PLOOF Therapy LLC Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Effective Date: 05/06/2023‍ ‍Who we are PLOOF Therapy LLC is a private counseling practice that provides behavioral health services to children, adolescents, and adults through in person and telehealth services, as applicable. This Notice of Privacy Practices describes how PLOOF Therapy LLC may use and disclose your protected health information and explains your rights regarding that information. Our legal duty PLOOF Therapy LLC is required by law to maintain the privacy of your protected health information, to provide you with notice of our legal duties and privacy practices, to notify you if there is a breach of unsecured protected health information as required by law, and to follow the terms of this notice currently in effect. We reserve the right to change the terms of this notice at any time. Any revised notice will apply to all protected health information maintained by PLOOF Therapy LLC. An updated copy will be available on our website and by request. How we may use and disclose your information We may use and disclose your protected health information for purposes of treatment, payment, and health care operations. These are routine and legally permitted uses that allow us to provide services and operate the practice. For treatment We may use and disclose your information to provide, coordinate, or manage your care. This may include assessment, diagnosis, treatment planning, referrals, care coordination with other healthcare providers, and consultation when clinically appropriate. Example: If you need psychiatric medication management, testing, or another healthcare service outside the scope of counseling, we may share relevant information with your physician, psychiatrist, or another provider involved in your care when permitted by law. For payment We may use and disclose your information to bill and collect payment for services we provide to you. Example: We may submit claims to your insurance company, verify benefits, obtain authorizations, or provide information required for reimbursement, utilization review, or claims processing. For health care operations We may use and disclose your information for practice operations necessary to run the business and ensure quality care. Example: We may use your information for quality review, clinical supervision or consultation when appropriate, compliance activities, credentialing, audits, licensing, staff training, record review, or business planning. Other uses and disclosures permitted or required by law We may use or disclose your protected health information without your written authorization in certain situations allowed or required by law, including the following: Emergency situations We may disclose information when necessary to address a medical or psychiatric emergency. Risk of harm If we believe there is a serious and imminent threat to your health or safety or the health or safety of another person, we may disclose information to law enforcement, medical personnel, or another person able to help reduce the threat, as permitted by law and ethical standards. Abuse, neglect, or exploitation We may disclose information when required to report suspected child abuse, neglect, elder abuse, abuse of a protected person, or exploitation. Judicial and administrative proceedings We may disclose information in response to a court order, subpoena, lawful process, or other legal requirement, subject to applicable confidentiality laws and professional standards. Law enforcement We may disclose information to law enforcement when required or permitted by law. Health oversight activities We may disclose information to health oversight agencies for audits, investigations, inspections, licensure matters, and other activities authorized by law. Workers compensation We may disclose information as necessary to comply with workers compensation laws or similar programs. Public health activities We may disclose information when required for public health reporting as authorized by law. Business associates We may share the minimum necessary information with business associates who perform services on our behalf, such as electronic health record vendors, billing services, claim processors, secure email providers, telehealth platforms, IT support, accountants, attorneys, or document storage services. All such parties are required to protect your information according to law and contract. Appointment reminders and administrative communications We may contact you to remind you of appointments, provide scheduling updates, respond to administrative requests, or communicate regarding billing, insurance, or other matters related to your care. Uses and disclosures requiring your written authorization Uses and disclosures of your protected health information for purposes other than those listed in this notice generally require your written authorization unless otherwise permitted or required by law. Your written authorization is typically required for most disclosures of psychotherapy notes, most marketing uses, and disclosures that would constitute a sale of protected health information. You may revoke an authorization at any time in writing. Revocation will apply going forward and will not affect actions already taken in reliance on your authorization. Special protection for certain records Some types of information may receive extra protection under federal or state law, including records related to substance use disorder treatment, HIV or AIDS related information, and other specially protected health information when applicable. When the law requires extra protection, PLOOF Therapy LLC will follow those requirements before disclosing such information. Your rights regarding your information Right to inspect and receive a copy You have the right to inspect and receive a copy of your protected health information in a designated record set, with limited exceptions. Requests must be made in writing. Reasonable cost based fees may apply where permitted by law. Right to request amendment You have the right to request that we amend your record if you believe information is incorrect or incomplete. Your request must be in writing and explain why the amendment is needed. We may deny the request in certain circumstances allowed by law. Right to an accounting of disclosures You have the right to request an accounting of certain disclosures of your protected health information made by this practice, as allowed by law. Right to request restrictions You have the right to request restrictions on certain uses or disclosures of your information. We are not required to agree to every restriction request, except where the law requires it. If we do agree, we will follow the restriction unless disclosure is needed for emergency treatment or otherwise required by law. Right to request confidential communications You have the right to request that we communicate with you in a specific way or at a specific location. For example, you may request contact only by phone, only by email, only through a secure portal, or only at a particular mailing address. We will accommodate reasonable requests. Right to a paper copy of this notice You have the right to receive a paper copy of this notice at any time, even if you agreed to receive it electronically. Right to file a complaint You have the right to file a complaint if you believe your privacy rights have been violated. You may file a complaint with PLOOF Therapy LLC and with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint. Electronic communication and telehealth PLOOF Therapy LLC may communicate with you through phone, email, text message, client portal, electronic health record messaging, or telehealth platforms. These methods may involve some privacy and security risk despite reasonable safeguards. By choosing electronic communication, you acknowledge those risks. Email and text messages should not be used for emergencies. If you are experiencing a medical or psychiatric emergency, call 911 or go to the nearest emergency room immediately. Information shared through email, text, portal messaging, telehealth sessions, or other electronic communications may become part of your clinical or administrative record when appropriate. Website and online privacy note This Notice applies to protected health information maintained by PLOOF Therapy LLC. It does not necessarily apply to general website browsing information that is not considered protected health information under HIPAA. If your website also includes a separate Website Privacy Policy or Terms and Conditions, those documents should be reviewed together with this Notice. Contact information Privacy Officer PLOOF Therapy LLC Brad Ploof, MS, LPC, NCC Website: [www.plooftherapy.com](http://www.plooftherapy.com) Practice Address: 319B AL 75, Albertville AL 35951 Phone: (256) 513-9220 Fax: (256) 223-9244 Privacy Email: [PloofTherapy@gmail.com](mailto:PloofTherapy@gmail.com) To request records, amendments, restrictions, confidential communications, or to file a privacy complaint with the practice, please submit your request in writing to the Privacy Officer using the contact information above. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Filing a complaint will not affect your care. Acknowledgment By receiving services from PLOOF Therapy LLC, you acknowledge that you were offered access to this Notice of Privacy Practices. I can also prepare the matching acknowledgment of receipt page and a shorter website posting version using this exact information.