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.

At HealHer, LLC, I am committed to protecting the privacy and confidentiality of your Protected Health Information (PHI). This Notice explains your rights, our legal duties, and how I may use or disclose your health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA), California law, and other applicable privacy regulations.

This Notice applies to all services provided through our practice, including:

  • Neuropsychological coaching

  • In-person services

  • Telehealth services

  • Biofeedback services

  • Brainspotting sessions

OUR LEGAL DUTIES

We are required by law to:

  • Maintain the privacy and security of your Protected Health Information (PHI).

  • Provide you with this Notice of our legal duties and privacy practices.

  • Notify you if a breach occurs that may compromise the privacy or security of your information.

  • Follow the terms of this Notice currently in effect.

HOW WE MAY USE OR DISCLOSE YOUR INFORMATION

1. Treatment

I may use and disclose your health information to provide, coordinate, or manage your care.

Examples include:

  • Reviewing assessments

  • Developing coaching or treatment recommendations

2. Payment

I may use or disclose your information to:

  • Bill insurance companies

  • Verify insurance eligibility

  • Obtain prior authorization

  • Process payments

  • Collect outstanding balances

Insurance companies may receive information necessary to determine payment for covered services.

3. Healthcare Operations

I may use your information to:

  • Improve quality of care

  • Conduct internal audits

  • Train staff

  • Evaluate business performance

  • Maintain licensure and accreditation

  • Meet legal compliance requirements

TELEHEALTH SERVICES

If you receive services virtually:

  • I use secure, HIPAA-compliant technology whenever required.

  • No technology can guarantee absolute security.

  • You are encouraged to participate from a private location.

  • Electronic communications may involve limited privacy risks despite reasonable safeguards.

Telehealth records receive the same privacy protections as in-person records.

BIOFEEDBACK SERVICES

Biofeedback sessions may involve collection of physiological information such as:

  • Heart rate variability

  • Breathing patterns

  • Muscle tension

  • Skin conductance

  • Temperature

  • Other physiological measures appropriate to your treatment

These data may become part of your clinical record when relevant to your care and are protected as Protected Health Information under applicable law.

BRAINSPOTTING SERVICES

Brainspotting is a focused therapeutic approach that may be incorporated into your care.

Documentation may include:

  • Treatment goals

  • Clinical observations

  • Progress notes

  • Responses during sessions

  • Clinical recommendations

I maintain only information reasonably necessary for treatment, payment, healthcare operations, and legal requirements.

APPOINTMENT REMINDERS

We may contact you by:

  • Telephone

  • Voicemail

  • Secure email

  • Secure text message

  • Patient portal

Unless you request otherwise in writing.

INDIVIDUALS INVOLVED IN YOUR CARE

With your permission, we may share relevant information with:

  • Family members

  • Caregivers

  • Other persons involved in your care

Unless prohibited by law.

AS REQUIRED BY LAW

We may disclose information when required for:

  • Public health reporting

  • Court orders

  • Law enforcement requests

  • Mandatory abuse or neglect reporting

  • Health oversight agencies

  • Workers' compensation

  • Serious threats to health or safety

  • Other disclosures required by federal or California law

USES REQUIRING YOUR WRITTEN AUTHORIZATION

Except as permitted or required by law, we will obtain your written authorization before:

  • Releasing records to individuals not involved in your care

  • Marketing communications (when required by law)

  • Other disclosures requiring authorization

You may revoke an authorization in writing at any time, except to the extent action has already been taken.

YOUR RIGHTS

You have the right to:

· Request Restrictions

· Request limitations on how your information is used or disclosed.

· Confidential Communications

· Request communication by alternative methods or at alternative locations.

· Access Your Records

· Inspect or obtain copies of your health records, subject to applicable legal limitations.

· Request Amendments

· Request corrections if you believe information is incomplete or inaccurate.

· Receive an Accounting of Disclosures

· Request a list of certain disclosures made outside treatment, payment, and healthcare operations.

· Obtain a Paper or Electronic Copy of this Notice

· You may request a copy of this Notice at any time.

· File a Complaint

· You may file a complaint if you believe your privacy rights have been violated.

· You will not be retaliated against for filing a complaint.

MINORS

Privacy rights involving minors are governed by California law. In certain circumstances, minors may have privacy rights independent of their parent or guardian. We will comply with applicable California statutes regarding access to records and confidentiality.

ELECTRONIC COMMUNICATIONS

If you communicate with me electronically through email, text messaging, or other electronic means, there may be privacy risks despite reasonable safeguards. Whenever possible, I encourage use of our secure patient portal or encrypted communication platforms.

RECORD RETENTION

I maintain records in accordance with applicable federal and California record retention requirements.

CHANGES TO THIS NOTICE

I reserve the right to revise this Notice at any time. Updated versions will be available in our office, on our website (if applicable), and upon request.

QUESTIONS OR COMPLAINTS

If you have questions regarding this Notice or wish to exercise your privacy rights, please contact:

Privacy Officer: Aisha Duncan

Practice Name: HealHer, LLC

Address: P.O. Box 1746

Phone: 909-300-5547

Email: info@healher.com

If you believe your privacy rights have been violated, you may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Filing a complaint will not affect your care or services.

ACKNOWLEDGMENT OF RECEIPT

I acknowledge that I have been offered a copy of the Notice of Privacy Practices.

Patient Name: ______________________________________

Signature: _________________________________________

Date: ______________________

If signed by personal representative:

Name: _____________________________________________

Relationship: ______________________________________