Notice of Privacy Practices

Juniper Lane Psychiatry
50 Pearl Road, Suite 111, Brunswick, OH 44212
Phone: 330-274-4225
Fax: 216-412-6932
Email: info@juniperlanepsychiatry.com

Our Commitment to Your Privacy

Juniper Lane Psychiatry understands that information about your health and health care is personal. We are committed to protecting the privacy and security of your protected health information ("PHI").

We create and maintain records regarding the psychiatric care and services you receive from our practice. These records are necessary to provide treatment, coordinate care, obtain payment, operate the practice, and comply with legal and professional requirements.

This Notice explains:

• ·How we may use and disclose your health information
• ·When your written authorization is required
• ·Your rights regarding your health information
• ·Our responsibilities for protecting your information
• ·How you may ask questions or file a privacy complaint

Our Responsibilities

Juniper Lane Psychiatry is required by law to:

• ·Maintain the privacy and security of your PHI
• ·Provide you with this Notice explaining our legal duties and privacy practices
• ·Follow the terms of the Notice currently in effect
• ·Notify affected individuals if a breach of unsecured PHI occurs when notification is required by law

We will not use or disclose your health information in ways that are inconsistent with this Notice unless permitted or required by law.

How We Typically Use and Share Your Health Information

Treatment

We may use your health information and share it with other health-care professionals involved in your treatment.

For example, we may communicate with your primary-care provider, pharmacy, laboratory, another psychiatric provider, or another treating health-care professional when necessary to coordinate your care.

Payment

We may use and disclose your health information to bill for services and obtain payment.

For example, we may provide information about your diagnosis, treatment, or services to your health insurance plan so that a claim can be processed.

Health Care Operations

We may use and disclose your health information as necessary to operate Juniper Lane Psychiatry and improve the quality of care we provide.

Examples include:

• ·Practice administration
• ·Billing and claims management
• ·Quality improvement
• ·Compliance activities
• ·Auditing
• ·Credentialing
• ·Staff training
• ·Technology and electronic health-record services
• ·Consulting with professionals who assist with practice operations

We may use qualified third-party vendors or business associates to perform certain functions on our behalf. When these organizations create, receive, maintain, or transmit PHI for Juniper Lane Psychiatry, appropriate privacy and security protections are required.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose PHI without your written authorization in certain circumstances permitted or required by law.

These may include the following.

Public Health and Safety

We may disclose information when legally permitted or required for activities such as:

• ·Preventing or controlling disease
• ·Reporting certain adverse reactions to medications or products
• ·Reporting suspected abuse, neglect, or exploitation when required by law
• ·Responding to certain public-health investigations
• ·Preventing or reducing a serious and imminent threat to the health or safety of a person or the public

Health Oversight

We may disclose PHI to authorized health-oversight agencies for activities such as audits, investigations, inspections, licensing, credentialing, or other activities authorized by law.

Required by Law

We may disclose information when state or federal law requires us to do so.

Workers' Compensation

We may disclose PHI as authorized or required for workers' compensation or similar programs.

Law Enforcement and Government Functions

Under circumstances permitted by law, PHI may be disclosed for certain:

• ·Law-enforcement purposes
• ·Judicial or administrative proceedings
• ·Government investigations
• ·Military or national-security functions
• ·Correctional or custodial purposes
• ·Other government activities authorized by law

Coroners, Medical Examiners, and Funeral Directors

We may disclose information to a coroner, medical examiner, or funeral director when permitted or required by law.

Organ and Tissue Donation

When applicable, health information may be disclosed to organizations involved in organ, eye, or tissue donation and transplantation.

Research

Health information may be used or disclosed for research only when permitted by applicable privacy laws and required protections have been satisfied.

Appointment Reminders and Health-Related Communications

We may use your contact information to:

• ·Remind you about appointments
• ·Communicate about your treatment
• ·Provide information about health-related services
• ·Send necessary administrative or billing communications

Family Members, Friends, and Others Involved in Your Care

Juniper Lane Psychiatry places particular importance on protecting the confidentiality of psychiatric treatment.

As a general practice policy, we request a written Release of Information (ROI) before routinely providing treatment information, appointment information, medication information, diagnoses, or other PHI to family members, friends, partners, employers, schools, or other individuals who are not otherwise legally authorized to receive the information.

You may authorize us to communicate with a specific person or organization by completing an ROI.

There are limited circumstances in which the law may permit or require disclosure without a signed ROI. For example, information may sometimes be disclosed:

• ·To a legally authorized personal representative
• ·When you are unable to express your wishes and disclosure is permitted by law and appropriate under the circumstances
• ·When necessary to prevent or lessen a serious and imminent threat to health or safety
• ·When disclosure is otherwise required or specifically permitted by law
• ·To assist in disaster-relief efforts when permitted by law

When disclosure is permitted, Juniper Lane Psychiatry will use professional judgment and disclose only information appropriate to the circumstances.

Personal Representatives

A person who has legal authority to act on your behalf regarding health-care decisions may also have authority to exercise certain privacy rights on your behalf.

Examples may include:

• ·A legal guardian
• ·An individual acting under an applicable health-care power of attorney
• ·A parent or legal guardian acting for a minor when permitted by law
• ·A representative of a deceased patient's estate when authorized by law

We may request documentation establishing the person's legal authority before releasing information or permitting the person to exercise your privacy rights.

Special confidentiality and consent rules may apply to minors depending upon the nature of the treatment and applicable law.

Uses and Disclosures Requiring Your Written Authorization

For uses and disclosures not otherwise described or permitted by law, we will obtain your written authorization.

You may revoke an authorization in writing at any time. Revocation will apply to future uses and disclosures and will not affect information already disclosed in reliance on a valid authorization.

Psychotherapy Notes

Most uses and disclosures of separately maintained psychotherapy notes, if such notes are created, require your written authorization except where disclosure is otherwise permitted or required by law.

Marketing

Juniper Lane Psychiatry does not use or disclose your PHI for marketing purposes that require authorization without first obtaining your written permission.

Sale of PHI

Juniper Lane Psychiatry does not sell your PHI.

Fundraising

Juniper Lane Psychiatry does not use PHI for fundraising purposes.

Substance Use Disorder Records

Certain substance use disorder treatment records may receive additional protection under federal law, including 42 C.F.R. Part 2.

To the extent Juniper Lane Psychiatry receives or maintains records that are protected by Part 2, those protections will be honored.

Part 2-protected substance use disorder records, or testimony describing the content of those records, generally may not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you unless you provide written consent or disclosure is authorized by a court order accompanied by a subpoena or other legal requirement compelling disclosure, as provided by federal law.

Nothing in this section means that every reference to substance use or substance use treatment in a psychiatric medical record automatically constitutes a Part 2-protected record.

Legal Proceedings, Court Orders, and Subpoenas

Requests for health information from attorneys, courts, law-enforcement agencies, government entities, or other parties involved in legal proceedings will be reviewed before information is released.

We may disclose PHI in response to a valid court or administrative order or subpoena when the disclosure is permitted or required under applicable law and all necessary legal requirements have been satisfied.

A subpoena does not automatically result in release of the entire medical record. Juniper Lane Psychiatry will evaluate legal requests according to applicable federal and state confidentiality requirements.

Additional protections apply to certain records, including Part 2-protected substance use disorder records and certain specially protected information.

Redisclosure of Information

When health information is lawfully disclosed to another person or organization, the recipient may not always be subject to the same federal privacy laws that apply to Juniper Lane Psychiatry. As a result, information disclosed in accordance with applicable law may potentially be redisclosed by the recipient and may no longer receive the same federal privacy protections.

Certain information, including records protected by other federal or state laws, may remain subject to additional restrictions.

Your Privacy Rights

You have important rights regarding your health information.

Right to Access Your Medical Record

You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information maintained by Juniper Lane Psychiatry.

We will generally provide access or a copy within the timeframe required by law.

A reasonable, cost-based fee may be charged when permitted by law.

Certain information may be excluded from the right of access or handled differently when permitted by federal or state law.

Right to Request an Amendment

If you believe information in your medical record is incorrect or incomplete, you may ask us to amend it.

We may deny the request in certain circumstances permitted by law. If we deny the request, we will provide an explanation in writing as required.

A request for amendment does not require the provider to remove clinically accurate information or change a professional opinion simply because the patient disagrees with it.

Right to Request Confidential Communications

You may ask us to communicate with you in a particular way or at a particular location.

For example, you may request that we:

• ·Call a particular telephone number
• ·Avoid leaving detailed voicemail messages
• ·Send communications to a particular address
• ·Use another reasonable method of communication

We will accommodate reasonable requests.

Right to Request Restrictions

You may ask us to limit how we use or disclose certain PHI for treatment, payment, or health-care operations.

We are generally not required to agree to the requested restriction.

If we agree to a restriction, we will follow it except when disclosure is otherwise permitted or required, including when information is necessary for emergency treatment.

Services Paid in Full Out of Pocket

If you pay for a health-care service in full out of pocket, you may request that we not disclose information about that service to your health insurance plan for payment or health-care operations.

When the requirements of federal law are met, we are required to honor that request unless disclosure is otherwise required by law.

Right to an Accounting of Certain Disclosures

You may request a list, known as an accounting of disclosures, describing certain disclosures of your PHI made during the six years before your request.

The accounting does not include every disclosure. For example, many disclosures made for treatment, payment, or health-care operations are not included.

One accounting during a 12-month period will generally be provided without charge. A reasonable cost-based fee may apply to additional requests when permitted by law.

Right to a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

Right to Choose Someone to Act for You

If another person has legal authority to act on your behalf, that person may exercise your privacy rights to the extent permitted by law.

We may verify the person's authority before taking action.

Right to Be Notified of Certain Breaches

You have the right to receive notification if a breach of unsecured PHI occurs and notification is required by law.

Questions and Complaints

If you have questions about this Notice, wish to exercise a privacy right, or believe your privacy rights have been violated, you may contact:

Privacy Officer
Juniper Lane Psychiatry
50 Pearl Road, Suite 111, Brunswick, OH 44212
Phone: 330-274-4225
Fax: 216-412-6932
Email: info@juniperlanepsychiatry.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights through its complaint process, by telephone at 1-877-696-6775, or by writing to:

U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201

Juniper Lane Psychiatry will not retaliate against you for filing a privacy complaint or exercising your privacy rights.

Changes to This Notice

Juniper Lane Psychiatry reserves the right to change the terms of this Notice and to make the revised Notice effective for PHI that we already maintain as well as information we receive in the future.

If this Notice is materially revised, the current version will be made available:

• ·Upon request
• ·At the Juniper Lane Psychiatry office
• ·Through the patient portal when appropriate
• ·On the Juniper Lane Psychiatry website

Acknowledgment of Receipt

By signing below, I acknowledge that I have received or been provided access to the Juniper Lane Psychiatry Notice of Privacy Practices.

I understand that this acknowledgment confirms receipt of the Notice only.

My signature does not:

• ·Authorize Juniper Lane Psychiatry to make disclosures beyond those permitted by law or by an authorization I separately sign
• ·Waive any of my privacy rights
• ·Prevent me from asking questions or filing a privacy complaint
• ·Mean that I agree with every use or disclosure described in the Notice

I understand that I may request a paper copy of this Notice at any time.