Notice of Privacy Practices

This Notice of Privacy Practices describes how Phenomenal You Psychiatry & Coaching PLLC may use and disclose your PHI in accordance with all applicable law. It also describes your rights regarding how you may gain access to and control your PHI. Phenomenal You Psychiatry & Coaching PLLC is required by law to maintain the privacy of PHI and to provide you with notice of its legal duties and privacy practices with respect to your PHI. Phenomenal You Psychiatry & Coaching PLLC is required to abide by the terms of this Notice of Privacy Practices. Phenomenal You Psychiatry & Coaching PLLC reserves the right to change the terms of its Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that it maintains at that time. Phenomenal You Psychiatry & Coaching PLLC will make available a revised Notice of Privacy Practices by sending you an electronic copy, sending a copy to you in the mail upon your request, or providing one to you in person.

How Phenomenal You Psychiatry & Coaching PLLC is Permitted to Use and Disclose Your PHI

• For Treatment: Phenomenal You Psychiatry & Coaching PLLC may use your protected PHI to provide you with treatment services.

• For Payment: Phenomenal You Psychiatry & Coaching PLLC may use and disclose your protected PHI so that it can receive payment for the treatment services provided to you.

• For Healthcare Operations: Phenomenal You Psychiatry & Coaching PLLC may use and disclose your protected PHI for certain purposes in connection with the operation of its professional practice, including supervision and consultation.

• Without Your Authorization: State and Federal law also permits Phenomenal You Psychiatry & Coaching PLLC to disclose information about you without your authorization in a limited number of situations, such as with a court order.

• With Authorization: Phenomenal You Psychiatry & Coaching PLLC must obtain written authorization from you for other uses and disclosures of your PHI. You may revoke such authorizations in writing in accordance with 45 CFR. 164.508(b)(5).

• Incidental Use and Disclosure: Phenomenal You Psychiatry & Coaching PLLC is not required to eliminate every risk of an incidental use or disclosure of your PHI. Specifically, a use or disclosure of your PHI that occurs as a result of, or incident to an otherwise permitted use or disclosure is permitted as long as it has adopted reasonable safeguards to protect your PHI, and the information being shared was limited to the minimum necessary.

Examples of How Phenomenal You Psychiatry & Coaching PLLC May Use and Disclose Your PHI

Listed below are examples of the uses and disclosures that Phenomenal You Psychiatry & Coaching PLLC may make of your PHI. These examples are not meant to be a complete list of all possible disclosures, rather, they are illustrative of the types of uses and disclosures that may be made.

• Treatment: Your PHI may be used and disclosed by Phenomenal You Psychiatry & Coaching PLLC for the purpose of providing, coordinating, or managing your health care treatment and any related services. This may include coordination or management of your health care with a third party, consultation or supervision activities with other health care providers, or referral to another provider for health care services.

• Payment: Phenomenal You Psychiatry & Coaching PLLC may use your PHI to obtain payment for your health care services. This may include providing information to a third-party payor, or, in the case of unpaid fees, submitting your name and amount owed to a collection agency.

• Healthcare Operations: Phenomenal You Psychiatry & Coaching PLLC may use or disclose your PHI in order to support the business activities of its professional practice including disclosures to others for health care education, or to provide planning, quality assurance, peer review, or administrative, legal, financial, or actuarial services to assist in the delivery of health care, provided it has a written contract with the business that prohibits it from re-disclosing your PHI and requires it to safeguard the privacy of your PHI. Phenomenal You Psychiatry & Coaching PLLC may also contact you to remind you of your appointments.

Other Uses and Disclosures That Do Not Require Your Authorization

• Required by Law: Phenomenal You Psychiatry & Coaching PLLC may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples of this type of disclosure include healthcare licensure related reports, public health reports, and law enforcement reports. Under the law, Phenomenal You Psychiatry & Coaching PLLC must make certain disclosures of your PHI to you upon your request. In addition, it must make disclosures to the US Secretary of the Department of Health and Human Services for the purpose of investigating or determining its compliance with the requirements of privacy rules.

• Health Oversight: Phenomenal You Psychiatry & Coaching PLLC may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors) and peer review organizations performing utilization and quality control. If it discloses PHI to a health oversight agency, to the extent it is required by law, it will have an agreement in place that requires the agency to safeguard the privacy of your information.

• Abuse or Neglect: Phenomenal You Psychiatry & Coaching PLLC may disclose your PHI to a state or local agency that is authorized by law to receive reports of abuse or neglect. However, the information disclosed is limited to only that information which is necessary to make the initial mandated report.

• Deceased Clients: Phenomenal You Psychiatry & Coaching PLLC may disclose PHI regarding deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics, or permitting inquiry into the cause of death.

• Criminal Activity or Threats to Personal Safety: Phenomenal You Psychiatry & Coaching PLLC may disclose your PHI to law enforcement officials if it reasonably believes that the disclosure will avoid or minimize an imminent threat to the health or safety of yourself or any third party.

Uses and Disclosures of PHI With Your Written Authorization

Other uses and disclosures of your PHI will be made only with your written authorization. Phenomenal You Psychiatry & Coaching PLLC will not make any other uses or disclosures of your psychotherapy notes, will not use or disclose your PHI for marketing purposes, and will not sell your PHI without your authorization. You may revoke your authorization in writing at any time. Such revocation of authorization will not be effective for actions it may have taken in reliance on your authorization of the use or disclosure.

Your Rights Regarding Your PHI

You have the following rights regarding PHI that Phenomenal You Psychiatry & Coaching PLLC maintains about you. Any requests with respect to these rights must be in writing. A brief description of how you may exercise these rights is included.

• Right of Access to Inspect and Copy: You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as it maintains the record. A "designated record set" contains medical and billing records and any other records that Phenomenal You Psychiatry & Coaching PLLC uses for making decisions about you. Your request must be in writing. It may charge you a reasonable cost-based fee for the copying and transmitting of your PHI. It can deny you access to your PHI in certain circumstances. In some of those cases, you will have a right of recourse to the denial of access. Please contact Phenomenal You Psychiatry & Coaching PLLC if you have questions about access to your medical record.

• Right to Amend: You may request, in writing, that Phenomenal You Psychiatry & Coaching PLLC amend your PHI that has been included in a designated record set. In certain cases, it may deny your request for an amendment. If it denies your request for amendment, you have the right to file a statement of disagreement with Phenomenal You Psychiatry & Coaching PLLC. It may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

• Right to an Accounting of Disclosures: You may request an accounting of disclosures other than those made to you, for treatment purposes, or made as a result of your authorization, for a period of up to six years. It may charge you a reasonable fee if you request more than one accounting in any 12-month period. Please contact Phenomenal You Psychiatry & Coaching PLLC if you have questions about accounting of disclosures.

• Right to Request Restrictions: You have the right to ask Phenomenal You Psychiatry & Coaching PLLC not to use or disclose any part of your PHI for treatment, payment, or health care operations or to family members involved in your care. Your request for restrictions must be in writing and it is not required to agree to such restrictions. You also have the right to restrict certain disclosures of your PHI to your health plan if you pay out of pocket in full for the healthcare that it provides to you. Please contact Phenomenal You Psychiatry & Coaching PLLC if you would like to request restrictions on the disclosure of your PHI.

• Right to Request Confidential Communication: You have the right to request to receive confidential communications from Phenomenal You Psychiatry & Coaching PLLC by alternative means or at an alternative location. It will accommodate reasonable written requests. It may also condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact. Please contact Phenomenal You Psychiatry & Coaching PLLC if you would like to make this request.

• Right to a Copy of this Notice: You have the right to obtain a copy of this notice from Phenomenal You Psychiatry & Coaching PLLC. Any questions you have about the contents of this document should be directed to Phenomenal You Psychiatry & Coaching PLLC.

• Right to Opt Out: You have the right to choose not to receive fundraising communications. However, Phenomenal You Psychiatry & Coaching PLLC does not contact clients for fundraising purposes.

• Right to Notice of Breach: You have the right to be notified of any breach of your unsecured PHI.