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

EDM Counseling and Wellness (the “Practice”) is committed to protecting yourprivacy. The Practice is required by federal law to maintain the privacy ofProtected Health Information (“PHI”), which is information that identifies orcould be used to identify you. The Practice is required to provide you withthis Notice of Privacy Practices (this “Notice”), which explains the Practice'slegal duties and privacy practices and your rights regarding PHI that wecollect and maintain.


YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, pleasesubmit a written request to the Practice at the address noted below.

To inspect and copy PHI.
• You can ask for an electronic or paper copy of PHI. The Practice may chargeyou a reasonable fee.
• The Practice may deny your request if it believes the disclosure willendanger your life or another person's life. You may have a right to have thisdecision reviewed.

To amend PHI.
• You can ask to correct PHI you believe is incorrect or incomplete. ThePractice may require you to make your request in writing and provide a reasonfor the request.
• The Practice may deny your request. The Practice will send a writtenexplanation for the denial and allow you to submit a written statement ofdisagreement.

To request confidential communications.
• You can ask the Practice to contact you in a specific way. The Practice willsay “yes” to all reasonable requests.

To limit what is used or shared.
• You can ask the Practice not to use or share PHI for treatment, payment, orbusiness operations. The Practice is not required to agree if it would affectyour care.
• If you pay for a service or health care item out-of-pocket in full, you canask the Practice not to share PHI with your health insurer.
• You can ask for the Practice not to share your PHI with family members or friendsby stating the specific restriction requested and to whom you want therestriction to apply.

To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your healthinformation has been shared. You can receive one accounting every 12 months atno charge, but you may be charged a reasonable fee if you ask for one morefrequently.

To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to receivethe Notice electronically.

To choose someone to act for you.
• If you have given someone medical power of attorney or if someone is yourlegal guardian, that person can exercise your rights.

To file a complaint if you feel your rights are violated.
• You can file a complaint by contacting the Practice using the followinginformation:
EDM Counseling and Wellness
3148 Derry Road Philadelphia, PA 19154
Ellise Milburn
215-584-7393

• You can file a complaint with the Secretaryof the U.S. Department of Health and Human Services, Office of Civil Rights,Region III, Regional Manager, Paul Cushing 150 S. Independence Mall West, Suite372, Public Ledger Bldg, Philadelphia, PA 19106-9111 - Phone 215-861-4441 - Website www.hhs.gov/region3 - Hotline 800-368-1019 - Fax 215-861-4431 -TDD 215-861-4440 - E-mail Paul.Cushing@hhs.gov

• You can file a complaint with the U.S.Department of Health and Human Services Office for Civil Rights by sending aletter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• The Practice will not retaliate against you for filing a complaint.

To opt out of receiving fundraising communications.
• The Practice may contact you for fundraising efforts, but you can ask not tobe contacted again.


OUR USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
The Practice is permitted under federal law to use and disclose PHI, withoutyour written authorization, for certain routine uses and disclosures, such asthose made for treatment, payment, and the operation of our business. ThePractice typically uses or shares your health information in the followingways:

To treat you.
• The Practice can use and share PHI with other professionals who are treatingyou.
• Example: Your primary care doctor asks about your mental health treatment.

To run the health care operations.
• The Practice can use and share PHI to run the business, improve your care,and contact you.
• Example: The Practice uses PHI to send you appointment reminders if youchoose.

To bill for your services.
• The Practice can use and share PHI to bill and get payment from health plansor other entities.
• Example: The Practice gives PHI to your health insurance plan so it will payfor your services.

2. Uses and Disclosures of PHI That May Be Made Without Your Authorization orOpportunity to Object
The Practice may use or disclose PHI without your authorization or anopportunity for you to object, including:

To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product recalls,and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: We may be required todisclose your PHI to the Secretary of Health and Human Services to investigateor determine our compliance with the requirements of the final rule onStandards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by governmentagencies that oversee the health care system, government benefit programs,other government regulatory programs, and civil rights laws.
• Serious threat to health or safety: To prevent a serious and imminent threat.
• Abuse or Neglect: To report abuse, neglect, or domestic violence.

To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law.
• Judicial and administrative proceedings: To respond to a court order,subpoena, or discovery request.
• Law enforcement: For law locate and identify you or disclose informationabout a victim of a crime.
• Specialized Government Functions: For military or national security concerns,including intelligence, protective services for heads of state, or your securityclearance.
• National security and intelligence activities: For intelligence,counterintelligence, protection of the President, other authorized persons orforeign heads of state, for purpose of determining your own security clearanceand other national security activities authorized by law.
• Workers' Compensation: To comply with workers' compensation laws or supportclaims.

To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized duties.
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional reviewboard.
• Inmates: The Practice created or received your PHI in the course of providingcare.
• Business Associates: To organizations that perform functions, activities orservices on our behalf.

3. Uses and Disclosures of PHI That May Be Made With Your Authorization orOpportunity to Object
Unless you object, the Practice may disclose PHI:

To your family, friends, or others if PHI directly relates to that person'sinvolvement in your care.

If it is in your best interest because you are unable to state your preference.

4. Uses and Disclosures of PHI Based Upon Your Written Authorization
The Practice must obtain your written authorization to use and/or disclose PHIfor the following purposes:

Marketing, sale of PHI, and psychotherapy notes.

You may revoke your authorization, at any time, by contacting the Practice inwriting, using the information above. The Practice will not use or share PHIother than as described in Notice unless you give your permission in writing.


OUR RESPONSIBILITIES
• The Practice is required by law to maintain the privacy and security of PHI.
• The Practice is required to abide by the terms of this Notice currently ineffect. Where more stringent state or federal law governs PHI, the Practicewill abide by the more stringent law.
• The Practice reserves the right to amend Notice. All changes are applicableto PHI collected and maintained by the Practice. Should the Practice makechanges, you may obtain a revised Notice by requesting a copy from thePractice, using the information above, or by viewing a copy on the website,EDMcounseling.org.
• The Practice will inform you if PHI is compromised in a breach.

This Notice is effective on 03/20/2023.

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