Notice of Privacy Practices

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

This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding protected health information we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your protected health information.

“Protected Health Information” means health information, including identifying information about you, we have collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present or future physical or mental health or condition, the provision of your health care, and payment for your health care services.

“We” and “our” in this Notice refers to the clinical practice operated by Alisha Allen, Licensed Clinical Social Worker #133553, doing business as Brightmane Therapeutic Center. This practice and its protected health information may become part of Brightmane Enterprises, LLC in the future, and this Notice shall apply to any such successor entity. We are required by law to maintain the privacy of your Protected Health Information, to provide you with this notice of our legal duties and privacy practices, and to abide by the terms of this notice.

II. Uses and Disclosures That Do Not Require Your Authorization

The following categories describe situations where we are permitted or required by law to use or disclose your Protected Health Information (PHI) without your written authorization. ● Emergencies: We may use or disclose your PHI in a medical emergency to facilitate treatment.

• As Required by Law: We will disclose your PHI when required by federal, state, or local law.

• To Avert a Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious and imminent threat to your health or safety or to the health or safety of the public or another person.

• Public Health Activities: We may disclose your PHI for public health activities, such as reporting child abuse or neglect, or reporting to public health authorities to prevent or control disease.

• Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections by the California Board of Behavioral Sciences.

• Legal Proceedings and Law Enforcement: We may disclose your PHI in response to a court order, subpoena, or other lawful process under certain circumstances. We may also disclose it to law enforcement when required by law, such as to report a death we believe may be the result of criminal conduct.

• Workers’ Compensation: We may disclose your PHI to comply with California’s workers’ compensation laws.

III. Your Rights Regarding Your PHI

You have the following rights concerning your PHI:

• Right to Inspect and Copy: With certain exceptions, you have the right to inspect and receive a copy of your clinical and billing records. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or supplies associated with your request. We may deny your request to inspect or copy your Protected Health Information in certain limited circumstances. In some cases, you will have the right to have the denial reviewed by a licensed health care professional not directly involved in the original decision to deny access. We will inform you in writing if the denial of your request may be reviewed. Once the review is completed, we will honor the decision. We must provide you with access to your Protected Health Information in the form and format requested by you, if it is readily producible in that form and format. If it cannot be provided in the form and format you request, we will provide it in a readable hard copy or in such other form as we mutually agree is acceptable.

• Right to Request an Amendment: If you feel that the PHI we have is incorrect or incomplete, you may request an amendment.

• Right to an Accounting of Disclosures: You have the right to request a list of certain non-routine disclosures of your PHI we have made.

• Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose.

• Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.

• Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice at any time.

• We may disclose your Protected Health Information to a family member, friend, or other person you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. In the event of your incapacity or an emergency, we will disclose based on our professional judgment of what is in your best interest, sharing only information directly relevant to their involvement in your care. You have the right to object to this type of disclosure.

IV. Website and Technology Privacy

• Client Portal & Records: Your clinical records are stored in my SimplePractice electronic health record (EHR) system, which is HIPAA-compliant.

• Scheduling: Scheduling is managed through Acuity (Squarespace Scheduling), a HIPAA-compliant service with a signed Business Associate Agreement (BAA).

• Payment Processing: Payments are processed via Square and Ivy Pay, a HIPAA-compliant payment processor with a signed BAA. HSA/FSA cards are accepted.

• Communication: I use Spruce, a HIPAA-compliant platform, for secure text and voice communication.

• Website Analytics: This website may collect anonymous data through tools like Google Analytics and Squarespace Analytics. This data cannot be used to identify you.

V. Complaints

If you believe your privacy rights have been violated, you can file a complaint with me at alisha@brightmane.com or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint. VI. Changes to This Notice We reserve the right to change the terms of this Notice of Privacy Practices. We reserve the right to make the revised notice effective for all PHI we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our website at Brightmane.com. You may also obtain a copy of the current notice by calling us at (650) 547-4826 and requesting that a copy be sent to you. EFFECTIVE DATE: [WEBSITE LAUNCH DATE]

Good Faith Estimate

Right to a Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.