy Policy explains how we collect, use, disclose, and protect information obtained through our website.
Information We Collect:
Information You Provide Voluntarily
We may collect information you voluntarily submit through our website, including:
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Name
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Email address
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Phone number
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Date of birth
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Insurance information
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Information provided through contact forms
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Information submitted when requesting appointments
Information Collected Automatically
When you visit our website, we may automatically collect:
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IP address
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Browser type
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Device information
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Pages visited
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Time spent on our website
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Referring website addresses
This information helps us improve website functionality and user experience.
How We Use Your Information
We may use information collected through our website to:
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Respond to inquiries
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Schedule appointments
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Communicate regarding services
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Verify insurance information
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Improve our website and services
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Maintain website security
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Comply with legal and regulatory requirements
HIPAA and Protected Health Information
Moonlit Mental Health complies with applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).
Information submitted through our patient portal or electronic health record system may constitute Protected Health Information (PHI) and is governed by our Notice of Privacy Practices.
Information submitted through general website contact forms should not include sensitive medical information unless specifically requested.
Patient Portal
Patients may access secure services through our patient portal. Information submitted through the portal is encrypted and protected in accordance with applicable privacy and security standards.
Please note that regular email communications may not be secure. We encourage patients to use the patient portal whenever possible for clinical communications.
Cookies and Analytics
Our website may use cookies and similar technologies to:
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Improve website performance
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Understand visitor behavior
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Enhance user experience
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Monitor website functionality
You may adjust your browser settings to refuse cookies; however, some website features may not function properly.
Information Sharing
We do not sell personal information.
We may share information with:
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Authorized healthcare providers involved in your care
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Insurance companies and payers
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Business associates who provide services on our behalf
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Legal or regulatory authorities when required by law
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Third-party vendors necessary for website operation and practice management
Any third-party service providers receiving information are required to maintain appropriate confidentiality and security protections.
Third-Party Services
Our website may contain links to third-party websites or services. Moonlit Mental Health is not responsible for the privacy practices or content of those websites.
We encourage users to review the privacy policies of any third-party websites they visit.
Security
We implement reasonable administrative, technical, and physical safeguards designed to protect personal information from unauthorized access, disclosure, alteration, or destruction.
While we strive to protect your information, no method of internet transmission or electronic storage can be guaranteed to be completely secure.
Children's Privacy
Our services may be provided to minors with appropriate parent or legal guardian involvement as required by law.
We do not knowingly collect information from children through our website without appropriate parental consent.
Your Rights
Depending on applicable law, you may have rights regarding your personal information, including:
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Access to your information
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Correction of inaccurate information
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Requesting restrictions on certain disclosures
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Requesting copies of records as permitted by law
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Filing privacy complaints
Requests regarding Protected Health Information should be directed to our Privacy Officer.
Communication Preferences
By providing your contact information, you consent to receive communications related to appointments, treatment, billing, and practice operations.
You may opt out of non-essential communications at any time. Certain healthcare-related communications may still be necessary for treatment and operations.
Changes to This Privacy Policy
Moonlit Mental Health reserves the right to modify this Privacy Policy at any time. Updated versions will be posted on this website with a revised effective date.
Contact Information
If you have questions regarding this Privacy Policy or our privacy practices, please contact:
Moonlit Mental Health, LLC
2249 W Washington St
Broken Arrow, OK, 74012
Phone: (918) 960-5335
Fax: (949) 988-2941
Privacy Officer: Jonathan Lurz
Emergency Notice
This website and any contact forms are not monitored continuously and should not be used for emergencies.
If you are experiencing a medical or mental health emergency, call 911, go to the nearest emergency room, or call/text 988 for immediate assistance.
MOONLIT MENTAL HEALTH, LLC
Notice of Privacy Practices
Effective Date: July 27, 2026
Last Revised: July 27, 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.
Moonlit Mental Health provides outpatient psychiatric evaluation, medication management, and related behavioral health services. Because we provide behavioral health care, some information contained in your medical record may receive additional protections under federal and Oklahoma law beyond those provided by HIPAA.
Your Information. Your Rights. Our Responsibilities.
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 all protected health information maintained by Moonlit Mental Health, LLC, whether created or received in paper, electronic, or other formats.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
• If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting:
Moonlit Mental Health LLC
Privacy Officer: Jonathan Lurz
2249 W Washington Street
Broken Arrow, OK, 74012
(918) 960-5335 ext. 101
*You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
*For additional information about your privacy rights, visit the U.S. Department of Health and Human Services website at https://www.hhs.gov/hipaa.
*We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family members, caregivers, close friends, legal guardians, personal representatives, or others involved in your care or payment for your care whom you identify or authorize.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we will not use or disclose your information unless you provide written authorization, except as otherwise permitted or required by law:
• Marketing purposes
• Sale of your protected health information
• Psychotherapy notes, when maintained separately from your medical record
Psychotherapy notes receive additional protections under HIPAA and generally require your written authorization before disclosure unless otherwise permitted or required by law. Communication Preferences
We may communicate with you through the patient portal and may send appointment reminders or other practice communications by telephone, text message, email, or mail. You may request a reasonable alternative method of communication or ask us to contact you at a different telephone number or address. Telehealth services will be provided in accordance with applicable law and Moonlit Mental Health’s telehealth policies.
Electronic Communications
Moonlit Mental Health may communicate with you using secure electronic methods, including our patient portal, encrypted email when appropriate, telephone, text messaging, and telehealth technology. While we employ reasonable safeguards to protect your information, no method of electronic communication can be guaranteed completely secure. You may request an alternative method of communication at any time.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Additional Protection for Substance Use Disorder Records
To the extent Moonlit Mental Health creates, maintains, or receives substance use disorder patient records protected by 42 CFR Part 2, those records receive additional protections under federal law. We will use and disclose those records only as permitted by applicable law and any required patient consent.
Substance use disorder treatment records protected by 42 CFR Part 2, or testimony describing the contents of those records, will not be used or disclosed in a civil, criminal, administrative, or legislative proceeding against you unless authorized by your written consent or by a qualifying court order issued in accordance with federal law. A court order authorizing disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure.
Additional Protections Under Oklahoma Law
Oklahoma law provides additional confidentiality protections for mental health records. When Oklahoma law provides greater privacy protection than HIPAA or other applicable federal law, Moonlit Mental Health will comply with the more protective state law.
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know without unreasonable delay and within the time required by applicable federal law if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and at:
www.moonlitmentalhealth.com