Notice of Privacy Practices

QualiCare Psychiatry, LLC

Your Information. Your Rights. Our Responsibilities.

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

QualiCare Psychiatry, LLC (“QualiCare Psychiatry,” “we,” “our,” or “the Practice”) is committed to protecting the privacy and confidentiality of your health information. This website version is organized to help patients quickly find key information about privacy rights, our responsibilities, and how health information may be used or shared.

Federal and applicable state laws protect information that identifies you and relates to your past, present, or future physical or mental health, health care, or payment for health care. We are required by law to maintain the privacy and security of your protected health information (“PHI”), provide this Notice, explain our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

Your Rights:

When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities.

Get an Electronic or Paper Copy of Your Medical Record

You may ask to see or obtain an electronic or paper copy of your medical record and other health information that we maintain about you. We will generally provide a copy or summary within 30 days of your request and may charge a reasonable, cost-based fee as permitted by law.

Mental and behavioral health information contained in your regular medical record is generally subject to your right of access. We will not automatically substitute a summary for your medical record merely because it contains sensitive mental-health information. Certain information may be excluded from your right of access when permitted by law.

Psychotherapy Notes

Psychotherapy notes receive special protection under federal law. They generally refer to notes recorded by a mental-health professional documenting or analyzing the contents of a counseling session and maintained separately from the rest of the medical record.

Psychotherapy notes generally do not include medication prescriptions and monitoring, counseling session start and stop times, treatment modalities and frequencies, clinical test results, diagnoses, symptoms, functional status, treatment plans, prognosis, or progress-to-date information. The general HIPAA right of access does not extend to psychotherapy notes as defined by HIPAA. Uses and disclosures of psychotherapy notes generally require written authorization except where otherwise permitted or required by law.

Ask Us to Correct Your Medical Record

You may ask us to correct health information about you that you believe is incorrect or incomplete. We may deny your request when permitted by law. If we deny the request, we will explain the reason in writing within the period required by law. You may have the right to submit a written statement of disagreement if your request is denied.

Request Confidential Communications

You may ask us to communicate with you in a particular way or at a particular location, such as a particular telephone number, cell phone, home or work number, mailing address, or other reasonable method. We will accommodate reasonable requests.

Ask Us to Limit What We Use or Share

You may ask us not to use or disclose certain health information for treatment, payment, or health care operations. We generally are not required to agree to your request. If we agree, we will comply with the restriction except when disclosure is otherwise permitted or required by law.

Services Paid in Full Out of Pocket

If you pay for a health care service or item completely out of pocket, you may ask us not to disclose information about that service or item to your health plan for payment or health care operations. We will honor that request unless disclosure is required by law.

Get a List of Certain Disclosures

You may request an accounting of certain disclosures of your health information. You may generally request information about certain disclosures made during the six years preceding your request. The accounting does not include every disclosure, such as certain disclosures for treatment, payment, and health care operations, or certain disclosures you specifically authorized.

We will provide one accounting during a 12-month period without charge. We may charge a reasonable, cost-based fee for additional requests during the same 12-month period.

Get a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you previously agreed to receive the Notice electronically. We will provide a paper copy promptly.

Choose Someone to Act for You

If you have given someone medical power of attorney, or if someone is your legal guardian or otherwise legally authorized to act as your personal representative, that person may exercise your rights and make certain choices regarding your health information. We will verify that the person has the appropriate legal authority before taking action.

File a Complaint

You may complain if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint or exercising your privacy rights.

QualiCare Psychiatry, LLC
42735 US Highway 27, Suite 202
Davenport, FL 33837
Phone: (407) 808-3808
Email: info@qcpsychiatry.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

Your Choices:

For certain health information, you may tell us your preferences about what we share. If you have a clear preference about how we share your information, please tell us. We will follow your instructions when required by law.

Family, Friends, Caregivers, and Others Involved in Your Care

You may tell us whether we may share relevant health information with family members, close friends, caregivers, or other individuals involved in your care or payment for your care. If you are unable to tell us your preference, we may share relevant information when permitted by law and when, using professional judgment, we believe doing so is in your best interest.

We may also use or disclose information when permitted by law to prevent or lessen a serious and imminent threat to the health or safety of you or another person.

Other Choices

· Disaster relief: We may share relevant information with organizations assisting in disaster-relief efforts when permitted by law.

· Marketing: We generally will not use or disclose your protected health information for marketing purposes when written authorization is required by law unless you provide that authorization.

· Sale of health information: We will not sell your protected health information when authorization is required by law unless you provide written authorization.

· Psychotherapy notes:Most uses and disclosures of psychotherapy notes require written authorization except in limited circumstances permitted by law.

· Fundraising: If QualiCare Psychiatry conducts permitted fundraising communications, you may tell us not to contact you again.

How We Typically Use or Share Your Health Information

We may use and disclose your health information without your written authorization for certain purposes permitted by law.

Treatment

We may use and disclose your health information to provide, coordinate, and manage your treatment. For example, we may share relevant information with physicians, therapists, hospitals, pharmacies, laboratories, and other health care professionals involved in your treatment.

Example: Another physician treating you may request information about your diagnoses or medications so your care can be appropriately coordinated.

Payment

We may use and disclose your health information to bill and obtain payment for services provided to you. This may include providing necessary information to health insurance plans, Medicare, Medicaid, other payers, billing companies, and collection services when legally appropriate.

Example: We may provide your insurance company with information necessary to determine coverage or payment for services we provided.

Health Care Operations

We may use and disclose your health information to operate our practice and improve the quality of care and services we provide.

· Quality assessment and improvement

· Credentialing

· Staff training

· Compliance activities

· Audits

· Licensing activities

· Business planning and administration

· Patient-service improvement

Appointment Reminders and Patient Communications

We may use your contact information to communicate with you about your care and our services, including appointment reminders, scheduling and rescheduling information, follow-up communications, administrative notices, billing communications, medication or prescription-related administrative communications, and other communications relating to your treatment or relationship with our Practice.

Depending on your communication preferences and the information you provide, we may communicate through telephone calls, voicemail, email, text messaging, patient portal communications, or mail. We will make reasonable efforts to accommodate confidential communication requests.

Text Messaging

If you choose to communicate with QualiCare Psychiatry by text message or consent to receive SMS communications, we may send text messages relating to your care or our administrative services. These may include appointment reminders, scheduling updates, customer-service communications, billing notifications, administrative medication or refill-status notifications, and other administrative communications relating to your care.

Standard SMS text messaging may involve privacy and security risks because messages may not always be encrypted. You may request an alternative method of communication. Text messaging is also governed by our separate SMS Terms & Conditions and applicable privacy policies.

Treatment Options and Health-Related Services

We may use your health information to communicate with you about treatment alternatives, health-related services, or other services that may be relevant to your care when permitted by law.

Business Associates

We may disclose protected health information to individuals or organizations that provide services for or on behalf of QualiCare Psychiatry. Examples may include billing companies, electronic health record vendors, information technology providers, communication vendors, practice-management providers, accounting, legal, or compliance professionals, and other service providers. When required by law, these organizations are considered Business Associates and are required to appropriately safeguard your protected health information.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose health information in other circumstances permitted or required under federal or state law.

Public Health and Safety

We may disclose health information for authorized public-health and safety activities, including preventing or controlling disease, reporting certain communicable diseases, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to health or safety.

Additional Permitted or Required Disclosures

· Research: We may use or disclose health information for research when applicable legal requirements have been satisfied.

· Compliance with law:We will disclose health information when required by applicable federal or state law, including to the U.S. Department of Health and Human Services when necessary to demonstrate compliance with federal privacy law.

· Health oversight: We may disclose health information to authorized health-oversight agencies for activities permitted by law, such as audits, investigations, inspections, licensing activities, and disciplinary proceedings.

· Workers’ compensation:We may disclose health information as authorized by and to the extent necessary to comply with workers’ compensation and similar laws.

· Law enforcement: We may disclose health information for law-enforcement purposes when permitted or required by applicable law.

· Judicial and administrative proceedings: We may disclose health information in connection with judicial or administrative proceedings when permitted or required by law, including in response to certain court orders, subpoenas, discovery requests, or other lawful processes. Additional protections may apply to mental-health records, psychotherapy notes, and substance-use-disorder records.

· Medical examiners, coroners, and funeral directors: We may disclose health information when permitted or required by law.

· Organ and tissue donation: When applicable, we may disclose health information to organizations involved in organ, eye, or tissue donation and transplantation.

· Special government functions: We may disclose health information for special government functions when permitted by law, including certain military, national-security, and protective-service activities.

· Serious threat to health or safety: When permitted by applicable law and professional ethical standards, we may use or disclose health information when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Substance Use Disorder Records — 42 CFR Part 2

Certain substance use disorder (“SUD”) patient records receive additional confidentiality protections under federal law, including 42 CFR Part 2.

QualiCare Psychiatry is not necessarily a Part 2 substance use disorder treatment program merely because we treat a patient who has a substance use disorder or because substance use information appears in a patient’s medical record. However, QualiCare Psychiatry may receive, create, or maintain records that are protected by 42 CFR Part 2. When we maintain Part 2-protected records, we will handle those records in accordance with applicable Part 2 and HIPAA requirements.

When permitted by applicable law and supported by appropriate patient consent, Part 2 records may be used and disclosed for treatment, payment, and health care operations.

Special Protection Against Use of Part 2 Records Against You

Part 2-protected records generally may not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you unless permitted under 42 CFR Part 2. When required by Part 2, such use or disclosure requires your written consent or an appropriate court order accompanied by a subpoena or other legal mandate that satisfies applicable Part 2 requirements.

If we maintain Part 2-protected records, we will comply with these additional federal confidentiality protections. If Part 2-protected information is used for fundraising communications, we will provide any notice and choice required by applicable law.

Authorizations

Uses and disclosures of your protected health information that are not otherwise permitted or required by law generally require your written authorization. An authorization will identify the information involved, the persons or organizations authorized to disclose and receive the information, the purpose of the disclosure, and other information required by law. You generally may revoke an authorization in writing at any time, except to the extent that we have already taken action in reliance upon the authorization.

Our Responsibilities

QualiCare Psychiatry is required by law to maintain the privacy and security of your protected health information, follow the duties and privacy practices described in this Notice, provide you with a copy of this Notice, notify you as required by law if a breach occurs that may have compromised the privacy or security of your information, and use and disclose your health information only as permitted or required by law or as authorized by you.

If you provide written authorization for a use or disclosure, you generally may revoke that authorization in writing at any time, subject to actions we have already taken in reliance upon it.

Changes to This Notice

We may change the terms of this Notice. Changes may apply to all protected health information we maintain, including information created or received before the revised Notice becomes effective.

When this Notice is materially revised, the current Notice will be available at our office, upon request, and on our website. We will follow the Notice currently in effect.

Questions or Complaints

If you have questions about this Notice, would like to exercise your privacy rights, or believe your privacy rights have been violated, please contact:

Privacy Officer
QualiCare Psychiatry, LLC
42735 US Highway 27, Suite 202
Davenport, FL 33837
Phone: (407) 808-3808
Email: info@qcpsychiatry.com
Website: QCPsychiatry.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. QualiCare Psychiatry will not retaliate against you for exercising your privacy rights or filing a complaint.