Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

My Commitment to Your Privacy

I am committed to protecting your health information. I maintain records of your care to provide treatment and comply with legal requirements. I am required by law to safeguard your protected health information (PHI), provide you with this notice, and follow its terms. I may update this notice at any time, and the current version will be available upon request.

Uses and Disclosures That Do Not Require Your Authorization

Subject to applicable law, I may use and disclose your PHI without your written authorization for the following purposes:

• Treatment, payment, and healthcare operations

• Legal requirements, including court orders, subpoenas, or law enforcement

• Public health and safety concerns (including abuse, neglect, or risk of harm)

• Health oversight activities and certain government functions

• Workers’ compensation purposes

• Appointment reminders and service-related communications

When appropriate, I make reasonable efforts to contact you for Authorization or to notify you.

Uses and Disclosures That Require Your Authorization

• Psychotherapy Notes: Psychotherapy notes are maintained separately and generally require your written authorization for disclosure, except as permitted or required by law.

• Marketing: I do not use or disclose your PHI for marketing purposes.

• Sale of PHI: I do not sell your PHI.

Uses and Disclosures You May Object To:

I may share relevant PHI with family members, friends, or others involved in your care or payment for your care, unless you object. In emergency situations, consent may be obtained retroactively.

Your Rights Regarding Your PHI

You have the right to:

• Request restrictions on how your PHI is used or disclosed (I am not required to agree if it would affect your care)

• Request restrictions on disclosures to health plans for services you have paid for out-of-pocket in full

• Request confidential methods of communication (e.g., alternative phone or mailing address)

• Access and obtain copies of your PHI (excluding psychotherapy notes)

• Request corrections to your PHI (I may deny the request, but will provide a written explanation)

• Receive a list of certain disclosures of your PHI

• Obtain a copy of this Notice

All requests must be made in writing. Reasonable fees may apply as permitted by law.

Acknowledgment of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.