Notice of Privacy Practices

This notice describes how your medical and mental health information may be used and disclosed, and how you can access this information. Please review it carefully. By receiving services from this practice, you acknowledge you have been provided this notice.

Understanding your health information

Each time you receive services, a record is created containing your health and treatment information. This record is used to plan your care, communicate with other professionals involved in your treatment, and to comply with legal requirements. This notice explains how that information may be used.

I am required by law to maintain the privacy of your Protected Health Information (PHI), provide you with this notice of my legal duties and privacy practices, and abide by the terms of the notice currently in effect.

How I may use and disclose your information

The following categories describe the different ways I may use and disclose your health information. Not every use in each category will be listed, but all permitted uses fall within one of these categories.

Treatment

I may use and disclose your PHI to provide, coordinate, or manage your mental health care. For example, I may share information with your prescribing physician or another provider involved in your care, if you have authorized such communication.

Payment I may use and disclose your PHI to obtain payment for services rendered. For example, if you use insurance, I may need to provide your insurer with information about your diagnosis and treatment to process a claim.

Healthcare operations I may use your PHI for operational purposes such as quality improvement, practice administration, and compliance activities. For example, I may review records to evaluate the quality of care provided.

As required by law I will disclose your PHI when required to do so by federal, state, or local law, including mandatory abuse reporting laws applicable in the states where services are provided.

Public health and safety activities I may disclose PHI to prevent or reduce a serious, imminent threat to the health or safety of a person or the public, including to report suspected child abuse, elder abuse, or dependent adult abuse as required by law.

Health oversight activities I may disclose PHI to government agencies conducting audits, investigations, or oversight of the healthcare system as authorized by law.

Legal proceedings I may disclose PHI in response to a court order, subpoena, or other lawful legal process. I will make reasonable efforts to notify you before doing so.

Law enforcement Under specific circumstances required by law, I may disclose PHI to law enforcement officials.

Decedents I may disclose PHI to coroners, medical examiners, or funeral directors as authorized by law.

Uses and disclosures requiring your written authorization

Other uses and disclosures of your PHI not described above will be made only with your written authorization, including:

• Psychotherapy notes — Notes I record about the content of your sessions (kept separately from your general medical record) require your specific written authorization for any disclosure, with limited legal exceptions.

• Marketing purposes

• Sale of PHI

• Any other use not described in this notice

You may revoke any written authorization at any time, in writing. Revocation does not apply to actions already taken in reliance on the authorization.

Your rights regarding your health information

Right to inspect and copy You have the right to inspect and obtain a copy of your PHI used to make decisions about your care. Requests must be made in writing. I may charge a reasonable fee for copies. I may deny access in limited circumstances.

Right to request amendments If you believe your PHI is incorrect or incomplete, you may request an amendment in writing. I may deny the request under certain circumstances, and you have the right to submit a written statement of disagreement if your request is denied.

Right to an accounting of disclosures You may request a list of disclosures of your PHI that I have made for purposes other than treatment, payment, and healthcare operations during the prior six years. The first accounting in any 12-month period is free; subsequent requests may incur a fee.

Right to request restrictions You may request restrictions on how I use or disclose your PHI for treatment, payment, or healthcare operations. I am not required to agree to your request, except in limited circumstances where you request a restriction on disclosure to a health plan for services you paid for out-of-pocket in full.

Right to confidential communications You may request that I communicate with you about your health information in a certain way or at a certain location. For example, you may request that I only contact you by email or at a specific address. I will accommodate reasonable requests.

Right to a paper copy of this notice You have the right to a paper copy of this notice at any time, even if you have agreed to receive it electronically.

Right to notification of a breach You have the right to be notified if there is a breach of your unsecured PHI, in accordance with applicable federal and state law.

Telehealth and multi-state practice

This practice provides services via telehealth to clients located across multiple states under PSYPACT authorization. When providing services to clients in a particular state, I am bound by the privacy and confidentiality laws of the state where you are located at the time of service, in addition to federal HIPAA requirements. This includes state-specific mandatory reporting laws, duty-to-warn requirements, and other health and safety laws that vary by state.

Telehealth sessions are conducted using HIPAA-compliant platforms. By participating in telehealth, you acknowledge inherent risks including the possibility of technical failures, interruptions, or unauthorized access despite security measures.

Changes to this notice

I reserve the right to change this notice and to make any revised notice effective for PHI I already have about you, as well as any PHI I receive in the future. The current version will always be available on this website with its effective date. I will provide you with a copy of the revised notice upon request or at your next appointment.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with this practice or with the U.S. Department of Health and Human Services Office for Civil Rights. To file with HHS, visit hhs.gov/ocr/privacy or call 1-800-368-1019. You will not be penalized or retaliated against for filing a complaint.