Notice of Privacy Practices

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

I. UNA THERAPY GROUP’S PLEDGE REGARDING HEALTH INFORMATION

Una Therapy Group understands that information about your health and health care is personal and is committed to protecting your health information. Una Therapy Group creates and maintains records of the care and services you receive from clinicians and staff affiliated with the practice. These records are necessary to provide you with quality care and to comply with legal and regulatory requirements.

This Notice applies to all records of your care created or maintained by Una Therapy Group, whether created by clinicians, administrative staff, or other members of the workforce. This Notice describes how Una Therapy Group may use and disclose your health information, your rights regarding that information, and Una Therapy Group’s legal obligations related to the use and disclosure of your health information.

Una Therapy Group is required by law to:

• Maintain the privacy of protected health information (“PHI”) that identifies you

• Provide you with this Notice of its legal duties and privacy practices

• Follow the terms of the Notice currently in effect

Una Therapy Group reserves the right to change the terms of this Notice. Any changes will apply to all PHI maintained by the practice. The revised Notice will be made available upon request, in the office, and on the practice website.

II. HOW UNA THERAPY GROUP MAY USE AND DISCLOSE HEALTH INFORMATION

The following categories describe the ways Una Therapy Group may use and disclose PHI. Not every use or disclosure in each category is listed; however, all permitted uses and disclosures fall within one or more of these categories.

Treatment, Payment, and Health Care Operations

Federal privacy regulations allow health care providers with a direct treatment relationship to use or disclose PHI without written authorization for treatment, payment, and health care operations.

• Treatment: PHI may be used or disclosed by clinicians within Una Therapy Group and shared with other health care providers involved in your care. For example, a clinician may consult with another licensed provider regarding diagnosis or treatment.

• Payment: PHI may be used or disclosed to obtain payment for services provided.

• Health Care Operations: PHI may be used or disclosed for practice operations such as quality assurance, training, supervision, administrative activities, and compliance.

Disclosures for treatment purposes are not limited to the minimum necessary standard, as clinicians require access to relevant clinical information to provide appropriate care.

Lawsuits and Legal Proceedings

If you are involved in a legal proceeding, Una Therapy Group may disclose PHI in response to a court or administrative order. PHI may also be disclosed in response to a subpoena, discovery request, or other lawful process, provided that appropriate efforts have been made to notify you or to obtain a protective order.

III. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Psychotherapy Notes

Una Therapy Group maintains psychotherapy notes as defined by 45 CFR § 164.501. Psychotherapy notes are kept separate from the medical record. Any use or disclosure of psychotherapy notes requires your written Authorization, except in the following circumstances:

• For use by the treating clinician within Una Therapy Group

• For training or supervision of mental health practitioners within the practice

• For defense of the practice or its clinicians in legal proceedings initiated by you

• For oversight activities conducted by the Secretary of Health and Human Services

• When required by law, limited to the scope of the legal requirement

• For certain health oversight activities related to the originator of the notes

• For duties performed by a coroner or medical examiner as authorized by law

• To prevent or lessen a serious and imminent threat to the health or safety of a person or the public

Marketing and Sale of PHI

Una Therapy Group does not use or disclose PHI for marketing purposes and does not sell PHI in the regular course of business.

IV. USES AND DISCLOSURES THAT DO NOT REQUIRE AUTHORIZATION

Subject to applicable legal requirements, Una Therapy Group may use or disclose PHI without your Authorization for the following purposes:

• As required by state or federal law

• For public health activities, including reporting suspected abuse or neglect and preventing serious threats to health or safety

• For health oversight activities such as audits, inspections, and investigations

• For judicial or administrative proceedings, including court orders

• For law enforcement purposes, including reporting crimes occurring on the premises

• To coroners or medical examiners performing authorized duties

• For research purposes, subject to applicable safeguards

• For specialized government functions, including military, national security, and correctional institution activities

• For workers’ compensation claims, as required by law

Appointment Reminders and Practice Communications

Una Therapy Group may use and disclose PHI to contact you regarding appointments, scheduling matters, treatment alternatives, or other health-related services offered by the practice.

V. USES AND DISCLOSURES REQUIRING AN OPPORTUNITY TO OBJECT

Family Members and Others Involved in Your Care

Una Therapy Group may disclose PHI to family members, friends, or other individuals involved in your care or payment for care, unless you object. In emergency situations, consent may be obtained retroactively when permitted by law.

VI. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights with respect to your PHI:

• Right to Request Restrictions: You may request limits on certain uses or disclosures of your PHI. Una Therapy Group is not required to agree to all requests.

• Right to Restrict Disclosures for Self-Pay Services: You may request that PHI related to services paid for out-of-pocket in full not be disclosed to health plans.

• Right to Confidential Communications: You may request that communications be sent to you in a specific manner or location. Reasonable requests will be accommodated.

• Right to Access Your PHI: Except for psychotherapy notes, you may request access to or copies of your PHI. Requests will be fulfilled within 30 days, and reasonable, cost-based fees may apply.

• Right to an Accounting of Disclosures: You may request a list of certain disclosures made within the past six years. One request per year is provided at no charge.

• Right to Amend PHI: You may request corrections or additions to your PHI. If a request is denied, a written explanation will be provided.

• Right to a Copy of This Notice: You may request a paper or electronic copy of this Notice at any time.