TAZA THERAPY NOTICE OF PRIVACY PRACTICES

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

I. OUR PLEDGE REGARDING HEALTH INFORMATION

At Taza Therapy, I understand that health information about you and your care is deeply personal. I am committed to protecting that information. I create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all records generated by this mental health practice.

I am required by law to:

• Ensure that protected health information (“PHI”) that identifies you is kept private.
• Provide you with this notice of my legal duties and privacy practices.
• Follow the terms of the notice currently in effect.

I reserve the right to change the terms of this Notice. Any new Notice will be available upon request, in my Newtown, PA office, and on the Taza Therapy website.

II. HOW TAZA THERAPY MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

Federal privacy rules allow health care providers to use or disclose PHI without a patient’s written authorization for the following purposes:

• For Treatment: I may use your PHI to provide, coordinate, or manage your mental health treatment. For example, if I consult with another licensed clinician or your primary care physician to coordinate your care, I am permitted to share PHI to assist in your diagnosis and treatment.
• For Payment: I may use and disclose PHI so that the services you receive may be billed and payment collected from you, an insurance company (such as Independence Blue Cross), or a third party.
• For Health Care Operations: I may use PHI to run my practice and ensure that all clients receive quality care.
• Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose PHI in response to a court or administrative order. I may also disclose PHI in response to a subpoena or discovery request, but only after efforts have been made to notify you.

III. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

• Psychotherapy Notes: I do keep “psychotherapy notes.” Any use or disclosure of these notes requires your specific Authorization, except for my use in treating you, defending myself in legal proceedings, or as required by the Secretary of Health and Human Services to investigate HIPAA compliance.
• Marketing & Sale of PHI: As a psychotherapist, I will never use or disclose your PHI for marketing purposes or sell your PHI in the regular course of business.

IV. USES AND DISCLOSURES NOT REQUIRING YOUR AUTHORIZATION

Subject to legal limitations, I can disclose your PHI without Authorization for:

• Mandatory Reporting: Required by state/federal law, such as suspected child, elder, or dependent adult abuse.
• Public Safety: To prevent or reduce a serious threat to your health/safety or the safety of others.
• Health Oversight: For audits or investigations by licensing boards (e.g., in PA, NJ, FL, or SC).
• Law Enforcement: To report crimes occurring on the practice premises.
• Appointment Reminders: To contact you (via phone, text, or email) to remind you of a scheduled session.

V. YOUR OPPORTUNITY TO OBJECT

Disclosures to Family/Friends: I may provide PHI to a family member or friend involved in your care or payment for care, provided you have been given the opportunity to agree or object.

VI. YOUR RIGHTS REGARDING YOUR PHI

• The Right to Request Limits: You may ask me not to use or disclose certain PHI for treatment or payment. I am not required to agree if it affects your care.
• The Right to Restrictions for Out-of-Pocket Payments: If you pay for a service in full out-of-pocket, you have the right to restrict disclosures of that PHI to your health plan.
• The Right to Choose Communication Methods: You have the right to ask me to contact you in a specific way (e.g., only via your portal or a specific phone number).
• The Right to Access: You have the right to see and get electronic or paper copies of your medical record (excluding psychotherapy notes). I will provide this within 30 days.
• The Right to an Accounting of Disclosures: You may request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or operations.
• The Right to Correct/Update: If you believe information in your record is incorrect, you may request an amendment in writing.
• The Right to Professional Accountability: You have the right to professional transparency. If you believe your privacy rights have been violated, you may contact me directly or file a complaint with the Department of Health and Human Services or the State Licensing Board in your respective state (PA, NJ, FL, or SC).

VII. GOOD FAITH ESTIMATE NOTICE

If you do not have insurance or are not using insurance, you have the right to receive a “Good Faith Estimate” explaining how much your psychotherapy services will cost.

• You can ask for a Good Faith Estimate before you schedule a service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. For more information, visit www.cms.gov/nosurprises.

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