MOOD CLINICAL P.C. Summary Notice Of Privacy Practices

THIS NOTICE OF PRIVACY PRACTICES (THIS “NOTICE”) DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY. THIS NOTICE IS BEING PROVIDED TO YOU PURSUANT TO FEDERAL LAW.

Your Protected Health Information (PHI)

Protected health information” (PHI) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health or condition, the provision of health care services, or the past, present or future payment for the provision of health care. Each time you have contact with a healthcare provider for delivery of healthcare, a record of your contact/visit is prepared. Your medical record is the physical property of Mood Clinical, MD, P.C. (“P.C.”), but you have certain rights to restrict, or request restrictions on, some of the uses or disclosures of the information in your medical record, as further described in this Notice. However, P.C. has the right to use and disclose the information contained in your medical record in the process of providing treatment, seeking or receiving payment, and performing other regular health care operations, as is further described herein.

Your Rights Regarding Your PHI

Except as otherwise provided by applicable law, you have the right to:

Inspect and copy your PHI and other medical records

Request an amendment to your PHI and other medical records

Request confidential communications

Request restrictions on the uses or disclosures of PHI

Receive an accounting of PHI disclosures

Receive a copy of this Notice

Choose someone to act for you

Additional rights; Complaint procedures

Your Choices

For certain health information, you can tell P.C. your choices about what P.C. may share. If you have a clear preference for how P.C. shares your information in the situations described below, please contact P.C. at hello@moodclinical.com with your preferences and P.C. will follow your instructions with respect to the your rights and choices in connection with the below:

P.C. may ask you to provide the name and contact information for friends and family members who you want to be involved in your care, and will abide by your instructions. If you are not able to communicate your preferences to P.C. (such as instances when you are unconscious), P.C. may proceed with sharing your information if P.C. believes doing so is in your best interest. P.C. may also share your information when needed to lessen a serious and imminent threat to health or safety.

In the below cases, P.C. will never share your information unless you provide P.C. with written permission to do so:

Our Uses and Disclosures of PHI

P.C. may use and share your PHI and other health information in connection with providing treatment, receiving payment for health services, and performing other regular health operations such as:

Examples of Uses and Disclosures of Your PHI

P.C. typically uses or shares your health information in the following ways.

Healthcare Delivery and Treatment

Information obtained from you by a physician, nurse, or other healthcare professional is documented in your record and used for the assessment, evaluation, diagnosis, and treatment of your medical condition(s). Following your treatment, this information may be provided to other healthcare professionals who may be involved in your care, such as other physicians, specialists, physical therapists, hospital-based providers, and/or other healthcare providers.

Example: Your physician and an P.C. provider may need to coordinate your care.

Billing and Payment

Your PHI is utilized to justify the level of care delivered to you and the charges incurred for the services. This information generally accompanies the bill and is sent to our payers.

Example: P.C. gives information about you to your health insurance plan so it will pay for your services.

Healthcare Operations

P.C. may disclose your PHI to other individuals and businesses in order to perform day-to-day operations. These other individuals and businesses include business associates such as vendors and/or contractors used for billing and claims management, medical research, disease management, and quality improvement initiatives, as well as management services organizations, laboratories, other free-standing diagnostic facilities, and legal counsel. P.C. requires all business associates to agree to appropriately protect the confidentiality of your PHI.

Example: P.C. uses health information about you to manage the way P.C. provides your treatment and services.

How else can P.C. use or share your health information?

P.C. is allowed or may be required to share your PHI or other health information in other ways – usually in ways that contribute to the public good, such as public health and research, which are summarized below. P.C. has to meet many conditions in the law before P.C. can share your information for these purposes. For more information on these permitted disclosures, please see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

To help with public health and safety issues

P.C. can share health information about you for certain situations such as: Reporting suspected abuse, neglect, or domestic violence; or Preventing or reducing a serious threat to anyone’s health or safety.

To conduct research

P.C. can use or share your information for health research where permitted by law or with your consent.

To comply with the law

P.C. will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that P.C. is complying with federal privacy law.

For Reminders and Treatment

P.C. may contact you to provide you with information P.C. feels is useful or helpful to you, based on your PHI. For example, P.C. may contact you (or instruct a specialist provider to whom you have been referred to contact you) to schedule an appointment or as an appointment reminder, to suggest alternative treatments, or to provide you with information on treatments you are already receiving.

For Legal Reasons

P.C. can use or share health information about you:

Other Miscellaneous Uses

Our Responsibilities

For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

P.C. may change the terms of this Notice, and the changes will apply to all information P.C. has about you. The new Notice will be available upon request, in P.C.’s offices, and on the P.C. website.