Notice of Privacy Practices (HIPAA)

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

Our Legal Duty

Lavender Integrative Psychiatry is required by law to:

• Maintain the privacy of your Protected Health Information (PHI)
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of this Notice currently in effect
• Notify you if a breach of unsecured protected health information occurs

Protected Health Information (PHI) includes information that identifies you and relates to your past, present, or future physical or mental health condition and related healthcare services.

How We May Use and Disclose Your Health Information

We may use and disclose your PHI without your written authorization for the following purposes:

1. Treatment

We may use and disclose your health information to provide, coordinate, or manage your healthcare. This may include communication with other healthcare providers involved in your care.

2. Payment

We may use and disclose your information to obtain payment for services provided, including billing insurance companies or other third parties.

3. Healthcare Operations

We may use and disclose your information for practice operations, including quality assessment, administrative activities, licensing, and accreditation.

4. As Required by Law

We may disclose your information when required by federal, state, or local law.

5. Public Health and Safety

We may disclose information when necessary to prevent or lessen a serious threat to your health and safety or the safety of others.

6. Abuse or Neglect

We may disclose information when required to report suspected abuse, neglect, or exploitation.

7. Judicial and Administrative Proceedings

We may disclose information in response to a court order, subpoena, or other lawful process.

8. Law Enforcement

We may disclose information to law enforcement officials when permitted or required by law.

Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization for:

• Use or disclosure of psychotherapy notes (if applicable)
• Marketing communications not related to treatment
• Any use or disclosure not described in this Notice

You may revoke your authorization at any time in writing.

Your Rights Regarding Your Health Information

1. Access

Request a copy of your health records in paper or electronic format.

2. Amend

Request correction of inaccurate or incomplete information.

3. Restrict Disclosures

Request restrictions on certain uses or disclosures. We are not required to agree to all requests.

4. Confidential Communications

Request that we contact you at a specific location or in a specific manner.

5. Accounting of Disclosures

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

6. Paper Copy

Receive a paper copy of this Notice upon request.

Our Responsibilities

We will not use or disclose your information in ways not described in this Notice without your written permission.

If we change our privacy practices, we reserve the right to update this Notice and make the revised Notice effective for all protected health information we maintain.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Lavender Integrative Psychiatry
Email: info@lavenderintegrativepsychiatry.com
Phone: 774-209-2291

You may also file a complaint with the U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be retaliated against for filing a complaint.

Contact Information

Lavender Integrative Psychiatry
Elizabeth Rose Lavender, PMHNP, AGNP
Email: info@lavenderintegrativepsychiatry.com
Phone: 774-209-2291