Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

We (Evolution Counseling Suite, hereafter “ECS”) understand that health information is personal. We are committed to protecting health information about you. We will create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This notice applies to all of the records of your care generated by us, and describes the ways in which we may use and disclose health information about you in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”) and regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules. Also described in this notice are your rights to the health information we keep about you, and certain obligations we have regarding the use and disclosure of your health information. By law we are required to:

• Make sure that PHI that identifies you is kept private.

• Give you this notice of our legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

We reserve the right to change the terms of this Notice at any time, and such changes will apply to all PHI that we maintain. The new notice will be available on our website and an electronic or paper copy will be provided to you upon your request.

WHEN DISCLOSURE IS REQUIRED OR MAY BE REQUIRED BY LAW:

The following categories describe different ways ECS uses and discloses health information. Not every specific use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories:

• For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment, or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

• Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. Treatment includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

• Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

• Under the law, we must disclose your PHI to you upon your request.

• We must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

WHEN DISCLOSURE REQUIRES YOUR AUTHORIZATION:

Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time by notifying us of the revocation in writing, except to the extent that we have already made use or disclosure based upon your authorization or if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

• Psychotherapy Notes are notes your therapist has made about your conversation during a counseling session, which he or she has kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. Any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For ECS’ use in treating you. b. For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For our use in defending ourselves in legal proceedings. d. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.

• As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

• As a psychotherapist, I will not sell your PHI.

WHEN DISCLOSURE DOES NOT REQUIRE YOUR AUTHORIZATION:

Subject to certain limitations in the law, ECS can use and disclose your PHI without your Authorization for the following reasons:

• When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

• For health oversight activities, including audits and investigations.

• For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an Authorization from you before doing so.

• For law enforcement purposes: We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, or in connection with the reporting of a crime in an emergency.

• To coroners or medical examiners, when such individuals are performing duties authorized by law.

• For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

• Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

• For workers' compensation purposes. Although our preference is to obtain an Authorization from you, we may provide your PHI in order to comply with workers' compensation laws.

• We may use or disclose your PHI in a medical or psychiatric emergency situation to medical personnel only in order to prevent serious harm.

• Serious Threat to Health or Safety: If you communicate to your therapist a threat of imminent serious physical violence against a readily identifiable victim or yourself or the public and he or she believes you intend to carry out that threat, your therapist must take steps to warn and protect. He or she must take such steps if it is believed you intend to carry out such violence, even if you have not made a specific verbal threat. The steps taken to warn and protect may include arranging for you to be admitted to a psychiatric unit of a hospital or other health care facility, advising the police of your threat and the identity of the intended victim, warning the intended victim or his or her parents if the intended victim is under 18, and warning your parents if you are under 18.

• Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.

CERTAIN USES AND DISCLOSURES REQUIRING YOUR OBJECTION:

ECS may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

• The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI about you. However, we are not required to agree to your request.

• The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

• The Right to Choose How ECS Sends PHI to You. You have the right to ask us to contact you in a specific way or at a certain location, and we will agree to all reasonable requests.

• The Right to See and Get Copies of Your PHI. Other than psychotherapy notes, you have the right to get an electronic or paper copy of your medical record and other information. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, and we may charge a reasonable fee for doing so. We may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. Upon your request, we will discuss with you the details of the request and denial process.

• The Right to Get a List of the Disclosures ECS Has Made. You have the right to request a list of instances in which we have disclosed your PHI (i.e., an accounting of disclosures) for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will provide the list to you at no charge, but if you make more than one request in any 12-month period, we may charge you a reasonable fee for each additional request.

• The Right to Amend Your PHI. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy.

• The Right to Breach Notifications. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.

• The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice and get a copy by e-mail. Even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

QUESTIONS AND COMPLAINTS:

If you have questions about this Notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you should inform us of your concerns.

If you believe that your privacy rights have been violated, you have the right to file a complaint with us. If you wish to file a complaint with us, you may send your written complaint to us at 8 Campus Drive, Suite 105, #3065, Parsippany, NJ 07054. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W., Washington, D.C. 20201 or by calling the toll free call center at 1-877-696-6775. We will not retaliate against you for exercising your right to file a complaint.

EFFECTIVE DATE AND CHANGES TO PRIVACY PRACTICES:

The effective date of this notice is August 1, 2024.