THIS NOTICE DESCRIBES:

How your protected health information (PHI) may be used and disclosed, and how you may access it. Please review it carefully.

OUR LEGAL DUTY

Under the Health Insurance Portability and Accountability Act (HIPAA) and applicable Pennsylvania law, including the Pennsylvania Mental Health Procedures Act (MHPA), Amplify Mental Health, LLC is required to:

• Protect the privacy of your medical and mental health information

• Provide you with this Notice of Privacy Practices

• Follow the privacy practices described in this notice

• Notify you if your unsecured PHI is breached

Your PHI includes information that identifies you and relates to your mental health, physical health, treatment, or payment for services.

HOW YOUR INFORMATION MAY BE USED AND DISCLOSED

1. Treatment

Your information may be used and shared to provide, coordinate, or manage your care. This includes communication with other healthcare providers involved in your treatment when appropriate.

2. Payment

Your information may be used for billing, claims submission, benefits determination, utilization review, and collections. This includes disclosures to:

• Insurance companies

• Billing services

• Other entities involved in payment processing

3. Health Care Operations

Your information may be used for activities such as:

• Quality assurance

• Documentation review

• Legal audits

• Compliance monitoring

• Training and supervision (without identifying details when possible)

USES AND DISCLOSURES WITHOUT YOUR AUTHORIZATION

Your information may be disclosed without your written permission only when required or permitted by law, including:

1. Danger to Self or Others

If you present an imminent risk of serious harm to yourself or another person, disclosure may occur to protect life.

2. Abuse or Neglect

Pennsylvania law requires reporting of suspected abuse, neglect, or exploitation of:

• Children

• Older adults

• Dependent adults

3. Court Orders

If a valid court order or subpoena requires disclosure, compliance is legally required.

4. Medical Emergencies

Information may be shared with emergency personnel when needed for your safety.

5. Public Health

Information may be shared with governmental authorities as required for disease control, public safety, or investigations.

6. Health Oversight

Disclosures may occur for audits, licensing, or investigations conducted by authorized agencies.

7. Law Enforcement

Limited PHI may be disclosed when legally required for criminal investigations or public safety concerns.

SPECIAL PROTECTIONS UNDER PENNSYLVANIA MHPA

Pennsylvania law provides stronger protections for mental health records than general medical records.

Under the Pennsylvania Mental Health Procedures Act (MHPA):

• Mental health records cannot be released without your written consent except under specific legal circumstances

• Even insurance companies may have limited access

• Psychotherapy notes receive heightened protection

• Disclosures must be narrowly tailored

MHPA protections apply in addition to HIPAA.

TELEHEALTH PRIVACY

Telehealth services are conducted using secure, HIPAA-compliant platforms including Alma. However, there are inherent risks with electronic transmission. You are responsible for maintaining privacy on your end.

Electronic communication is not guaranteed to be 100% secure.

YOUR RIGHTS UNDER HIPAA

You have the right to:

• Request access to your records

• Request corrections to your records

• Request restrictions on certain disclosures

• Request confidential communications

• Receive a list of disclosures

• Receive a paper copy of this Notice

• Be notified of breaches of unsecured PHI

• File a complaint without retaliation

Requests must be made in writing.

AUTHORIZATION REQUIREMENTS

Written authorization is required for:

• Psychotherapy note disclosures

• Marketing

• Sale of PHI

• Any use not described in this Notice

You may revoke authorization in writing at any time.

BREACH NOTIFICATION

If a breach of your unsecured PHI occurs, you will be notified as required by federal law.

CHANGES TO THIS NOTICE

This Notice may be updated at any time. The most current version will always apply.

COMPLAINTS

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

Victoria Potente, LCSW victoriapotentelcsw@amplifymentalhealth.com (215) 259-8149

Or with:

U.S. Department of Health and Human Services Office for Civil Rights www.hhs.gov/ocr

You will not be retaliated against for filing a complaint.

ACKNOWLEDGMENT

I acknowledge that I have received and reviewed this Notice of Privacy Practices.