Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

You may have additional rights under state or local law. Please consult with a licensed attorney in your state if you have legal questions about your health information rights.

Acknowledgement of receipt of privacy notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information (PHI).

I. Our pledge regarding health information

At Soulstice Therapy, we understand that health information about you and the care you receive is personal. We are committed to protecting your privacy. This Notice applies to all records of your care created by our practice.

We are required by law to:

• Maintain the privacy of PHI that identifies you.
• Provide you with this Notice explaining our legal duties and privacy practices.
• Abide by the terms of this Notice currently in effect.

We reserve the right to update this Notice and will make revised copies available on our website.

II. How we may use and disclose your health information

The following categories describe different ways we may use and disclose your PHI without your written authorization:

For Treatment, Payment, or Health Care Operations:
We may use or disclose your PHI to provide treatment, obtain payment, or conduct health care operations. For example:

• Therapists may consult with other providers regarding your care.
• We may send appointment reminders or invoices.
• PHI may be used for supervision, training, or administrative functions within the practice.

Lawsuits and Disputes:
We may disclose health information in response to a court order or subpoena, subject to legal conditions and your notification where applicable.

III. Uses and disclosures requiring your authorization

Psychotherapy Notes:
Use or disclosure of psychotherapy notes requires your written authorization unless used:

• By your therapist for treatment or supervision.
• In legal proceedings initiated by you.
• As required by law or regulatory oversight.

Marketing Purposes:
We will not use or share your PHI for marketing without your signed HIPAA authorization. If you provide a review, we will request consent before sharing it publicly if it contains PHI. You may revoke this consent at any time in writing.

Sale of PHI:
We do not sell your PHI.

IV. Uses and disclosures that do not require your authorization

We may use or disclose your PHI without your written consent for the following:

• Appointment reminders and treatment alternatives.
• Mandated reporting (e.g., child, elder, or dependent adult abuse).
• Health oversight (audits, licensing, investigations).
• Legal proceedings or law enforcement.
• Coroners, medical examiners, organ donation.
• Research (with safeguards).
• Workers’ compensation claims.
• Specialized government functions (e.g., military, corrections).

V. Uses and disclosures requiring an opportunity to object

We may disclose your PHI to family, friends, or caregivers involved in your care if you do not object or in emergency situations. You have the right to request restrictions on these disclosures.

VI. Your rights regarding PHI

You have the right to:

• Request Restrictions: Limit disclosures for treatment, payment, or operations.
• Restrict Disclosures to Health Plans: When services are paid out-of-pocket in full.
• Confidential Communications: Receive PHI at an alternate address or via alternate contact method.
• Inspect and Copy Records: Receive a paper or electronic copy of your record within 30 days of request. Reasonable fees may apply.
• Request Amendment: Ask for corrections to your PHI. We may deny your request, but we will respond in writing.
• Receive an Accounting of Disclosures: A list of non-routine disclosures over the past 6 years.
• Receive a Paper or Electronic Copy of this Notice.
• Appoint a Representative: A legal guardian or person with medical power of attorney may act on your behalf.
• Revoke an Authorization in writing at any time.
• File a Complaint: If you believe your privacy rights have been violated, you may contact us or:
  • U.S. Department of Health & Human Services (HHS)
    Office for Civil Rights
    200 Independence Avenue, S.W.
    Washington, D.C. 20201
    www.hhs.gov/ocr/privacy/hipaa/complaints
    Phone: (877) 696-6775

We will not retaliate for filing a complaint.