Notice of Privacy Practices

How we may use and disclose your PHI

We may use and disclose your PHI without your written authorization for the following purposes:

• Treatment. To provide, coordinate, or manage your mental health care, including consultation with other providers involved in your care.
• Payment. To bill and receive payment for services, including verifying coverage and submitting claims to your health plan.
• Health care operations. For quality-improvement activities, licensing, credentialing, and general administration of the practice.
• Required by law. When federal, state, or local law requires disclosure (for example, mandated reporting of suspected abuse or neglect, court orders, or subpoenas that meet legal requirements).
• Serious threat to health or safety. To prevent or lessen a serious and imminent threat to you or others, consistent with applicable law and professional standards.
• Public health, oversight, and safety activities. As permitted or required by HIPAA.
• Business associates. To vendors who help us operate the practice (for example, our secure telehealth platform, electronic health record, and billing platforms). Each business associate is contractually required to safeguard your PHI.

Uses and disclosures that require your written authorization

Except as described above, we will not use or disclose your PHI without your written authorization. This includes:

• Most uses and disclosures of psychotherapy notes.
• Uses and disclosures for marketing purposes.
• Sale of your PHI.

You may revoke a written authorization at any time in writing, except to the extent we have already relied on it.

Your rights

You have the right to:

• Inspect and copy your PHI, with limited exceptions (including psychotherapy notes).
• Request an amendment of your PHI if you believe it is inaccurate or incomplete.
• Request restrictions on certain uses and disclosures. We are not required to agree to every requested restriction, but we will honor a request to restrict disclosure to a health plan for services you paid for in full out-of-pocket.
• Request confidential communications at an alternative address or by an alternative method.
• Receive an accounting of certain disclosures we have made of your PHI.
• Receive a paper copy of this notice, even if you agreed to receive it electronically.
• Be notified of a breach of your unsecured PHI.

To exercise any of these rights, please contact us in writing using the contact information below.

Our responsibilities

• We are required by law to protect the privacy of your PHI.
• We must provide you with this notice of our legal duties and privacy practices.
• We must follow the terms of the notice currently in effect.
• We will notify you if a breach occurs that may have compromised the privacy or security of your PHI.

Changes to this notice

We reserve the right to change this notice and to make the revised notice effective for PHI we already have as well as PHI we receive in the future. The current notice will always be available on this page, and we will provide a copy at your request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

Contact — Privacy Officer

Kyla C. Kaufman, MEd, LPC — Privacy Officer, TeleKyla LLC
Email: kyla@telekyla.com
Or send a message.