Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

Notice Effective: April 30, 2021

This notice describes how health information about you may be used and disclosed and how you can get access to this information as directed by the Health Insurance Portability and Accountability Act (HIPAA). Please review the information carefully.

This Notice of Privacy Practices describes how L. D. Mormile Adult Psychiatric Health Care, LLC including its providers, staff or business associates, hereafter referred to as LDM LLC 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. It also describes your rights to access and control your protected health information. Protected health information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

LDM LLC is required to abide by the terms of this Notice of Privacy Practices. LDM LLC may change the terms of this notice at any time. The new notice will be effective for all protected health information that LDM LLC maintains at that time. You may request a revised copy by asking your provider, by writing or by calling the office. LDM LLC will provide you with the revised Notice of Privacy Practices at the time of your first appointment after the revision.

Permitted Uses and Disclosures of Protected Health Information

Your PHI may be used and disclosed by LDM LLC and others that are involved in your care and treatment for the purpose of providing health care services to you. Your PHI may also be used and disclosed for billing and payment functions to reimburse LDM LLC for services provided to you. There are other times when your PHI may be used and/or disclosed by LDM LLC. The following are examples of the types of uses and disclosures of your PHI that LDM LLC is permitted to make. These examples are not all-inclusive, but describe the most frequent uses and disclosures of PHI that may be made by LDM LLC.

Treatment: LDM LLC may use or disclose your health information in the normal course of providing you with necessary services. For example, an LDM LLC provider may use your health information to write a prescription for you. Or the provider may disclose your health information to a pharmacy when the provider contacts them to order a prescription for you. Other staff or business associates of LDM LLC may use or disclose your health information in order to assist others in your treatment.

Payment: Your PHI may be used to seek approval for or to pay for the health care services payment from your health plan, from other sources of coverage such as an automobile insurer, other third-party payers who are responsible for paying all or part of the cost of your care. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Healthcare Operations: LDM LLC may use or disclose, as needed, your PHI in order to support the business activities of the practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of nursing students, or arranging for other business activities. For example, LDM LLC may disclose your PHI to practicum or intern students that see clients at the office. In addition, your LDM LLC provider may call you by name in the waiting room when you are ready to be seen. LDM LLC may use or disclose your PHI, as necessary to contact you to remind you of or reschedule your appointments. LDM LLC will share your PHI with third party business associates who perform various activities (e.g. billing) for the practice. Whenever an arrangement between LDM LLC and an outside business involves the use of or disclosure of your PHI, LDM LLC will have a business associate agreement that contains terms that will protect the privacy of your PHI.

Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization: Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization at any time, in writing, except to the extent that LDM LLC has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity To Object: LDM LLC may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use of disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then LDM LLC providers may, using their professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.

Others Involved In Your Healthcare: Unless you object, a LDM LLC provider or staff member may disclose to a member of your family, a relative, a close friend or any other person your identity, your PHI that directly relates to that person's involvement in your healthcare. If you are unable to agree or object to such disclosure, an LDM LLC provider or staff person may disclose such information as necessary if LDM LLC determines that it is in your best interest based on the provider’s professional judgment. An LDM LLC provider or staff person may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person who is responsible for your care of your location, general condition or death. Finally, LDM LLC employees may use or disclose your PHI to alert an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your care.

Other permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object: LDM LLC may use or disclose your PHI in the following situations without your authorization. These situations include: Required By Law: LDM LLC may use or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law of any such uses or disclosures. Public Health: LDM LLC may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. LDM LLC may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority. Communicable Diseases: LDM LLC may disclose your PHI to a health oversight agency for activities authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. Health Oversight: LDM LLC may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations and programs, other government regulatory programs and civil rights laws. Abuse or Neglect: LDM LLC may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect In addition, LDM LLC may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. Food and Drug Administration: LDM LLC may disclose your PHI to a person or company required by the FDA to report adverse events, product defects or problems, biological product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required. Legal proceedings: LDM LLC may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized) in certain conditions in response to a subpoena, discovery request or other lawful process. Law Enforcement: LDM LLC may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes required by law, (2) limited information request for identification and location purposes, (3) pertaining to victims of a crime (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the practice's premises) and it is likely that a crime has occurred. Coroner, Funeral Directors, and Organ Donation: LDM LLC may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. LDM LLC may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. LDM LLC may disclose such information in reasonable anticipation of death. PHI may be used and disclosed for cadaver, organ, eye or tissue donation purposes. Research: LDM LLC may disclose your PHI to researchers when their research has to be approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI. Criminal Activity: Consistent with applicable federal and state laws, LDM LLC may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. LDM LLC may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual. Military Activity and National Security: When the appropriate conditions apply, LDM LLC may use or disclose PHI of individuals who are Armed Forces personnel (1) for the activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. LDM LLC may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized. Worker's Compensation: Your PHI may be disclosed by LDM LLC as authorized to comply with worker's compensation laws and other similar legally established programs. Required Uses and Disclosures: Under the law, LDM LLC must make disclosure to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine my compliance with the requirements of Section 164.500.

Your Rights

The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights. You have the right to inspect and obtain a copy of your protected health information. You may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A designated record set may contain counseling and billing records and other records that LDM LLC uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny may be able to be reviewed. Please contact us if you have any questions about access to your medical record. You have the right to request a restriction on the release of your protected health information. This means you may ask LDM LLC not to use or disclose any part of your PHI for the purpose of treatment or payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. LDM LLC is not required to agree to a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If we do agree to the requested restriction, LDM LLC may not use or disclose your PHI in violation of the restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with us. Request a restriction form from your LDM LLC provider. You have the right to receive confidential communications from LDM LLC by alternative means or at an alternative location. LDM LLC will accommodate reasonable requests. LDM LLC may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. LDM LLC will not request an explanation from you as to the basis for the request. Please make this request in writing. You have the right to request amendments to your protected health information. You may request an amendment of your PHI. If LDM LLC denies your request for an amendment, you have the right to file a statement of disagreement with LDM LLC and LDM LLC may prepare a rebuttal to your statement. LDM LLC will provide you with a copy of any such rebuttal. Please contact LDM LLC if you have questions about amending your medical record. You have the right to receive an accounting of certain disclosures we have made of your protected health information. This right applies to disclosure for purposes other than treatment payment or healthcare operations as described in the Notice of Privacy Practices. It excludes disclosures LDM LLC may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. Disclosures made pursuant to a signed authorization by you are also excluded from the accounting. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations

you in a designated record set for as long as I maintain this information. In certain cases, LDM may deny your request

Electronic Communications

LDM LLC attempts to provide you with the greatest flexibility when communicating with us. All forms of electronic communication are subject to interception by third parties. Some present greater risk than others. HIPAA-approved forms of electronic communication may change over time, as does the technology and safeguards. In general, only traditional mail, land based phones and facsimiles are considered secure. LDM LLC also uses email that includes a form of electronic security that is HIPAA compliant; however, you are responsible for security once the message is retrieved from our secure server. Our providers and staff may communicate with you by cell phone, text message, or another manner at your request. Initiating, participating or providing us with your cell phone number/user name/etc. is an acknowledgment of the risks and considered a waiver of HIPAA’s electronic communications security requirements. You must notify LDM LLC in writing if you no longer wish to communicate with us in that manner.

Complaints

You may complain to LDM LLC or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with LDM LLC by notifying Leslie Mormile. LDM LLC will not retaliate against you for filing a complaint. You may contact Dr. Mormile at (575) 551-1183 for further information about the complaint process.

This notice was published and becomes effective on April 30, 2021