Notice of Privacy Practices

This notice describes how your medical records and related personal information may be used and disclosed by Holding Arms L.L.C. and how you are able to access this information. Please review it carefully. This notice applies to all providers and all locations at which you may receive care through Holding Arms L.L.C..

Holding Arms L.L.C. is required by law to maintain the privacy of your protected health information (PHI). This document provides you with notice of your privacy rights and the legal duties and privacy practices of your practitioners and Holding Arms L.L.C. with respect to your PHI. All terms of this notice regarding your PHI will be followed, unless terms are amended or added to remain in accordance with federal and state law. If this notice changes, you will receive a copy of the revised notice by U.S. mail to the last address you provided, or by email if you indicated you prefer electronic communication. At any time you may request a paper copy of this notice, and one will be provided to you.

Protected health information is any identifiable client information that contains:

• Any information that concerns your health and medical status or personal identifying information.
• Any information about medical or psychiatric care that has been, is being, or will be delivered to you.
• Financial information regarding payment for your visits and procedures, and insurance information.
• Any information about genetic testing or results, information about you or your family members, a request for genetic services, clinical research participation related to genetics, or symptoms and diagnosis of a genetic disease or condition of you or a family member.

The purpose of creating and storing your record is to document your visits and communications between you and your health care providers. This allows Holding Arms L.L.C. to provide informed, quality care and to remain in compliance with applicable federal and state laws. Your record will contain, among other things, examinations and test or lab results, diagnoses, treatments, visit notes, prescription orders, and a plan for future care or treatment.

Although your health record is the physical property of Holding Arms L.L.C., the information contained in it belongs to you. You have the following privacy rights:

• The right to request restrictions on the use and disclosure of your PHI to carry out treatment, payment, or health care operations. If agreeing to certain requests would negatively affect your care, Holding Arms L.L.C. reserves the right to deny your request. If you pay out of pocket, in full, for a service, you may request that we not share that information with your health insurer, and we will abide provided no law requires that information to be shared.
• The right to ask Holding Arms L.L.C. to correct health information you believe to be incorrect or incomplete. Holding Arms L.L.C. reserves the right to deny your request, and you will be given written notice within 60 days as to why. If denied, you may request documentation of your request be included in your health record along with the denial, and included in future disclosures. Requests to amend documentation created by an outside agency will automatically be denied.
• The right to ask us to contact you confidentially. You may specify your preferred means of communication (telephone, U.S. mail, email, and so on) and we will do our best to accommodate this request, within reason.
• The right to request restrictions on the use and disclosure of your name, the location where you receive care, your health or medical status, diagnoses, or other identifying information — including limiting disclosure to family and friends, certain disclosures to those involved in your care unless it would negatively affect the quality of care, or in the event of a disaster relief situation.
• The right to get a list (an “accounting”) of those with whom we have shared your health information and why, for up to six years prior to the date of your request.
• The right to file a complaint if you feel your rights have been violated. We will not retaliate against you for filing a claim.
• The right to inspect and copy your PHI, in the presence of a staff person, except for psychotherapy notes or where your clinician or treatment team has determined disclosure would be detrimental to your physical or mental health or likely to cause harm to you or another.
• The right to rescind a release of information or authorization at any time by submitting your request in writing. If information has already been shared with your permission, we cannot take that information back.

What is not included in an accounting of disclosures

• Disclosures you requested we make to specific individuals or entities.
• Disclosures made for purposes of payment.
• Disclosures that are industry practice for health care operations.
• Disclosures mandatory under federal or state law, or for maintaining our license with DHS or the Department of Health.

One accounting is available to you per year at no cost. If you require more than one list in a 12-month span, you may be required to pay a reasonable fee.

You may request copies of your PHI by submitting a written request or completing a release of information form. We will provide requested documents within a reasonable period, no more than 10 business days. There may be a fee for each page copied.

Filing a complaint

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201; by calling 1-877-696-6775; or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• It is our duty to keep your health information secure, private, and protected.
• It is our duty to notify you if there has been a breach of your health information.
• We will follow the responsibilities and practices laid out in this notice and remain up to date with changes in federal or state law.
• We will abide by your requests regarding your PHI, within reason and according to applicable law.
• We will never share your information for marketing purposes or sale of your information without your written consent.
• We will make all attempts to ensure your PHI is a thorough and complete representation of the services and treatments you receive with Holding Arms L.L.C..

Please note that a signed and dated release of information or written consent is generally only valid for a period of one year, or less if specified. With your consent we may use or disclose your PHI:

• For the purposes of your treatment, payment for services, and the general operations of Holding Arms L.L.C..
• When you have requested your record, or portions of it, be released to another agency or entity.
• When organ and tissue donation or organ procurement organizations request it.
• For health, medical, or scientific research, provided you do not object. If you object, your health information will not be released.

If portions of your health record are released for research, you may request, and we will provide, information on who received it and when. In most cases, Holding Arms L.L.C. will not connect your name to health records released for research purposes.

Holding Arms L.L.C. may share your personal information with public health or other authorized agencies without your consent, under federal and state law, when:

• The disclosure is to a related entity affiliated with Holding Arms L.L.C. and is related to your treatment.
• The disclosure provides health care services in a medical emergency or disaster relief situation.
• There is a substantial barrier to communicating with you and our clinical staff believe you intend for us to provide care to you.
• Health care services are provided to you as an inmate.
• We are required by law to treat you and are unable to obtain your consent despite attempting to do so.
• We are complying with certain government functions such as military, national security, correctional facilities, and presidential protective services.
• It is necessary to protect or reduce a serious threat to someone's health or safety.
• Suspected abuse or neglect of a child or vulnerable adult is reported.
• Reporting product recalls, preventing or controlling diseases, or reporting adverse reactions to medications.
• It is part of oversight activities such as audits, inspections, or government investigations.
• It is part of managing our operations with business partners, who are required by law to keep your information secure.
• It is required for workers' compensation claims, or necessary to work with a medical examiner or coroner.
• A public health authority is collecting information regarding vital life events, such as birth or death.
• Legal actions require it, such as a court order, grand jury subpoena, warrant, other legal process, or law enforcement purposes.
• To defend Holding Arms L.L.C. in a legal action or related proceedings you bring against Holding Arms L.L.C..
• Federal or state law requires it.

Psychotherapy notes and substance use treatment

Psychotherapy notes and records related to substance use treatment may be part of your PHI. These portions of your health record require separate written consent that explicitly states the types of records to be released or communication that can take place, the purpose of the release, the expiration date, and the person, agency, or entity the records are to be released to.

Mandated reporting

Under certain state law, persons in designated professional occupations are mandated to report suspected child abuse or neglect of vulnerable adults. These persons may be required by law to report to authorities if they know or have reason to believe a person is being abused or neglected, and this may be done without your consent. Behavioral health personnel may be required to break confidentiality and report certain information to the appropriate authorities.

Medical and durable powers of attorney

If you have a health care directive and have appointed a medical power of attorney or durable power of attorney, that person will have the ability to make medical decisions for you and access your PHI, but only if you become incapacitated or incompetent.

Adults who have guardians

If a guardian has been appointed to you through a court order, your guardian has the power to give necessary consent for you to receive care and has full access to your PHI.

Minors

Minors are persons under the age of 18. Parents of certain minor children who are able to consent for treatment on their own do not have access to their minor child's health record, and release of records or PHI requires written consent from the minor child. The only exception is if the treating professional believes that failure to inform the parent or guardian would seriously jeopardize the health of the minor. Minors who are able to consent for treatment on their own include:

• Minors who live apart from their parents or legal guardians and manage their own financial affairs.
• Minors who are married.
• Minors who are parents to a biological child.
• When the services are to determine the presence of or treat pregnancy and associated conditions.
• When the services are related to venereal diseases, STDs, or STIs.
• For Hepatitis B vaccinations.
• When the services are for the assessment or treatment of alcohol or drug abuse.
• Emergency treatment for medical, dental, or other health services where the risk to the minor's life or health is such that treatment should be given without delay.

Additionally, parents may be deemed not to be personal representatives of their minor child, and therefore have limited or no access to the child's PHI, if the minor is subject to domestic violence, abuse, neglect, or endangerment and notifying the parent may place the minor in further danger.

Questions about this notice, or to request a paper copy: Info@holdingarms.com · (612) 000-0000