HIPAA Notice of Privacy Practices

Our Pledge Regarding Your Health Information

The privacy of your health information is important to us. We understand that your health information is personal and we are committed to protecting it. We are required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice that is currently in effect.

This notice applies to all records of your care generated or maintained by Serenity Mind Wellness, whether created by your therapist, our staff, or other professionals involved in your care at our practice.

How We May Use and Disclose Your Protected Health Information

The following describes the ways we may use and disclose your health information. Not every use or disclosure is listed, but all of the ways we are permitted to use and disclose information fall within one of these categories.

Treatment

We may use your health information to provide you with mental health treatment and services. We may also disclose your health information to other healthcare providers who are involved in your treatment. For example, if you are receiving coordinated care, your therapist may consult with your psychiatrist or primary care physician to ensure the best possible treatment plan.

Payment

We may use and disclose your health information to obtain payment for the services we provide. For example, we may submit claims to your health insurance plan and share the minimum necessary information required for reimbursement, including diagnosis codes, dates of service, and types of services provided.

Healthcare Operations

We may use and disclose your health information for our internal healthcare operations. This includes quality assessment activities, employee review, training programs, licensing, accreditation, and other business activities necessary to run our practice and provide you with quality care.

Other Permitted Uses and Disclosures

We may also use or disclose your protected health information in the following circumstances:

• As required by law — We will disclose your 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 preventing or controlling disease, injury, or disability, and reporting to public health authorities
• Abuse, neglect, or domestic violence — We may disclose health information to appropriate authorities if we reasonably believe a patient is a victim of abuse, neglect, or domestic violence
• Serious threat to health or safety — We may use or disclose your health information when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of another person or the public
• Judicial and administrative proceedings — We may disclose health information in response to a court or administrative order, or in response to a subpoena, discovery request, or other lawful process
• Law enforcement and government requests — We may disclose health information for law enforcement purposes, for workers' compensation claims, or for specialized government functions such as military and national security activities
• Coroners and funeral directors — We may disclose health information to a coroner, medical examiner, or funeral director as permitted by law

For any use or disclosure not described above, we will seek your written authorization before using or disclosing your health information. You may revoke an authorization in writing at any time.

Your Rights Regarding Your Health Information

You have the following rights regarding the health information we maintain about you:

• Right to access — You have the right to inspect and obtain a copy of your health records. We will provide a copy or summary within 30 days of your written request. A reasonable fee may be charged for copying and mailing.
• Right to request amendment — You may ask us to amend your health records if you believe they are inaccurate or incomplete. We may deny your request under certain circumstances, and we will provide a written explanation within 60 days.
• Right to an accounting of disclosures — You may request a list of certain disclosures we have made of your health information for purposes other than treatment, payment, and healthcare operations, for the six years prior to your request.
• Right to request restrictions — You may ask us to limit the ways we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request, except in certain circumstances required by law.
• Right to confidential communications — You may request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we only contact you by mail or at a specific phone number.
• Right to breach notification — You have the right to be notified in the event of a breach of your unsecured protected health information. We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
• Right to a paper copy — You have the right to obtain a paper copy of this notice at any time, even if you have agreed to receive it electronically.
• Right to choose a personal representative — If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information on your behalf.

Our Duties

• We are required by law to maintain the privacy and security of your protected health information
• We must provide you with this notice of our legal duties and privacy practices with respect to your health information
• We must abide by the terms of the notice currently in effect
• We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information
• We will not use or share your information other than as described here unless you tell us we can in writing. If you give us authorization, you may revoke it at any time by notifying us in writing

Changes to This Notice

We reserve the right to change this notice and to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our website. The notice will contain the effective date on the first page.

How to File a Complaint

If you believe your privacy rights have been violated, you have the right to file a complaint. You will not be penalized or retaliated against for filing a complaint.

• Complain to our practice — Contact our Privacy Officer using the information below to file a complaint directly with our practice
• Complain to the U.S. Department of Health and Human Services (HHS) — You may file a complaint with the Secretary of HHS by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting www.hhs.gov/hipaa/filing-a-complaint

Privacy Officer Contact

For questions about this notice, to submit a request regarding your health information, or to file a complaint, please contact our Privacy Officer: