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.

Elements of Motivation is required by law to protect the privacy and security of your Protected Health Information (PHI) and to provide you with this Notice explaining our legal duties, privacy practices, and your rights regarding your health information.

Your health record contains personal information about your health, diagnosis, treatment, services, and payment for care. This information is referred to as Protected Health Information (PHI).

This Notice applies to health information maintained by Elements of Motivation in paper, electronic, verbal, or other forms.

When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you exercise them.

You may ask to inspect or receive an electronic or paper copy of your health record and other health information we maintain about you.

We will generally provide access, a copy, or a summary within the time required by law. In some circumstances, access to certain information may be limited or denied as permitted by law.

Some records may also be available electronically through your client portal.

Reasonable, cost-based fees may apply for copies when permitted by federal and Nevada law.

You may ask us to amend health information that you believe is incorrect or incomplete.

We may deny your request in certain circumstances, but if we do, we will explain the reason in writing as required by law. You may have the right to submit a written statement of disagreement that becomes part of your record.

You may ask us to communicate with you in a specific way or at a different location. For example, you may ask us to contact you only at a particular phone number, email address, or mailing address.

We will accommodate reasonable requests as required by law.

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations.

We are generally not required to agree to every requested restriction. If we agree to a restriction, we will follow it except when disclosure is otherwise permitted or required by law, including when information may be needed for emergency treatment.

If you pay for a healthcare service in full out of pocket, you may ask us not to disclose information about that service to your health plan for purposes of payment or healthcare operations.

We will honor that request unless disclosure is otherwise required by law.

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

The accounting does not include every disclosure. For example, many disclosures for treatment, payment, healthcare operations, or disclosures you specifically authorized are not included.

We will provide one accounting within a 12-month period without charge. A reasonable, cost-based fee may apply if you request additional accountings within the same 12-month period.

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

The current Notice is also available through our client portal.

If another person has legal authority to act as your personal representative, such as a legal guardian or person with appropriate healthcare decision-making authority, that person may exercise your privacy rights as permitted by law.

We may require documentation establishing that person's legal authority before allowing access to records or other protected information.

For minor clients, the rights of parents, guardians, and minors may vary depending on applicable law, custody arrangements, court orders, and the circumstances under which treatment was provided.

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

You may contact:

Privacy Officer: Diana Saunders
Elements of Motivation
Phone: 702-331-4874
Email: diana@elementslv.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, including through the HHS Office for Civil Rights complaint process or by calling 1-877-696-6775.

Elements of Motivation will not retaliate against you for exercising your privacy rights or filing a complaint.

For certain health information, you may tell us your preferences regarding how information is shared.

When permitted by law, we may share relevant information with family members, close friends, caregivers, or others involved in your care or payment for your care when:

• You give us permission;
• You are present and do not object;
• We can reasonably infer that you do not object; or
• You are unable to tell us your preference and, using professional judgment, we determine that a limited disclosure is in your best interest.

We may also disclose limited information when necessary to prevent or lessen a serious and imminent threat to health or safety, as permitted by law.

When permitted by law, we may share limited information with organizations assisting in disaster relief or emergency response so that family members or others responsible for your care can be informed about your location, condition, or safety.

We will obtain your written authorization before using or disclosing your PHI when an authorization is required by law.

If you provide written authorization, you may revoke that authorization in writing at any time. Revocation will not affect information already disclosed or actions already taken in reliance on your authorization.

Uses or disclosures of your information that are not otherwise permitted or required by law and are not described in this Notice will be made only with your written authorization.

We may use and disclose your PHI to provide, coordinate, or manage your treatment.

This may include appropriate communication among therapists, supervisors, clinical leadership, psychiatric or medical providers, and other professionals involved in your care when permitted by law.

Your therapist may also participate in professional consultation or supervision as part of providing quality care.

We may use and disclose PHI as necessary to obtain payment for services.

This may include:

• Verifying insurance eligibility and benefits;
• Obtaining prior authorization;
• Submitting insurance claims;
• Providing information requested to determine medical necessity;
• Responding to claim reviews, audits, or appeals;
• Coordinating benefits; and
• Conducting permitted billing and collection activities.

When the HIPAA minimum necessary standard applies, we will make reasonable efforts to limit the information used or disclosed to what is reasonably necessary for the purpose.

We may use and disclose PHI as necessary to operate Elements of Motivation and provide quality services.

Healthcare operations may include:

• Clinical supervision and consultation;
• Quality improvement and quality assurance;
• Staff training;
• Credentialing and licensing activities;
• Compliance activities;
• Audits;
• Billing and record management;
• Appointment scheduling and reminders;
• Client communication;
• Care coordination;
• Business planning and administration;
• Risk management;
• Legal and regulatory compliance; and
• Reviewing the performance and quality of services.

We may also share PHI with approved vendors or Business Associates that perform services on our behalf, such as billing, electronic health record, technology, communication, records management, or other administrative services.

Business Associates that receive PHI are required to appropriately safeguard the information as required by law and applicable agreements.

We may contact you regarding appointments, billing, forms, treatment coordination, records, or other care-related matters through methods such as phone, voicemail, text message, email, mail, your client portal, or approved website messaging or chat features.

You may request reasonable restrictions or alternative methods of confidential communication.

 Federal and state laws allow or require us to disclose PHI in certain circumstances. Each type of disclosure is subject to applicable legal requirements and limitations.

We may use or disclose health information for certain public health or safety purposes, including when permitted or required to:

• Report suspected abuse, neglect, exploitation, or domestic violence;
• Prevent or control disease;
• Report certain injuries or health conditions;
• Report adverse reactions or problems with regulated products; or
• Prevent or lessen a serious threat to the health or safety of an individual or the public.

We may disclose PHI to authorized health oversight agencies for activities permitted by law, such as audits, investigations, inspections, credentialing, licensing, disciplinary proceedings, and government program oversight.

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

This may include disclosures to the U.S. Department of Health and Human Services when necessary to demonstrate compliance with federal privacy laws.

We may disclose health information for certain law-enforcement or government purposes when permitted or required by law and when applicable legal requirements have been satisfied.

This may include certain:

• Law-enforcement requests;
• Workers' compensation matters;
• Health oversight activities;
• Military or veterans' activities;
• National security activities; or
• Other government functions authorized by law.

Mental-health and substance-use information may have additional protections that limit these disclosures.

We may disclose PHI in connection with a judicial or administrative proceeding when permitted or required by law, including in response to an appropriate court order, subpoena, or other lawful process when the applicable requirements for disclosure have been satisfied.

The existence of a subpoena or request does not necessarily mean that all requested treatment information may automatically be released. We will evaluate legal requests in accordance with applicable federal and Nevada confidentiality requirements.

When permitted by law, we may disclose health information to a coroner, medical examiner, or funeral director as necessary to perform legally authorized duties.

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

Health information may be used or disclosed for research only when permitted by applicable privacy laws, such as when you authorize the disclosure or an appropriate legal exception or approval allows the information to be used.

Because Elements of Motivation provides behavioral-health services in Nevada, your records may receive confidentiality protections under Nevada law and the professional standards applicable to your provider in addition to protections provided by HIPAA.

Where Nevada law or an applicable professional licensing requirement provides greater privacy protection than HIPAA, Elements of Motivation will follow the more protective requirement.

Certain confidential mental-health information may require your written consent before it can be released unless another law permits or requires disclosure.

Records created during couples, family, or group therapy may contain confidential information concerning multiple participants. Access to or disclosure of these records may require additional precautions and, in some circumstances, authorization from multiple participants as required by Nevada law and professional standards.

Federal law provides additional confidentiality protections for certain records relating to substance use disorder (SUD) treatment that are subject to 42 CFR Part 2.

To the extent that Elements of Motivation creates, receives, or maintains records that are protected by Part 2, those records will be used and disclosed in accordance with applicable Part 2 requirements.

Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you unless:

1. You provide the consent required by applicable law; or
2. Disclosure is authorized by an appropriate court order and subpoena or other process as required by Part 2.

Part 2 protections may continue to apply even when information is otherwise permitted to be disclosed under HIPAA.

Separately maintained SUD counseling notes may receive additional protections and may require a separate consent for certain uses or disclosures.

If Part 2 information is used for fundraising communications when permitted by law, you will receive the notice and opportunity to opt out required by applicable law.

We are required by law to maintain appropriate privacy and security safeguards for your PHI.

If a breach of unsecured PHI occurs that may have compromised the privacy or security of your information, we will notify you as required by applicable law.

Elements of Motivation is required to:

• Maintain the privacy and security of your PHI;
• Follow the duties and privacy practices described in the Notice currently in effect;
• Provide you with a copy of this Notice;
• Notify you as required by law following certain breaches of your information;
• Respect your privacy rights;
• Follow any restrictions we have agreed to or are legally required to honor; and
• Obtain written authorization before using or disclosing your information when authorization is required by law.

We will not use or disclose your PHI in a manner inconsistent with this Notice unless you authorize us to do so in writing or the use or disclosure is otherwise permitted or required by law.

Elements of Motivation may change the terms of this Notice and our privacy practices as permitted by law.

Changes may apply to all PHI we maintain, including information created or received before the revised Notice became effective.

If we make a material change to this Notice, the updated Notice will be available upon request and through appropriate locations, which may include:

• Our website;
• Our client portal;
• Our office; and
• Other electronic resources made available to clients.

You may request a current paper or electronic copy at any time.