HIPAA Notice of Privacy Practices

Our Commitment to Your Privacy

At Elite Performance EMDR, we understand that information about you and your health is personal. We are committed to protecting the privacy of your Protected Health Information (PHI) and maintaining the confidentiality of your health records. This Notice of Privacy Practices (NPP) describes how we may use and disclose your PHI for treatment, payment, and healthcare operations, as well as for other purposes permitted or required by law. It also describes your rights regarding your PHI.

Who This Notice Applies to:

This Notice applies to Elite Performance EMDR and all of its personnel, trainees, and volunteers involved in your care.

Your Protected Health Information (PHI):

Your PHI includes demographic information and health information that identifies you and relates to your past, present, or future physical or mental health or condition and related health care services.

How We May Use and Disclose Your PHI

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

1. For Treatment: We may use and disclose your PHI to provide, coordinate, or manage your mental health care and any related services. This includes sharing information with other healthcare providers who are involved in your treatment (e.g., your physician, psychiatrist, or other therapists) to ensure coordinated care, but only with your explicit consent or if legally mandated (e.g., in a life-threatening emergency).

2. For Payment: We may use and disclose your PHI to bill and collect payment for the services we provide to you.

3. For Healthcare Operations: We may use and disclose your PHI for activities necessary to run our practice and ensure quality care. These activities include, but are not limited to, clinical supervision, quality assessment and improvement activities, training new staff, licensure and credentialing, scheduling, and general business management.

   • Example: Your PHI may be used in a confidential manner for clinical consultation or for quality review of our services to ensure we are providing effective and ethical care.

Uses and Disclosures That Require Your Written Authorization

Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. You may revoke an authorization at any time, in writing, except to the extent that we have already acted in reliance on the authorization.

Specifically:

• Psychotherapy Notes: Most uses and disclosures of "psychotherapy notes" (as defined by HIPAA) require your written authorization. These are notes taken by your therapist during a counseling session.

• Marketing: We require your written authorization for any use or disclosure of your PHI for marketing purposes, except for face-to-face communications or promotional gifts of nominal value.

• Sale of PHI: We require your written authorization for any disclosure of your PHI that constitutes a sale of PHI.

Uses and Disclosures Required or Permitted by Law Without Your Authorization

We may use or disclose your PHI without your authorization under specific circumstances as permitted or required by law, including:

• Required by Law: When a law requires that we report information about your PHI to government agencies or law enforcement.

• Public Health Activities: To prevent or control disease, injury or disability, report births and deaths, or report reactions to medications or problems with products.

• Victims of Abuse, Neglect, or Domestic Violence: To government authorities if we reasonably believe you are a victim of abuse, neglect, or domestic violence.

• Health Oversight Activities: For audits, investigations, inspections, and licensure necessary for the government to monitor the healthcare system.

• Judicial and Administrative Proceedings: In response to a court order, subpoena, discovery request, or other lawful process.

• Law Enforcement Purposes: To law enforcement officials for specific purposes, such as identifying or locating a suspect, fugitive, material witness, or missing person; about victims of a crime; about a death; in response to a warrant or subpoena; or for emergencies.

• Coroners, Medical Examiners, and Funeral Directors: To assist them in carrying out their duties.

• Organ and Tissue Donation: For organ, eye, or tissue donation.

• Research: Under specific conditions, we may use and disclose your PHI for research purposes.

• Serious Threat to Health or Safety: If we believe, in good faith, that a disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

• Workers' Compensation: For workers' compensation or similar programs.

• National Security and Intelligence Activities: To authorized federal officials for intelligence, counterintelligence, and other national security activities.

• Correctional Institutions: To a correctional institution or law enforcement official if you are an inmate, for your health and the health and safety of others.

Your Rights Regarding Your PHI

You have the following rights regarding your PHI. You must submit a written request to us to exercise these rights.

1. Right to Request Restrictions: You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request, except if you request that we restrict disclosure of your PHI to a health plan for services for which you paid in full out-of-pocket, and the disclosure is not otherwise required by law.

2. Right to Receive Confidential Communications: You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. We will accommodate reasonable requests.

3. Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI that we maintain in a designated record set, for as long as we maintain the PHI. We may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain limited circumstances.

4. Right to Amend: If you feel that PHI we have about you is incorrect or incomplete, you have the right to request an amendment to your record. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if the PHI is accurate and complete, was not created by us, is not part of the PHI kept by us, or is not subject to your right to inspect and copy.

5. Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures." This is a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or healthcare operations, or those made with your authorization, or those made for certain other purposes (such as national security). Your request must state a time period, which may not be longer than six years.

6. Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may ask us for a paper copy at any time.

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI.

• We are required to provide you with this Notice of our legal duties and privacy practices with respect to your PHI.

• We are required to abide by the terms of the Notice currently in effect.

• We will notify you if we are unable to agree to a requested restriction.

• We will notify you if there is a breach of your unsecured PHI.

We reserve the right to change the terms of this Notice at any time. Any changes will apply to all PHI we maintain. If we make material changes to this Notice, we will post the revised Notice on our website at www.eliteemdr.com and make paper copies available in our office.

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