THIS NOTICE DESCRIBES HOW WELLMIND.ONLINE CA LICENSED CLINICAL SOCIAL WORKER PROF. CORP. AND ITS PROVIDERS (“WE”, “US” or “WELLMIND”) MAY USE AND DISCLOSE YOUR HEALTH INFORMATION AND HOW YOU CAN GET ACCESS TO THIS IN- FORMATION. THIS NOTICE ONLY APPLIES TO REGISTERED PATIENTS OF WELLMIND. WELLMIND DOES NOT COLLECT PROTECTED HEALTH INFORMATION OF WEBSITE VISITORS.

I. WELLMIND’S PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you and your healthcare is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from Wellmind. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by Wellmind’s mental healthcare practice. This notice will tell you about the ways in which we may use and disclose health information about you. The Notice also describes your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.

WE ARE REQUIRED BY LAW TO:

• Maintain the privacy and security of protected health information (“PHI”) that identifies you is kept private.
• Let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• Give you this Notice of Wellmind’s legal duties and privacy practices with respect to health information.
• Follow the terms of the Notice that is currently in effect.
• Not use or share your PHI other than as described here unless you tell Wellmind in writing that we can. If you tell Wellmind we can, you may change your mind at any time. Let us know in writing if you change your mind.
• Wellmind can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, at our office, and on our website.
• For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

FOR TREATMENT PAYMENT, OR HEALTHCARE OPERATIONS: Federal privacy rules (regulations) allow healthcare providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the pa- tient’s written authorization, to carry out the healthcare provider’s own treatment, to bill and get payment from health plans and other entities, or healthcare operations, including running our practice, improving your care, and contacting you when necessary. We may also disclose your protected health information for the treatment activities of any healthcare provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed healthcare provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other healthcare provid- ers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of healthcare providers with a third party, consultations between healthcare providers and referrals of a patient for healthcare from one healthcare provider to another.

LAWSUITS AND DISPUTES: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. We do keep “psychotherapy notes” as that term is defined in 45 C.F.R. § 164.501, and any use or disclosure of
   such notes requires your Authorization unless the use or disclosure is:
   1. For my Wellmind’s use in treating you.
   2. For Wellmind’s use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
   3. For Wellmind’s use in defending itself in legal proceedings instituted by you.
   4. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
   5. Required by law and the use or disclosure is limited to the requirements of such law.
   6. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
   7. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. As licensed providers, we will not use or disclose your PHI for marketing purposes. You may, however, at your own discretion, opt-in to Wellmind’s email list which may be managed by a third party. If you choose to opt-in to this list, your name and email address may be shared with a third party.
3. Sale of PHI. As a licensed providers, we will not sell your PHI in the regular course of Wellmind’s business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:
Subject to certain limitations in the law, we can use and disclose your PHI without your authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, orpreventing or reducing a erious threat to anyone’s health or safety, reporting adverse reactions to medication, helping with product recalls, or preventing disease.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although Wellmind’s preference
   is to obtain an Authorization from you before doing so.
5. For law enforcement purposes or with a law enforcement official, including reporting crimes occurring on our premises.
6. To coroners, funeral directors, or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although Wellmind’s preference is to obtain an Authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
10. Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with Wellmind. We may also use and disclose your PHI to tell you about treatment alternatives, or other healthcare services or benefits that we offer.
11. For organ and tissue donation requests from organ procurement organizations.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

1. Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your healthcare, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
2. You have the right and choice to tell us to share your information in a disaster relief situation.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask Wellmind not to use, share, or disclose certain PHI for treatment, payment, or healthcare operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your healthcare.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or healthcare operations purposes if the PHI pertains solely to a healthcare item or a healthcare service that you have paid for out-of- pocket in full. We will say “yes” to such requests unless a law requires use to share that information.
3. The Right to Choose How We Send PHI to You. You have the right to ask Wellmind to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that we have about you. Ask Wellmind how to submit such requests. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we will charge $.50 per page fee for doing so.
5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or healthcare operations, or for which you provided us with an a Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge $.50 per page fee for the additional requests.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. Ask Wellmind how to submit such requests. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it. We will provide you with a paper copy promptly.
8. The Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
9. The Right to File a Complaint if You Feel Your Rights Are Violated. You can complain if you feel we have violated your rights by contacting us using the information on page 1 of this Notice. 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, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

EFFECTIVE DATE OF THIS NOTICE
October 1, 2020