Psych Pointe LLC

113 Lincolnway East Mishawaka, IN 46544

Phone: 574-314-5987    Fax: 833-907-2315

Notice of Privacy Practices

Purpose: This notice explains how Psych Pointe LLC may use or disclose your health (medical) information, and about yourrights and Psych Pointe's obligations under federal and state law to protect the privacy and confidentiality of your healthinformation. If you have any questions regarding this Notice of Privacy Practices, please contact the Privacy Officer (contact information is at the end of this notice). This notice describes how medical information about you may be used and disclosed and how you can get access to the information.Please review it carefully.

 Information We Collect

·       Personal information that you voluntarily provide to us when you express interest in obtaining information about our services, when you participate in activities on the website, or otherwise when you contact us. 

·       Personal information provided by you: name, phone numbers, email address, and other similar information. All information that you provide to us must be true, complete, and accurate, and you must notify us of any changes to such personal information.

·       Information automatically collected: some information- such as your Internet Protocol (IP) address and/or browser and device characteristics-is collected automatically when you visit our website. This information does not reveal your specific identify but may include device and usage information. This information is primarily needed to maintain the security and operation of our website, and for our internal analytics and reporting purposes. Like many businesses, we also collect information through cookies and similar technologies.

Summary of Privacy Practices

· We may use and disclosure your health information, without your permission, for treatment, payment, and healthcare operations activities, and when required or authorized by law for public health and interest activities, law enforcement,judicial and administrative proceedings, research, and certain other public benefit functions, including disaster reliefsituations.

· We may disclose your health information to your family members, friends, and others you involve in your healthcare or payment for healthcare, unless you tell us not to.

· We will not otherwise use or disclose your health information without your written authorization.

·  You have the right to examine and receive a copy of your health information, to receive an accounting of certain disclosures wemay make of your health information, and to request that we amend, further restrict the use and disclosure of or communicatein confidence with you about your health information Please review this entire notice for details about the uses and disclosureswe may make of your health information, about your rights and how to exercise them, and about complaints regarding them or about additional information about our privacy practices.

Our Legal Duty

· We are required by applicable state and federal law to maintain the privacy of your health information. We are also required to give you notices about our privacy practices, our legal duties, and your rights concerning your health information. We mustfollow the practices that are described in this notice while it is in effect. The notice takes effect January 1, 2024, and willremain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law.

· We reserve the right to change our privacy practices and the terms of this notice at any time as permitted by applicable law andmake such changes effective for all health information we maintain, including health information we created or receivedbefore we made the changes. We will change this notice and make a new notice available to you before we make any significantchanges to our privacy practices.

· You may request a copy of this notice at any time. For more information about our privacy practices or for additional copies ofthis notice, please contact us (contact information is at the end of this notice).

Uses and Disclosures of Health Information

·       Treatment: We may use your health information, without your permission, to treat you, which includes our evaluationand diagnostic services. We may also disclose your health information to a physician or other healthcare provider for your treatment, including coordinating your care with other providers, health plans, and in consultation with other providers related to your care; and, if we refer you to other providers for care.

·       Payment: We may use and disclose your health information, without your permission, to obtain or provide reimbursement for healthcare services we provide you, including submitting claims to health plans, other insurers, orothers. These payment activities may include determining your eligibility for health services, demonstrating themedical necessity of the services we provide to you, and obtaining pre-authorization to provide you with healthcareservices.

·       Operations: We may use and disclose your health information, without your permission, for healthcare operations.Healthcare operations include, for example: healthcare quality assessment and improvement activities; healthcareprovider licensing and certification; conducting or arranging for medical reviews, audits, and legal services, including fraud and abuse detection and prevention; and business planning, development, and management.

·       We may disclose your health information to a health plan or another healthcare provider who is subject to federal privacyprotection laws, if the provider or health plan has a relationship with you and the health information is for that provider's or health plan's healthcare quality assessment and improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection and prevention.

Your Authorization

·  You may give us written authorization to use or disclose your health information to anyone for any purpose. If you give uswritten authorization, you may revoke it at any time. The revocation will not affect any use or disclosure permitted byyour authorization while it was in effect. Unless you give us written authorization, we will not use or disclose your healthinformation for any purpose other than those described in this notice.

Family, Friends, and Others Involved in Your Care

·  We may disclose your health information to a family member, friend, or any other person you involve in your healthcareor payment for healthcare. We will disclose only the health information relevant to the person's involvement. Before we make such a disclosure we will give you an opportunity to object. If you are not present or are incapacitated or it is an emergency, we will use our professional judgment to determine whether disclosing your health information is in your bestinterest under the circumstances.

·  We may use or disclose your name, location, and general condition to notify, or to assist an appropriate public or privacyagency to locate and notify, a person responsible for your healthcare in appropriate situations, such as an emergency or during disaster relief efforts.

Health-related Products or Services

·  We may use your health information to contact you to provide appointment reminders and to communicate with you about treatment alternatives and other health-related benefits and services that may be of interest to you.

Public Health and Benefit Activities

·  We may use and disclose your health information, without your permission, when required by law, and when authorized by law for the following kinds of public health and interest activities, judicial and administrative proceedings, law enforcement, research, and other public benefit functions:

·  For public health, including to report disease and vital statistics, child abuse, adult abuse, neglect, or domestic violence.

·   To avert a serious and imminent threat to health and safety.

·  For healthcare oversight, such as state licensing and peer review authorities, and fraud prevention enforcement agencies.

·   For research (where additional privacy protections are in place).

·   In response to court and administrative orders and other lawful purposes.

·  To law enforcement officials regarding crime victims, crimes on our premises, crime reporting in emergencies, andidentifying or locating suspects or other persons.

·   To coroners, medical examiners, funeral directors, and organ procurement organizations.

·  To the military, to federal officials for lawful intelligence, counterintelligence, and national security activities; and tocorrectional institutions and law enforcement regarding persons in lawful custody

·   As authorized by state worker's compensation laws.

Your Rights

·  Access: You have a right to examine and receive a copy of your health information, with limited exceptions. You shouldsubmit your request to the Psych Pointe's Privacy Officer (contact information is provided at the end of this notice), who willprovide you with a form to complete. There may be a reasonable, cost-only fee charged for copies.

·  Disclosure Accounting: You have the right to a list of instances in which we disclosed your health information for purposesother than treatment, payment, healthcare operations, as authorized by you, and for certain other activities. You should submit your request to the Psych Pointe's Privacy Officer, who will provide you with a form to complete. We are not required to provide you with a list of disclosure instances that occurred six or more years before the date of your request. If yourequest an accounting more than once in a twelve-month period, we may charge you a reasonable, cost-only fee for theadditional requests.

·  Amendment: You have the right to request that we amend your health information. You should submit your request to the Psych Pointe's Privacy Officer, who will provide you with a form to complete. You will need to explain why the informationshould be amended. We may deny your request only for certain reasons; if we deny your request we will provide you witha written explanation. If we accept your request, we will make your amendment part of your health information and usereasonable efforts to inform others who we know may have to rely on the information (if reliance on the amendedinformation would be to your detriment) and others you want to receive the amendment.

·  Restriction: You have the right to request that we restrict our use or disclosure of your health information for treatment,payment, or healthcare operations, or with family, friends, or others you identify. You should submit your request to thePsych Pointe's Privacy Officer, who will provide you with a form to complete. We are not required to agree to your request.If we do agree, we will abide by our agreement, except in a medical emergency or as required or authorized by law.

·  Confidential Communications: You have the right to request that we communicate with you about your health information inconfidence by alternative means or to alternative locations that you specify. You should submit your request to the PsychPointe's Privacy Officer, who will provide you with a form to complete. We will accommodate your request if it isreasonable; we will not ask you to explain the reason for your request.

·  Electronic Notice: If you receive this notice on our website or by electronic mail (e-mail), you are entitled to receive it inwritten form. Please contact the Psych Pointe's Privacy Officer to request a written copy.

Questions and Complaints: If you want more information about our privacy practices or have questions or concerns, pleasecontact the Psych Pointe's Privacy Officer. If you are concerned that we may have violated our privacy rights, or if you disagree with a decision, we made about access to your health information, (including our response to a request you made to amend,restrict the use and disclosure of, or communicate in confidence about your health information), you may also submit a written complaint to the Office for Civil Rights, U.S. Department of Health, and Human Services, 233 N. Michigan Ave., Suite 240,Chicago, IL 60601. Voice Phone (312) 886-2359, FAX (312) 886-1807, or online at www.hhs.gov/ocr/privacy/hipaa/complaints/.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the Office for Civil Rights.

Privacy Officer Contact Information

Name: Jessica Browning Psych Pointe LLC

113 Lincolnway East

Mishawaka, IN 46544

Phone: 574-314-5987

Fax: 833-907-231