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

In accordance with the Health  Insurance Portability and Accountability Act of 1996 and regulations  promulgated thereunder, commonly known as HIPAA and federal Privacy  Rule, 45 CFR parts 160 and 164 (the “Privacy Rule”) and applicable state  law, the Practice is committed to maintaining the privacy of your  protected health information (“PHI”). PHI includes information about  your health condition and the care and treatment you receive from the  Practice and is often referred to as your health care or medical record. This Notice explains how your PHI may be used and disclosed to third parties. This Notice also details your rights regarding your PHI.

We collect protected health information from you through treatment, payment and related  healthcare operations, the application and enrollment process, and/or  healthcare providers or health plans, or through other means, as  applicable. Your protected health information that is protected by law  broadly includes any past, present and future healthcare  information. Your protected health information includes any information  that is created or received through oral, written or electronic  communications by certain health care entities, including health care providers, such as physicians and hospitals, as well as, health insurance companies or plans. The law specifically protects health information that contains data  consisting of eighteen (18) identifiers described in the HIPAA Privacy  Rule including but not limited to your name, address, social security  number, date of birth and others that could be used to identify you as the individual patient who is associated with that health information.

Generally, we may not use or disclose your protected health  information without your permission. Further, once your permission has  been obtained, we must use or disclose your protected health information  in accordance with the specific terms of that permission. The following  uses and disclosures require an authorization:

• Most uses and disclosures of psychotherapy notes;
• Uses and Disclosures of protected health information for marketing purposes unless: 
  • the communication occurs face-to-face;
  • consists of marketing gifts of nominal value;
  • is regarding a prescription refill reminder that is for a prescription currently prescribed or a generic equivalent;
  • is for treatment pertaining to existing condition(s) and the  Practice does not receive any financial remuneration in either case or  cash equivalent; and/or
  • communication from a healthcare provider to recommend or direct  alternative treatments, therapies, healthcare providers, or settings of  care when the Practice does not receive any financial remuneration for  making the communication; and
• Disclosures that constitute a sale of protected health information.

The following are the circumstances  under which the Practice is permitted by law to use or disclose your  protected health information. The Practice, in accordance with this  Notice and without asking for your express consent or authorization, may use and disclose your PHI for the purposes of:

• Treatment – To provide you with the health care you  require, the Practice may use and disclose your PHI to those health  care professionals, whether on the Practice’s staff or not, so that it  may provide, coordinate, plan and manage your health care. 
  • Examples of treatment activities include: (a) the  provision, coordination, or management of health care and related  services by health care providers; (b) consultation between health care  providers relating to a patient; or (c) the referral of a patient for  health care from one health care provider to another.
• Payment – To get paid for services provided to you,  the Practice may provide your PHI, directly or through a billing  service, to a third party who may be responsible for your care,  including insurance companies and health plans. If necessary, the  Practice may use your PHI in other collection efforts with respect to  all persons who may be liable to the Practice for bills related to your  care. 
  • Examples of payment activities include: (a) billing and  collection activities and related data processing; (b) actions by a  health plan or insurer to obtain premiums or to determine or fulfill its  responsibilities for coverage and provision of benefits under its  health plan or insurance agreement, determinations of eligibility or  coverage, adjudication or subrogation of health benefit claims; (c)  medical necessity and appropriateness of care reviews, utilization  review activities; (d) disclosure to consumer reporting agencies of  information relating to collection of premiums or reimbursement; and (e)  the Practice may need to provide the Medicare program with information  about health care services that you received from the Practice so that  the Practice can be reimbursed.
• Health Care Operations – To operate in accordance  with applicable law and insurance requirements, and to provide quality  and efficient care, the Practice may need to compile, use and disclose  your PHI. 
  • Examples of health-care operations include: (a) development  of clinical guidelines; (b) contacting patients with information about  treatment alternatives or communications in connection with case  management or care coordination; (c) reviewing the qualifications of and  training health care professionals; (d) underwriting and premium  rating; (e) medical review, legal services, and auditing functions; and  (f) general administrative activities such as customer service and data  analysis.

The Practice may use or disclose your  protected health information to the extent that such use or disclosure  is required by law and the use or disclosure complies with and is  limited to the relevant requirements of such law. The Practice may also  use and disclose your PHI without your consent or authorization in the  following instances:

• De-identified Information – The Practice may use  and disclose health information that may be related to your care but  does not identify you and cannot be used to identify you. The Practice  will remove all 18 identifiable characteristics from your PHI prior to  it being used.
• Business Associate – The Practice may use and  disclose PHI to one or more of its business associates if the Practice  obtains satisfactory written assurance, in accordance with applicable  law, that the business associate will appropriately safeguard your PHI. A  business associate is an entity that assists the Practice in  undertaking some essential function, such as a billing company that  assists the office in submitting claims for payment to insurance  companies.Please Note: Mobile numbers and consent data  collected for text messaging (SMS) are strictly protected and will not  be shared with third-party business associates, vendors, or affiliates  for marketing or advertising purposes.
• Family/Friends or Personal Representative – The  Practice may disclose to a family member, other relative, a close  personal friend, or any other person identified by you (Personal  Representative), your PHI directly relevant to such person’s involvement  with your care or the payment for your care. The Practice may also use  or disclose your PHI to notify or assist in the notification (including  identifying or locating) a family member, a personal representative, or  another person responsible for your care, of your location, general  condition or death. However, in both cases, the following conditions  will apply: 
  • (i) If you are present at or prior to the use or disclosure of your  PHI, the Practice may use or disclose your PHI if you agree, or if the  Practice can reasonably infer from the circumstances, based on the  exercise of its professional judgment, that you do not object to the use  or disclosure.
  • (ii) If you are not present, the Practice will, in the exercise of  professional judgment, determine whether the use or disclosure is in  your best interests and, if so, disclose only the PHI that is directly  relevant to the person’s involvement with your care.
• Emergency Situations – The Practice may use and  disclose PHI for the purpose of obtaining or rendering emergency  treatment to you provided that the Practice attempts to obtain your  consent as soon as possible. The Practice may also use and disclose PHI  to a public or private entity authorized by law or by its charter to  assist in disaster relief efforts, for the purpose of coordinating your  care with such entities in an emergency situation.
• Public Health Activities – The Practice may use and  disclose PHI when required by law to provide information to a public  health authority. Public health activities including, preventing or  controlling disease or other injury, public health surveillance or  investigations, reporting adverse events with respect to food or dietary  supplements or product defects or problems to the Food and Drug  Administration, medical surveillance of the workplace or to evaluate  whether the individual has a work-related illness or injury in order to  comply with Federal or state law.
• Abuse, Neglect or Domestic Violence – The Practice  may use and disclose PHI when authorized by law to provide information  if it believes that the disclosure is necessary to prevent serious harm  or disclosures regarding victims of abuse, neglect, or domestic violence  including, reporting to social service or protective services agencies.
• Health Oversight Activities – The Practice may use  and disclose PHI when required by law. Health oversight activities  including, audits, civil, administrative, or criminal investigations,  inspections, licensure or disciplinary actions, or civil,  administrative, or criminal proceedings or actions, or other activities  necessary for appropriate oversight of government benefit programs.
• Judicial and Administrative Proceeding – The  Practice may use and disclose PHI in judicial and administrative  proceedings in response to an order of a court or administrative  tribunal, a warrant, subpoena, discovery request, or other lawful  process.
• Law Enforcement Purposes – The Practice may use and  disclose PHI, when authorized, to a law enforcement official. For  example, your PHI may be released for the purpose of identifying or  locating a suspect, fugitive, material witness, or missing person, or  reporting crimes in emergencies, reporting a death or may be the subject  of a grand jury subpoena.
• Coroner, Medical Examiners and Funeral Directors –  The Practice may use and disclose PHI to a coroner or medical examiner  for the purpose of identifying you or determining your cause of death.  We may also release protected health information to funeral directors as  necessary for them to carry out their duties.
• Organ, Eye or Tissue Donation – The Practice may use and disclose PHI if you are an organ donor to the entity to whom you have agreed to donate your organs.
• Research – The Practice may use and disclose PHI  subject to applicable legal requirements if the Practice is involved in  research activities.
• Avert a Threat to Health or Safety – The Practice  may use and disclose PHI if it believes that such disclosure is  necessary to prevent or lessen a serious and imminent threat to the  health or safety of a person or the public and the disclosure is to an  individual who is reasonably able to prevent or lessen the threat.
• Specialized Government Functions – The Practice may use and disclose PHI when authorized by law with regard to certain military and veteran activity.
• Workers’ Compensation – The Practice may use and  disclose PHI if you are involved in a Workers’ Compensation claim to an  individual or entity that is part of the Workers’ Compensation system.  These programs provide benefits for work-related injuries or illness.
• National Security and Intelligence Activities – The  Practice may use and disclose PHI to authorized governmental officials  with necessary intelligence information for national security activities  and intelligence activities, protective services of the President and  others and medical suitability determinations by entities that are  components of the Department of State.
• Military and Veterans – The Practice may use and  disclose PHI if you are a member of the armed forces, as required by the  military command authorities.
• Treatment Alternatives – We may use and disclose  your protected health information to manage and coordinate your  healthcare and inform you of treatment alternatives that may be of  interest to you. This may include telling you about treatments,  services, products and/or other healthcare providers.Please Note: Mobile data, text messaging originator opt-in data, and text consent  information will not be used, sold, or shared for marketing or  promotional distribution.
• Advice of Appointment and Services – The Practice  may, from time to time, contact you to provide appointment reminders or  information about treatment alternatives or other health-related  benefits and services that may be of interest to you. The following  appointment reminders may be used by the Practice: a) a postcard mailed  to you at the address provided by you; b) telephoning your phone number  on file and leaving a message on your answering machine or with the  individual answering the phone; and c) text messages (SMS) sent to your  mobile phone number on file if you have opted in to receive them.
• Inmates – If you are an inmate of a correctional  institution or under the custody of a law enforcement official, we may  release your protected health information to the correctional  institution or law enforcement official. The release of protected health  information is required: a) for the institution to provide you with  health care; b) to protect your health and safety of others; and c) for  the safety and security of the correctional institution.

• Data Collection and Consent: We collect your mobile  phone numbers when you voluntarily share them with us through our web  forms, registration portals, or check-box options. By opting in to  receive SMS text messages, you authorize the Practice to send automated  operational texts, interactive appointment reminders, clinical  follow-ups, and practice updates to your mobile number.
• Strict Privacy Baseline: We respect your data  privacy. Text messaging originator opt-in data, mobile numbers, and text  consent details are securely maintained and will not be sold, rented, leased, or shared with any third parties, business partners, or affiliates for promotional or marketing campaigns.
• Rates and Message Frequency: Message and data rates  may apply depending on your cellular provider plan. Message frequency  varies based on your requested appointment schedule and interactions  with our administrative staff.
• Opt-Out and Help: You retain full control over your communications. You can cancel text messaging enrollment at any time by replying STOP to any message you receive from us. Once processed, we will send a  final automated SMS confirming you have unsubscribed. To request  assistance or technical support, reply HELP or call our main privacy office directly.

Except as otherwise permitted or  required, as described above, we may not use or disclose your protected  health information without your written authorization. Further, we are  required to use or disclose your protected health information consistent with the terms of your authorization. You may revoke your authorization, in writing,  the use or disclosure of any protected health information at any time,  except to the extent that we have taken action in reliance on such authorization,  or, if you provided the authorization as a condition of obtaining  insurance coverage, other law provides the insurer with the right to contest a claim under the policy.

Under HIPAA, you have certain rights  with respect to your protected health information. The following is a  brief overview of your rights and our duties with respect to enforcing  those rights.

• (a) Revoke any Authorization or consent you have  given to the Practice, at any time. To request a revocation, you must  submit a written request to the Practice’s Privacy Officer.
• (b) Request special restrictions – on certain uses  and disclosures of your PHI as authorized by law. In general, this  relates to your right to request special restrictions concerning  disclosures of your PHI regarding uses for treatment, payment and  operational purposes under Privacy Rule, Section 164.522(a) and  restrictions related to disclosures to your family and other individuals  involved in your care under Privacy Rule, Section 164.510(b). Except in  certain instances, the Practice may not be obligated to agree to any  requested restrictions. To request restrictions, you must submit a  written request to the Practice’s Privacy Officer. In your written  request, you must inform the Practice of what information you want to  limit, whether you want to limit the Practice’s use or disclosure, or  both, and to whom you want the limits to apply. If the Practice agrees  to your request, the Practice will comply with your request unless the  information is needed in order to provide you with emergency treatment.  We will not accept a request to restrict uses or disclosures that are  otherwise required by law.
• (c) Right to Request Restriction on Disclosures to Health Plans for Services Paid for In Full at Time of Service – You have the right under the American Recovery and Reinvestment Act,  Section 13405(a) to request the Practice to restrict disclosures of  protected health information to a health plan for purposes of carrying  out payment or healthcare operations if the protected health information  pertains solely to a healthcare item or service for which the Practice  has been paid out of pocket in full at time of service.
• (d) Receive confidential communications or PHI by  alternative means or at alternative locations as provided by Privacy  Rule Section 164.522(b). For instance, you may request all written  communications to you marked “Confidential Protected Health  Information.” You must make your request in writing to the Practice’s  Privacy Officer. The Practice will accommodate all reasonable requests.  We may condition the provision of confidential communications on you  providing us with information as to the specification of an alternative  address or other method of contact. We may require that a request  contain a statement that disclosure of all or a part of the information  to which the request pertains could endanger you. We may not require you  to provide an explanation of the basis for your request as a condition  of providing communications to you on a confidential basis. We must  permit you to request and must accommodate reasonable requests by you to  receive communications of protected health information from us by  alternative means or at alternative locations.

You have the right to inspect and copy  your PHI as provided by federal law (including Privacy Rule, Section  164.524) and state law. To inspect and copy your PHI, you must submit a  written request to the Practice’s Privacy Officer. The Practice can charge you a fee for the cost of copying, mailing or other supplies associated with your request.  These situations are defined by State law, the Practice may deny your  request, in the case of (a) psychotherapy notes, (b) information  compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative  action or proceeding, and (c) health information maintained by us to  the extent to which the provision of access to you would be prohibited  by law.

We may require written requests. We must provide you with access to your protected health information in the form or format requested by you, if it is readily producible in such form or format, or, if not, in a readable hard copy form or such other form or format. We may provide you with a summary of the protected  health information requested, in lieu of providing access to the  protected health information or may provide an explanation of the  protected health information to which access has been provided, if you agree in advance to such a summary or explanation and agree to the fees imposed for such summary or explanation.

We will provide you with access as requested in a timely manner as required by State law, including arranging with you a convenient time and place to inspect or obtain copies of your protected health information or mailing a copy to you at your request. We will discuss the scope, format, and other aspects of your request for access as necessary to facilitate timely access. If  you request a copy of your protected health information or agree to a  summary or explanation of such information, we may charge a reasonable  cost-based fee, as provided in State law for copying,  postage, if you request a mailing, and the costs of preparing an  explanation or summary as agreed upon in advance.

We reserve the right to deny you  access to and copies of certain protected health information as  permitted or required by law. We will reasonably attempt to accommodate  any request for protected health information by, to the extent possible,  giving you access to other protected health information after excluding the information as to which we have a ground to deny access. Upon denial of a  request for access or request for information, we will provide you with  a written denial specifying the legal basis for denial, a statement of your rights, and a description of how you may file a complaint with us. If we do not maintain the information that is the subject of your request for access but we know where the  requested information is maintained, we will inform you of where to direct your request for access.

You have the right to amend your PHI  as provided by federal law (including Privacy Rule, Section 164.526) and  state law. To request an amendment, you must submit a written request  to the Practice’s Privacy Officer. You must provide a reason  that supports your request. The Practice may deny your request if: (a)  we determine that the information or record that is the subject of the  request was not created by us, unless you provide a  reasonable basis to believe that the originator of the information is no  longer available to act on the requested amendment, (b) the information  is not part of your designated record set maintained by us, (c) the  information is prohibited from inspection by law, (d) the  information is accurate and complete, (e) the request is not in writing  or (f) if you do not provide a reason in support of your request.

If you disagree with the Practice’s denial, you will have the right to submit a written statement of disagreement. If we deny your request, we will provide you with a written denial stating the basis of the denial, your right  to submit a written statement disagreeing with the denial, and a  description of how you may file a complaint with us or the Secretary of the U.S. Department of Health and Human Services (“DHHS”). This denial will also include a notice that if  you do not submit a statement of disagreement, you may request that we  include your request for amendment and the denial with any future disclosures of your protected health information that is the subject of the requested amendment. Copies of all requests, denials, and statements of disagreement will be included in your designated record set. If we accept your request for amendment, we will make reasonable efforts to inform and provide the amendment within a reasonable time to persons identified  by you as having received protected health information of yours prior  to amendment and persons that we know have the protected health  information that is the subject of the amendment and that may have relied, or could foreseeably rely, on such information to your detriment. All requests for amendment shall be sent to the Practice’s Privacy Officer.

You have the right to receive an  accounting of disclosures of your PHI as provided by federal law  (including Privacy Rule Section 164.528) and state law. You have the  right to receive a written accounting of all disclosures of your  protected health information that we have made within the six  (6) year period immediately preceding the date on which the accounting  is requested. You may request an accounting of disclosures for a period  of time less than six (6) years from the date of the request. Such  disclosures will include the date of each disclosure, the name and, if known, the address of the entity or person who received the information, a brief description of the information disclosed, and a brief  statement of the purpose and basis of the disclosure or, in lieu of  such statement, a copy of your written authorization or written request  for disclosure pertaining to such information.

We are not required to provide accountings of disclosures for the following purposes: (a) treatment, payment, and healthcare operations, (b) disclosures pursuant to your authorization, (c) disclosures to you, (d) for a facility directory or to persons involved in your care, (e) for national security or intelligence purposes, (f) to correctional institutions, and (g) with respect to disclosures occurring prior to 4/14/03. We reserve  our right to temporarily suspend your right to receive an accounting of  disclosures to health oversight agencies or law enforcement officials,  as required by law.

We will provide the first accounting to you in any twelve (12) month period without  charge, but will impose a reasonable cost-based fee for responding to  each subsequent request for accounting within that same twelve (12) month period. All requests for an accounting shall be sent to  the Practice’s Privacy Officer. The request should indicate in what  form you want the list (such as a paper or electronic copy). The  Practice will notify you of the costs, if any and you can decide to withdraw or modify your request before any costs are incurred.

• Request special authorization to allow the Practice  to use and disclose your protected health information (PHI) for  purposes other than those enumerated in this Notice of Privacy Practices  (NPP). This request must be made in writing to the Practice’s Privacy  Officer.
• Receive a paper copy of this Privacy Notice from  the Practice (as provided by Privacy Rule Section 164.520(b)(1)(iv)(F))  upon request to the Practice’s Privacy Officer, or from this Practice’s  web site.

You may complain to the Practice or to the Secretary of HHS (as provided by Privacy Rule Section  164.520(b)(1)(vi)). If you have questions regarding this Notice or if  you believe your privacy rights have been violated or you wish to file  a complaint about our privacy practices, you may contact the Practice’s  Privacy Officer by phone or submission of your complaint in writing by  mail or E-mail to the Practice’s Privacy Officer. You also have the  right to file your complaint with the Secretary of DHHS.

A complaint must name the entity that is the subject of the complaint and describe the acts or omissions believed to  be in violation of the applicable requirements of HIPAA or this Privacy  Policy. A complaint must be received by us or filed with the Secretary  of DHHS within 180 days of when you knew or should have known that the act or omission complained of occurred. You will not be  penalized for filing any complaint. As required by law, the Practice  will notify you in the event that a breach of your protected health  information has occurred.

We reserve the right to revise or amend this Privacy Policy at any time. These revisions or amendments may be made effective for all protected health  information we maintain even if created or received prior to the  effective date of the revision or amendment. We will provide  you with notice of any revisions or amendments to this Privacy Policy,  or changes in the law affecting this Privacy Notice, within 60 days of the effective date of such revision, amendment, or change.

• The Practice is required by federal law to maintain the privacy of  your PHI and to provide you with this Privacy Notice detailing the  Practice’s legal duties and privacy practices with respect to your PHI.
• Under the Privacy Rule, The Practice may be required by State law to  grant greater access or maintain greater restrictions on the use or  release of your PHI than that which is provided for under federal law.
• The Practice is required to abide by the terms of this Privacy Notice.
• The Practice reserves the right to change the terms of this Privacy  Notice and to make the new Privacy Notice provisions effective for all  of your PHI that it maintains.
• The Practice will distribute any revised Privacy Notice to you prior  to implementation. The Practice will not retaliate against you for  filing a complaint.