HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Sunshine Psychiatry Consult ("we," "us," or "the practice") is 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 currently in effect. This Notice is provided under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR 164.520.

Our duties

We are required to:

• Maintain the privacy of your protected health information.
• Abide by the terms of this Notice that is currently in effect.
• Notify you in the event of a breach of unsecured PHI.
• Provide you with a copy of this Notice, on request, in paper or electronic form.

How we may use and disclose your health information

The following describes the ways we may use and disclose your PHI without your separate written authorization.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your health care. For example, we may share information with your primary care provider, a therapist you also see, or a pharmacy that fills your prescriptions.

Payment

We may use and disclose your PHI to obtain payment for the services we provide. For example, we may send claims and supporting clinical detail to your insurance company so that a session can be reimbursed.

Health care operations

We may use and disclose your PHI for routine operational activities. For example, we may review records to evaluate the quality of care delivered, or share information with a business associate (such as our HIPAA-compliant electronic health record provider) under a written Business Associate Agreement.

Other uses permitted or required by law

We may use or disclose your PHI without your authorization in the following additional circumstances permitted or required by 45 CFR 164.512:

• Public health activities — such as reporting communicable disease, vital statistics, or adverse events to public health authorities.
• Victims of abuse, neglect, or domestic violence — disclosures to appropriate government agencies as required or permitted by law.
• Judicial and administrative proceedings — in response to a court order, subpoena, or discovery request, with applicable patient notice or protective order safeguards.
• Law enforcement — to identify or locate a suspect, fugitive, material witness, or missing person, and other limited law-enforcement purposes.
• Deceased persons — to coroners, medical examiners, and funeral directors as needed to carry out their duties.
• Organ and tissue donation — to organizations that handle procurement, banking, or transplantation.
• Research — when an Institutional Review Board has approved a waiver of authorization or when only de-identified data is used.
• Serious threat to health or safety — to prevent or lessen a serious and imminent threat to a person or the public.
• Workers' compensation — as authorized by and to the extent necessary to comply with workers' compensation laws.
• Military and veterans — for activities deemed necessary by appropriate military command authorities, and similar disclosures involving veterans, national security, or protective services.

Uses and disclosures requiring your authorization

Some uses and disclosures of PHI require your written authorization. You may revoke an authorization at any time in writing, except to the extent we have already acted in reliance on it.

• Psychotherapy notes. Because this is a psychiatric practice, this protection is particularly important: with limited exceptions, we will not use or disclose psychotherapy notes — separately maintained notes documenting the contents of a counseling session — without your specific written authorization.
• Marketing. Most uses and disclosures of PHI for marketing purposes require your authorization.
• Sale of PHI. Disclosures that constitute a sale of PHI require your authorization.
• Other uses and disclosures not described in this Notice — will be made only with your written authorization.

Your rights

With respect to your PHI, you have the following rights under HIPAA:

• Right to inspect and copy. You may inspect and request a copy of your medical and billing records, in paper or electronic form, subject to limited exceptions.
• Right to amend. You may request an amendment of PHI we maintain about you, if you believe it is incorrect or incomplete. We may deny the request under limited circumstances and will respond in writing.
• Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your PHI during the prior six years.
• Right to request restrictions. You may request that we restrict certain uses or disclosures of your PHI. We are not required to agree, except for disclosures to a health plan for services you have paid for in full out of pocket.
• Right to request confidential communications. You may request that we contact you at a specific phone number, address, or by a specific method. We will accommodate reasonable requests.
• Right to a paper copy. You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
• Right to file a complaint. You may file a complaint with us and with the U.S. Department of Health and Human Services, as described below, without retaliation.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or directly with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Complaints to the practice:

Privacy Officer
Sunshine Psychiatry Consult
[Privacy Officer contact — placeholder]

Complaints to HHS Office for Civil Rights:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, D.C. 20201

You may also file electronically at ocrportal.hhs.gov.

Changes to this Notice

We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain. A revised Notice will be posted on this page with a new effective date, and a copy will be available to you on request.

Contact for further information

Lorraine Black, MSN, PMHNP — Privacy Officer
Sunshine Psychiatry Consult
[Email — placeholder]
[Phone — placeholder]