NOTICE OF PRIVACY PRACTICES

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

The Untitled Mind - Notice of Privacy Practices

Your Rights Regarding Your Health Information
This section explains your rights and our responsibilities to help you.

1. Get an Electronic or Paper Copy of Your Medical Record:

   • To request a copy of your medical records or to have them sent to another healthcare provider, please complete our HIPAA Release Form, which is available here. Submit the completed form to adam@theuntitledmind.com.

2. Ask Us to Correct Your Medical Record:

   • If you believe your health information is incorrect or incomplete, you can ask us to correct it. We may deny your request, but we will provide a written explanation within 60 days.

3. Request Confidential Communications:

   • You can ask us to contact you in a specific way (e.g., home or office phone) or to send mail to a different address. All reasonable requests for alternative methods of communication will be accommodated unless they are unreasonable or impractical.

4. Ask Us to Limit What We Use or Share:

   • You can request restrictions on the use or sharing of your health information for treatment, payment, or operations. While we are not required to agree to your request, we will comply if it does not affect your care. If you pay out-of-pocket in full for a service or item, you can request that we do not share that information with your health insurer. We will agree unless required by law to share that information.

Cookies and Website Data Collection

Our website uses cookies to enhance your browsing experience. Cookies are small data files stored on your device when you visit websites. They help us measure activity, improve functionality, and remember your preferences for future visits. You may refuse the use of cookies by selecting the appropriate settings on your browser. However, please note that certain features of the website may not function properly without cookies.

We automatically collect aggregated data (e.g., number of visitors, traffic patterns), which does not personally identify you. This information helps us optimize the site’s performance. If personal data is collected (e.g., through account creation), it will be handled according to this Privacy Notice and not shared without your consent.

Public Forums

Our website may provide public forums, such as message boards or chat rooms, where you can communicate with others. Please note that information shared in these forums is public and can be viewed by third parties. We cannot control how others may use the information you post, so please be cautious about sharing any personal or health-related information in public areas of our site.

Your Rights

1. Get a List of Those with Whom We’ve Shared Information:

   • You can request an accounting of the times we’ve shared your health information over the past six years, including who we shared it with and why. This list excludes disclosures for treatment, payment, and healthcare operations. We provide one free accounting each year, with a reasonable, cost-based fee for additional requests within the same 12-month period.

2. Get a Copy of This Privacy Notice:

   • You can request a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will promptly provide a paper copy.

3. Choose Someone to Act for You:

   • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make decisions about your health information. We will verify this authority before taking any action.

4. File a Complaint if You Feel Your Rights Are Violated:

   • You can file a complaint with us using the contact information on the back page. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your preferences about what we share. If you have a clear preference for how we share your information in the situations described below, let us know, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care.

• Share information in a disaster relief situation.

• Include your information in a hospital directory.

If you are unable to tell us your preference (e.g., if you are unconscious), we may share your information if we believe it is in your best interest. We may also share your information to reduce a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes.

• Sale of your information.

• Most sharing of psychotherapy notes.

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

How We Typically Use or Share Your Health Information

We use or share your health information in the following ways:

1. Treat You:

   • We can use your health information and share it with other professionals who are treating you.

   • Example: A doctor treating you for an injury asks another doctor about your overall health condition.

2. Run Our Organization:

   • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

   • Example: We use health information about you to manage your treatment and services.

3. Bill for Your Services:

   • We can use and share your health information to bill and get payment from health plans or other entities.

   • Example: We give information about you to your health insurance plan so it will pay for your services.

Data Security

We are committed to protecting the security of your personal and health information. We implement administrative, physical, and technical safeguards to protect your data from unauthorized access or disclosure. However, no data transmission over the internet or electronic storage method can be guaranteed to be completely secure. While we strive to protect your personal information, we cannot ensure or warrant its absolute security, and you share your information at your own risk.

Our Uses and Disclosures

Psychotherapy Notes:
Psychotherapy notes are created for your treatment, and we must obtain your prior written authorization, most recent identification, and verbal consent before using or disclosing them, except in specific situations (e.g., for treatment, training programs, or defense of a proceeding brought by you). “Psychotherapy Notes” exclude medication prescription and monitoring, session start and stop times, treatment modalities and frequencies, and summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress. We may deny your request for these notes if providing them could be harmful or detrimental.

Other Ways We Can Use or Share Your Health Information

We are allowed or required to share your information in ways that contribute to the public good, such as public health and research, under certain conditions. For more information, visit: HHS Privacy.

• Help with Public Health and Safety Issues:
  We can share health information about you for specific situations, such as preventing disease, reporting adverse reactions to medications, and reporting suspected abuse or domestic violence.

• Do Research:
  We can use or share your information for health research.

• Comply with the Law:
  We will share information about you if required by state or federal laws, including with the Department of Health and Human Services to ensure compliance with federal privacy law.

• Respond to Organ and Tissue Donation Requests:
  We can share health information about you with organ procurement organizations.

• Work with a Medical Examiner or Funeral Director:
  We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

• Address Workers’ Compensation, Law Enforcement, and Other Government Requests:
  We can use or share health information about you for workers’ compensation claims, law enforcement purposes, health oversight activities, and special government functions such as military and national security.

• Respond to Lawsuits and Legal Actions:
  We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Colorado Privacy Act (CPA):
The Colorado Privacy Act (CPA) applies to personal data that is not classified as Protected Health Information (PHI) under HIPAA. For residents of Colorado, the CPA provides the following rights regarding your personal data that is collected for purposes beyond your healthcare treatment and services, such as marketing, website activity, or communications outside of clinical care:

• The right to opt-out of the processing of personal data for targeted advertising, the sale of personal data, and automated profiling.

• The right to access the personal data we hold about you.

• The right to correct inaccuracies in your personal data.

• The right to have your personal data deleted.

• The right to obtain a portable and usable copy of your personal data.

Please note that these rights pertain to personal data that does not fall under the category of Protected Health Information (PHI) regulated by HIPAA. For more information on your rights under the CPA and to exercise them, refer to our Privacy Policy or contact us directly. For information regarding your health information rights, please see the HIPAA section of this notice.

For more details on the CPA, visit: Colorado Privacy Act.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.

• We will notify you promptly if a breach occurs that may compromise the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and provide you with a copy of it.

• We will not use or share your information other than as described here unless you give us written permission. You can revoke this permission at any time by letting us know in writing.

For more information, visit: HHS Privacy Notice.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available upon request, in our office, and on our website.