Notice of Policies and Practices to Protect the Privacy of Your Health Information

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

I. Uses and Disclosures for Treatment, Payment, and Health Care Operations

Ruby Counseling LLC's counselors may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes in most instances without your consent under HIPAA, but Ruby Counseling LLC's counselors will obtain consent in another form for disclosing PHI for other reasons, including disclosing PHI outside of Ruby Counseling LLC's practice, except as otherwise outlined in this Policy. In all instances Ruby Counseling LLC's counselors will only disclose the minimum necessary information in order to accomplish the intended purpose. To help clarify these terms, here are some definitions:

• “PHI” refers to information in your health record that could identify you.

• “Treatment, Payment and Health Care Operations”

– Treatment is when Ruby Counseling LLC's counselors provide, coordinate or manage your health care and other services related to your health care.

An example of treatment would be when Ruby Counseling LLC's counselors consult with another health care provider, such as your family physician or another therapist.

- Payment is when Ruby Counseling LLC's counselors obtain reimbursement for your healthcare. Examples of payment are when Ruby Counseling LLC's counselors disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage, which would include an audit.

- Health Care Operations are activities that relate to the performance and operation of Ruby Counseling LLC's practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

• “Use” applies only to activities within Ruby Counseling LLC's practice, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

• “Disclosure” applies to activities outside of Ruby Counseling LLC's practice, such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures Requiring Authorization

Ruby Counseling LLC's counselors may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances, when Ruby Counseling LLC's counselors are asked for information for purposes outside of treatment, payment and health care operations, Ruby Counseling LLC's counselors will obtain an authorization from you before releasing this information, including uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI. Examples of disclosures requiring an authorization include disclosures to your partner, your spouse, your children, except in some limited instances where they are involved in your health care, in which case Ruby Counseling LLC's counselors will obtain your consent first. Any disclosure involving psychotherapy notes, if Ruby Counseling LLC's counselors maintain them, will require your signed authorization, unless Ruby Counseling LLC's counselors are otherwise allowed or required by law to release them. You may revoke an authorization for future disclosures, but this will not be effective for past disclosures which you have authorized.

III. Uses and Disclosures Requiring Neither Consent nor Authorization

Ruby Counseling LLC's counselors may use or disclose PHI without your consent or authorization as allowed by law, including under the following circumstances:

• Serious Threat to Health or Safety: If Ruby Counseling LLC's counselors believe that you pose a clear and substantial risk of imminent serious harm, or a clear and present danger, to yourself or another person Ruby Counseling LLC's counselors may disclose your relevant confidential information to public authorities, the potential victim, other professionals, and/or your family in order to protect against such harm. If you communicate to me an explicit threat of inflicting imminent and serious physical harm or causing the death of one or more clearly identifiable victims, and Ruby Counseling LLC's counselors believe you have the intent and ability to carry out the threat, then Ruby Counseling LLC's counselors may take one or more of the following actions in a timely manner: 1) take steps to hospitalize you on an emergency basis, 2) establish and undertake a treatment plan calculated to eliminate the possibility that you will carry out the threat, and initiate arrangements for a second opinion risk assessment with another mental health professional, 3) communicate to a law enforcement agency and, if feasible, to the potential victim(s), or victim's parent or guardian if a minor, all of the following information: a) the nature of the threat, b) your identity, and c) the identity of the potential victim(s). Ruby Counseling LLC's counselors will inform you about these notices and obtain your written consent, if Ruby Counseling LLC's counselors deem it appropriate under the circumstances.

• Worker’s Compensation: If you file a worker’s compensation claim, Ruby Counseling LLC's counselors may be required to give your mental health information to relevant parties and officials.

• Felony Reporting: Ruby Counseling LLC's counselors are allowed to report any felony that you report to me that has been or is being committed.

• For Health Oversight Activities: Ruby Counseling LLC's counselors may use and disclose PHI if a government agency is requesting the information for health oversight activities. Some examples could be audits, investigations, or licensure and disciplinary activities conducted by agencies required by law to take specified actions to monitor health care providers, or reporting information to control disease, injury or disability.

• For Specific Governmental Functions: Ruby Counseling LLC's counselors may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, and for national security reasons, such as for protection of the President.

• For Lawsuits and Other Legal Proceedings: If you are involved in a court proceeding and a request is made for information concerning your evaluation, diagnosis or treatment, such information is protected by law. Ruby Counseling LLC's counselors cannot provide any information without your (or your personal or legal representative’s) written authorization, or a court order, or at times an administrative subpoena, unless the information was prepared for a third party. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order me to disclose information. If a patient files a complaint or lawsuit against me, Ruby Counseling LLC's counselors may disclose relevant information regarding that patient in order to defend Ruby Counseling LLC.

• Abuse, Neglect, and Domestic Violence: If Ruby Counseling LLC's counselors know or have reason to suspect that a child under 18 years of age or a developmentally disabled, or physically impaired child under 21 years of age has suffered or faces a threat of suffering any physical or mental wound, injury, disability, or condition of a nature that reasonably indicates abuse or neglect of the child or developmentally disabled individual under 21, the law requires that Ruby Counseling LLC's counselors file a report with the appropriate government agency, usually the County Children Services Agency. Once such a report is filed, Ruby Counseling LLC's counselors may be required to provide additional information. If Ruby Counseling LLC's counselors have reasonable cause to believe that a developmentally disabled adult, or an elderly adult in an independent living setting or in a nursing home is being abused, neglected, or exploited, the law requires that Ruby Counseling LLC's counselors report such belief to the appropriate governmental agency. Once such a report is filed, Ruby Counseling LLC's counselors may be required to provide additional information. If Ruby Counseling LLC's counselors know or have reasonable cause to believe that a patient or client has been the victim of domestic violence, Ruby Counseling LLC's counselors must note that knowledge or belief and the basis for it in the patient’s or client’s records.

• To Coroners and Medical Examiners: Ruby Counseling LLC's counselors may disclose PHI to coroners and medical examiners to assist in the identification of a deceased person and to determine a cause of death.

• For Law Enforcement: Ruby Counseling LLC's counselors may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.

• Required by Law. Ruby Counseling LLC's counselors will disclose health information about you when required to do so by federal, state or local law.

• Public Health Risks. Ruby Counseling LLC's counselors may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, non-accidental physical injuries, reactions to medications or problems with products.

• Information Not Personally Identifiable. Ruby Counseling LLC's counselors may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Other uses and disclosures will require your signed authorization, unless the use or disclosure is allowed or required by law.

IV. Patient's Rights and Duties

Patient’s Rights:

• Right to Request Restrictions and Disclosures

You have the right to request restrictions on certain uses and disclosures of protected health information about you for treatment, payment or health care operations. However, Ruby Counseling LLC's counselors are not required to agree to a restriction you request, except under certain limited circumstances, and will notify you if that is the case. One right that Ruby Counseling LLC's counselors may not deny is your right to request that no information be sent to your health care plan if payment in full is made for the health care service. If you select this option then you must request it ahead of time and payment must be received in full each time a service is going to be provided. Ruby Counseling LLC's counselors will then not send any information to the health care plan for that session unless Ruby Counseling LLC's counselors are required by law to release this information.

• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations

You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. If your request is reasonable, then Ruby Counseling LLC's counselors will honor it.

• Right to Inspect and Copy

You have the right to inspect or obtain a copy (or both) of PHI in Ruby Counseling LLC's mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record, except under some limited circumstances. If Ruby Counseling LLC's counselors maintain the information in an electronic format you may obtain it in that format. This does not apply to information created for use in a civil, criminal or administrative action or proceeding. Ruby Counseling LLC's counselors may charge you reasonable amounts for copies, mailing or associated supplies under most circumstances. Ruby Counseling LLC's counselors may deny your request to inspect and/or copy your record or parts of your record in certain limited circumstances. If you are denied copies of or access to your PHI, you may ask that Ruby Counseling LLC's denial be reviewed. Under certain stances where Ruby Counseling LLC's counselors feel, for clearly stated treatment reasons, the disclosure of your record might have an adverse effect on you, Ruby Counseling LLC's counselors will provide your records to another mental health therapist of your choice.

• Right to Amend

You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Ruby Counseling LLC's counselors may deny your request, but will note that you made the request. Upon your request, Ruby Counseling LLC's counselors will discuss with you the details of the amendment process.

• Right to an Accounting

With certain exceptions, you generally have the right to receive an accounting of disclosures of PHI, not including disclosures for treatment, payment or health care operations for paper records on file for the past six years and for an accounting of disclosures made involving electronic records, including disclosures for treatment, payment or health care operations, for a period of three years. On your request Ruby Counseling LLC's counselors will discuss with you the details of the accounting process.

• Right to a Paper Copy

You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.

My Duties:

• Ruby Counseling LLC's counselors are required by law to maintain the privacy of PHI, to provide you with this notice of Ruby Counseling LLC's legal duties and privacy practices with respect to PHI, and to abide by the terms of this notice.

• Ruby Counseling LLC's counselors reserve the right to change the privacy policies and practices described in this notice and to make those changes effective for all of the PHI Ruby Counseling LLC's counselors maintain.

• If Ruby Counseling LLC's counselors revise Ruby Counseling LLC's policies and procedures, which Ruby Counseling LLC's counselors reserve the right to do, Ruby Counseling LLC's counselors will make available a copy of the revised notice to you on Ruby Counseling LLC's website, if Ruby Counseling LLC's counselors maintain one, and one will always be available at Ruby Counseling LLC's office. You can always request that a paper copy be sent to you by mail.

• In the event that Ruby Counseling LLC's counselors learn that there has been an impermissible use or disclosure of your unsecured PHI, unless there is a low risk that your unsecured PHI has been compromised, Ruby Counseling LLC's counselors will notify you of this breach.

V. Complaints

If you are concerned that Ruby Counseling LLC's counselors have violated your privacy rights, or you disagree with a decision Ruby Counseling LLC's counselors make about access to your records, you may file a complaint with me and Ruby Counseling LLC's counselors will consider how best to resolve your complaint. Contact me, the Privacy Officer, if you wish to file a complaint with me. In the event that you aren’t satisfied with Ruby Counseling LLC's response to your complaint, or don’t want to first file a complaint with me, then you may send a written complaint to the Secretary of the U.S. Department of Health and Human Services in Washington, D.C., 200 Independence Avenue S.W., Washington, D.C. 20201, Ph: 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/compliants/.

There will be no retaliation against you for filing a complaint.

VI. Effective Date:

This notice is effective as of July 1, 2024.

VII. Privacy and Security Officer:

Ruby Counseling LLC's counselors act as their own Privacy and Security Officers. Their contact information is listed on their contact page.