Notice of Privacy Practices

1. Our Responsibilities

We are required by law to:

• Maintain the privacy of your protected health information
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of the Notice currently in effect
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests to communicate with you by alternative means or at alternative locations
• Notify you in the event of a breach of your unsecured protected health information

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. Any changes will apply to all information we already have about you. A copy of the current Notice will be available at our office and on our website.

2. Uses and Disclosures of PHI

We may use and disclose your protected health information for the following purposes:

Treatment

We may use your health information to provide you with medical treatment and services. We may disclose your health information to doctors, nurses, technicians, or other personnel involved in your care. For example, your physician may share your information with a specialist to coordinate your care.

Payment

We may use and disclose your health information to bill and receive payment for the treatment and services you receive. For example, we may send information about your treatment to your health insurance company to obtain payment.

Healthcare Operations

We may use and disclose your health information for our healthcare operations, which include quality assessment, employee review, training, licensing, and other administrative activities. For example, we may use your health information to evaluate our staff's performance.

3. Other Permitted Uses and Disclosures

We may also use or disclose your health information without your authorization in the following circumstances:

• As Required by Law: We will disclose health information when required to do so by federal, state, or local law
• Public Health Activities: We may disclose health information for public health activities, such as reporting disease and vital statistics
• Health Oversight Activities: We may disclose health information to health oversight agencies for activities authorized by law
• Legal Proceedings: We may disclose health information in response to a court order or subpoena
• Law Enforcement: We may disclose health information to law enforcement officials for certain law enforcement purposes
• To Prevent a Serious Threat: We may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of others
• Military and Veterans: If you are a member of the armed forces, we may disclose health information as required by military command authorities
• Workers' Compensation: We may disclose health information for workers' compensation claims
• Coroners, Medical Examiners, and Funeral Directors: We may disclose health information to coroners, medical examiners, and funeral directors as necessary for their duties
• Organ Donation: We may disclose health information to organizations that handle organ procurement or transplantation
• Research: Under certain circumstances, we may use or disclose health information for research purposes

4. Uses and Disclosures Requiring Your Authorization

We will obtain your written authorization before using or disclosing your health information for purposes other than those described above (or as otherwise permitted by law). You may revoke your authorization at any time by submitting a written request to our Privacy Officer. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect.

The following uses and disclosures require your authorization:

• Most uses and disclosures of psychotherapy notes (where appropriate)
• Uses and disclosures of PHI for marketing purposes
• Disclosures that constitute a sale of PHI
• Other uses and disclosures not described in this Notice

5. Your Rights Regarding Your Health Information

You have the following rights regarding your health information:

Right to Access

You have the right to inspect and obtain a copy of your health information. To request access, submit a written request to our Privacy Officer. We may charge a reasonable fee for copies.

Right to Request Amendment

You have the right to request that we amend your health information if you believe it is incorrect or incomplete. Submit your request in writing with a reason for the amendment. We may deny your request under certain circumstances.

Right to an Accounting of Disclosures

You have the right to receive a list of certain disclosures we have made of your health information. Submit a written request to our Privacy Officer specifying the time period (not longer than six years).

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request except when you request that we not disclose information to your health plan for services you paid for in full out-of-pocket.

Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters through alternative means or at alternative locations. Submit your request in writing, and we will accommodate reasonable requests.

Right to a Paper Copy

You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Right to Be Notified of a Breach

You have the right to be notified in the event of a breach of your unsecured protected health information.

6. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer using the information below.

To file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

• Online: www.hhs.gov/ocr/complaints
• Phone: 1-800-368-1019
• TDD: 1-800-537-7697

7. Changes to This Notice

We reserve the right to change this Notice at any time. Any changes will be effective for all health information we maintain. The revised Notice will be available at our office, on our website, and upon request.

8. Contact Information

For questions about this Notice, to exercise your rights, or to file a complaint, please contact our Privacy Officer: