Notice of Privacy Practices

Effective Date: January 1, 2025

Our Commitment to Your Privacy

At Yoma Psychiatric Solutions, we understand that your health information is deeply personal. We are committed to protecting the privacy of your protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA), as well as applicable state laws. This notice explains your rights and our obligations regarding your health information.

We want you to feel safe and informed. If anything in this notice is unclear, please do not hesitate to ask us — we are always happy to explain.

How We May Use and Disclose Your Protected Health Information

The following describes the ways we may use and share your health information. Not every use or disclosure is listed, but all of the ways we are permitted to use and disclose information fall within one of these categories.

For Treatment

We may use and share your health information to provide, coordinate, or manage your mental health care. For example, your therapist may consult with another provider within our practice about your treatment, or share relevant information with a specialist to whom you have been referred, with your authorization.

For Payment

We may use and share your health information to bill and collect payment for the services we provide. For example, we may share information with your health insurance company to obtain authorization for treatment or to process claims. The information shared may include your diagnosis, treatment dates, and the services provided.

For Health Care Operations

We may use your health information for activities that support the operation of our practice and ensure the quality of the care we provide. This may include quality improvement activities, training, compliance programs, and business management.

Additional Permitted Uses and Disclosures

We may also use or disclose your health information in the following situations, without your written authorization:

• As required by law: When federal, state, or local law requires disclosure.
• To avert a serious threat: If we believe in good faith that disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of you or others.
• For public health activities: As required for public health reporting, such as reporting suspected abuse, neglect, or domestic violence.
• Health oversight activities: For audits, investigations, inspections, and other activities authorized by law.
• Judicial and administrative proceedings: In response to a court order, subpoena, or other lawful process.
• Workers' compensation: As necessary for workers' compensation claims.
• Coroners, medical examiners, funeral directors: As authorized by law following a death.

Uses and Disclosures That Require Your Written Authorization

Most uses and disclosures of psychotherapy notes (where applicable), uses and disclosures for marketing purposes, and disclosures that constitute a sale of PHI require your written authorization. You may revoke any authorization you provide at any time in writing, except to the extent that we have already taken action in reliance on it.

Your Rights Regarding Your Health Information

You have the following rights with respect to your protected health information:

Right to Access

You have the right to inspect and obtain a copy of your health information maintained in your clinical record. To request access, please submit a written request to our Privacy Officer. We may charge a reasonable fee for copying and mailing costs.

Right to Amend

If you believe that the health information we have about you is incorrect or incomplete, you may request that we amend it. Your request must be in writing and include the reason for the amendment. We may deny your request in certain circumstances, and if so, we will explain why in writing.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your health information. This list will not include disclosures made for treatment, payment, or health care operations, or disclosures you authorized in writing.

Right to Request Restrictions

You have the right to request a restriction on how we use or disclose your health information for treatment, payment, or health care operations. While we will consider your request, we are not required to agree to it, except in certain circumstances (for example, if you pay for services out of pocket in full and request that we not disclose information to your health insurance plan for that service).

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health information in a particular way or at a particular location. For example, you may ask that we contact you only by mail or at a specific phone number. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this notice at any time, even if you have already received one. Simply ask at our front desk or contact us using the information below.

Right to Be Notified of a Breach

You have the right to be notified if a breach of your unsecured protected health information occurs. We will notify you as required by law.

Our Duties

• We are required by law to maintain the privacy of your protected health information and to provide you with this notice of our legal duties and privacy practices.
• We are required to abide by the terms of this notice currently in effect.
• We reserve the right to change the terms of this notice and to make the new provisions effective for all PHI we maintain. If we make significant changes, we will provide the updated notice to you and post it in our office and on our website.

How to File a Complaint

If you believe your privacy rights have been violated, you have the right to file a complaint. You will not be penalized or retaliated against for filing a complaint.

You may file a complaint with:

• Our Privacy Officer: Contact us using the information below. We take every complaint seriously and will investigate and respond promptly.
• The U.S. Department of Health and Human Services (HHS): Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201. You may call 1-877-696-6775 or visit www.hhs.gov/hipaa/filing-a-complaint.

Contact Information

If you have questions about this notice or would like to exercise any of your rights, please contact our Privacy Officer:

• Practice: Yoma Psychiatric Solutions
• Address: Fully Virtual — Serving Patients Online
• Phone: (314) 438-6043
• Email: mamuyovwe68@gmail.com

Acknowledgment of Receipt

You will be asked to sign an acknowledgment that you have received a copy of this notice at your first appointment. If you have any questions before signing, your therapist will be happy to discuss this notice with you.