DISCLAIMERS

Notice of Privacy Practices

Practice Information

Marrow & Moss Therapy Collective

1780 S. Bellaire St. Suite 401 Denver, CO 80222

Phone: (303) 351-1262

Email: hello@marrowandmosstherapy.com

Website: marrowandmosstherapy.com

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Notice of Privacy Practices

Marrow & Moss Therapy Collective (henceforth referred to as “This Practice”) is dedicated to maintaining the privacy of your protected health information (PHI) and electronic protected health information (ePHI) (henceforth condensed and referred to as simply PHI). PHI is information that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services either in paper or electronic format. This Notice of Privacy Practices (“Notice”) is required by law to provide you with the legal duties and the privacy practices that This Practice maintains concerning your PHI. It also describes how medical and mental health information may be used and disclosed, as well as your rights regarding your PHI. Please read carefully and discuss any questions or concerns with your therapist.

Commitment to Your Privacy

Beauty in Becoming Counseling (henceforth referred to as “This Practice”) is dedicated to maintaining the privacy of your protected health information (PHI) and electronic protected health information (ePHI) (henceforth condensed and referred to as simply PHI). PHI is information that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services either in paper or electronic format. This Notice of Privacy Practices (“Notice”) is required by law to provide you with the legal duties and the privacy practices that This Practice maintains concerning your PHI. It also describes how medical and mental health information may be used and disclosed, as well as your rights regarding your PHI. Please read carefully and discuss any questions or concerns with your therapist.

Legal Duty to Safeguard Your PHI

By federal and state law, This Practice is required to ensure that your PHI is kept private. This Notice explains when, why, and how This Practice would use and/or disclose your PHI. Use of PHI means when This Practice shares, applies, utilizes, examines, or analyzes information within its practice; PHI is disclosed when This Practice releases, transfers, gives, or otherwise reveals it to a third party outside of This Practice. With some exceptions, This Practice may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, This Practice is always legally required to follow the privacy practices described in this Notice.

Uses and Disclosures

This Practice will not use or disclose your PHI without your written authorization, except as described in this Notice or as described in the “Information, Authorization and Consent to Treatment” document. Below, you will find the different categories of possible uses and disclosures with some examples.

• For Treatment: This Practice may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed healthcare providers who provide you with healthcare services or are otherwise involved in your care. Example: If you are also seeing a psychiatrist for medication management, This Practice may disclose your PHI to them in order to coordinate your care. Except in an emergency, This Practice will always ask for your authorization in writing prior to any such consultation.

• For Health Care Operations: This Practice may disclose your PHI to facilitate the efficient and correct operation of its practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

• To Obtain Payment for Treatment: This Practice may use and disclose your PHI to bill and collect payment for the treatment and services This Practice provided to you. Example: This Practice might send your PHI to your insurance company or managed health care plan to get payment for the health care services that have been provided to you. This Practice could also provide your PHI to billing companies, claims processing companies, and others that process health care claims for This Practice’s office if either you or your insurance carrier are not able to stay current with your account. In this latter instance, This Practice will always do its best to reconcile this with you first prior to involving any outside agency.

• Employees and Business Associates: There may be instances where services are provided to This Practice by an employee or through contracts with third-party “business associates.” Whenever an employee or business associate arrangement involves the use or disclosure of your PHI, This Practice will have a written contract that requires the employee or business associate to maintain the same high standards of safeguarding your privacy that is required of This Practice.

Note: Federal law provides additional protection for certain types of health information, including alcohol or drug abuse, mental health, and AIDS/HIV, and may limit whether and how This Practice may disclose information about you to others.

Uses and Disclosures: Special Circumstances

This Practice may use and/or disclose your PHI without your consent or authorization for the following reasons:

• Law Enforcement: Subject to certain conditions, This Practice may disclose your PHI when required by federal, state, or local law; judicial, board, or administrative proceedings; or law enforcement.

• Lawsuits and Disputes: This Practice may disclose information about you to respond to a court or administrative order or a search warrant. This Practice may also disclose information if an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena duces tecum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel. This Practice will only do this if efforts have been made to tell you about the request and you have been provided an opportunity to object or to obtain an appropriate attorney to quash the subpoena or court order protecting the information requested.

• Public Health Risks: This Practice may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, disability, to report births and deaths, and to notify persons who may have been exposed to a disease or at risk for getting or spreading a disease or condition.

• Food and Drug Administration (FDA): This Practice may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

• Serious Threat to Health or Safety: This Practice may disclose your PHI if you are in such mental or emotional condition as to be dangerous to yourself or the person or property of others and if This Practice determines in good faith that disclosure is necessary to prevent the threatened danger. Under these circumstances, This Practice may provide PHI to law enforcement personnel or other persons able to prevent or mitigate such a serious threat to the health or safety of a person or the public.

• Minors: If you are a minor (under 18 years of age), This Practice may be compelled to release certain types of information to your parents or guardian in accordance with applicable law.

• Abuse and Neglect: This Practice may disclose PHI if mandated by local child, elder, or dependent adult abuse and neglect reporting laws. Example: If This Practice has a reasonable suspicion of child abuse or neglect, This Practice will report this to the appropriate authorities.

• Coroners, Medical Examiners, and Funeral Directors: This Practice may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person, determine the cause of death, or perform other duties as authorized by law. This Practice may also disclose PHI to funeral directors, consistent with applicable law, to carry out their duties.

• Communications with Family, Friends, or Others: This Practice may release your PHI to the person you named in your Durable Power of Attorney for Health Care (if you have one), to a friend or family member who is your personal representative (i.e., empowered under law to make health-related decisions for you), or any other person you identify, relevant to that person’s involvement in your care or payment related to your care. In addition, This Practice may disclose your PHI to an entity assisting in disaster relief efforts so that your family can be notified about your condition.

• Military and Veterans: If you are a member of the armed forces, This Practice may release PHI about you as required by military command authorities. This Practice may also release PHI about foreign military personnel to the appropriate military authority.

• National Security, Protective Services for the President, and Intelligence Activities: This Practice may release PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state to conduct special investigations for intelligence, counterintelligence, and other national activities authorized by law.

• Correctional Institutions: If you are or become an inmate of a correctional institution, This Practice may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.

• For Research Purposes: In certain limited circumstances, This Practice may use information you have provided for medical/psychological research, but only with your written authorization. The only circumstance where written authorization would not be required would be if the information you have provided could be completely disguised in such a manner that you could not be identified directly or through any identifiers linked to you.

• For Workers' Compensation Purposes: This Practice may provide PHI in order to comply with Workers' Compensation or similar programs established by law.

• Appointment Reminders: This Practice is permitted to contact you, without your prior authorization, to provide appointment reminders or information about alternative or other health-related benefits and services that you may need or that may be of interest to you.

• Health Oversight Activities: This Practice may disclose health information to a health oversight agency for activities such as audits, investigations, inspections, or licensure of facilities. These activities are necessary for the government to monitor the health care system, government programs, and compliance with laws.

Required Written Authorization

In the following cases, This Practice will never share your information unless you give us written permission: marketing purposes, sale of your information, most sharing of psychotherapy notes, and fundraising. In any other situation not covered by this notice, This Practice will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying This Practice in writing.

Your Rights Regarding Your PHI

The Right to See and Get Copies of Your PHI: You may request paper or electronic copies of your PHI. This request must be made in writing. You will receive a response within 15 days of receipt.

The Right to Request Limits on Uses and Disclosures: You have the right to ask that This Practice limit how it uses and discloses your PHI. If you pay for a service out-of-pocket in full, you can ask us not to share that information for the purpose of payment or operations with your health insurer.

The Right to Choose How This Practice Sends PHI to You: You may ask that PHI be sent to an alternate address or by an alternate secure method. The Right to Get a List of Disclosures: You are entitled to an accounting of disclosures made by This Practice (excluding routine treatment, payment, or authorized disclosures) within the past 6 years.

The Right to Choose Someone to Act for You: Legal guardians or medical powers of attorney may exercise your privacy rights on your behalf.

The Right to Amend Your PHI: If you believe there is an error in your PHI, you may submit a written request to amend the record.

The Right to Get This Notice by Email: You have the right to receive a copy of this notice electronically or request a paper copy at any time.

Submit All Written Requests To:

Practice Director & Privacy Officer: Amanda Sweetbark

Practice Entity: Marrow & Moss Therapy Collective

Address: 1780 S. Bellaire St. Suite 401 Denver, CO 80222

Email: amanda@marrowandmosstherapy.com

Complaints and Practice Responsibilities

We are required by law to maintain the privacy and security of your PHI and will notify you promptly if a breach occurs. If you believe your privacy rights have been violated, you may file a complaint with This Practice or with the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights. Under no circumstances will you be penalized or retaliated against for filing a complaint.