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



NeuroEdge Psychological Services is committed to protecting your privacy and safeguarding information related to
your psychological, neuropsychological, behavioral health, cognitive, developmental, assessment, consultation,
telehealth, billing, insurance, and administrative care. We are required by federal law to maintain the privacy of health information that identifies you or could reasonably be used to identify you, known as Protected Health Information (“PHI”), and to notify you following a breach of unsecured PHI when required by law.

We are also required to provide you with this Notice of Privacy Practices (“Notice”), which explains our legal duties,
privacy practices, and your rights regarding PHI that we collect, create, receive, maintain, or transmit. We are required to follow the terms of the Notice currently in effect. We reserve the right to change the privacy practices described in this Notice and to make the revised practices effective for all PHI we maintain. If we make a material change, you may obtain a revised Notice by contacting our office or accessing https://info6359724.wixsite.com/mysite.

Virtual Practice and Technology

NeuroEdge is a virtual-only practice. We intend to use Office Ally for EHR/practice management, scheduling, documents, and insurance claims, and Spruce for SMS/text messaging, voicemail, secure links to forms, and telehealth appointment links. These platforms may create, receive, maintain, or transmit PHI on behalf of NeuroEdge. NeuroEdge should maintain appropriate business associate agreements and privacy/security safeguards with vendors when required by law.


Uses and Disclosures of Protected Health Information


A. Routine Uses and Disclosures for Treatment, Payment, and Healthcare Operations

Federal law permits us to use and disclose PHI without your written authorization for certain routine purposes,
including treatment, payment, and healthcare operations. The examples below are not exhaustive but illustrate common circumstances.

For Treatment: We may use and disclose your PHI to provide, coordinate, or manage care, assessment, consultation,
telehealth, or related services. For example, we may share relevant information with another healthcare provider,
physician, psychiatrist, therapist, school-based provider, referral source, or authorized caregiver involved in your care
or evaluation when permitted and clinically appropriate.

For Payment: We may use and disclose PHI as needed to obtain payment for services. For example, we may provide
information to a health plan, billing service, payer, attorney, agency, or other authorized payer to support claims,
invoices, authorizations, eligibility, utilization review, insurance claim submission through Office Ally, or payment-
related activities.

For Healthcare Operations: We may use or disclose PHI to support the operation of the Practice. Examples may include quality review, case consultation, supervision, credentialing, compliance, auditing, training, business planning, legal services, technology support, record maintenance, secure messaging workflows, and other administrative activities.


B. Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object

We may use or disclose your PHI without your authorization or opportunity to object in the following situations, when permitted or required by law:

- Required by the Secretary of Health and Human Services: We may disclose PHI to the Secretary of Health and
Human Services to investigate or determine compliance with HIPAA.

- Required by Law: We may use or disclose PHI when required by federal, state, or local law.

- Public Health: We may disclose PHI for public health activities to authorized public health authorities or other
agencies.

- Health Oversight: We may disclose PHI to health oversight agencies for audits, investigations, inspections,
licensure, or other legally authorized activities.

- Abuse, Neglect, or Domestic Violence: We may disclose PHI to government agencies authorized to receive reports
of abuse, neglect, or domestic violence, including child abuse or neglect, elder/dependent adult abuse, or other
mandated reports, as required or permitted by law.

- Judicial and Administrative Proceedings: We may disclose PHI in response to a court or administrative order,
subpoena, discovery request, or other lawful process when legal requirements are met.

- Law Enforcement: We may disclose PHI for law enforcement purposes when applicable legal requirements are
met.

- Coroners, Medical Examiners, and Funeral Directors: We may disclose PHI when necessary for these individuals
to perform legally authorized duties.

- Organ Donation: If applicable, we may disclose PHI to organ procurement organizations as necessary to facilitate
donation or transplantation.

- Research: Under certain circumstances, we may disclose PHI for research approved by an institutional review
board or privacy board, or as otherwise permitted by law.

- Serious Threat to Health or Safety: We may disclose PHI when necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public, consistent with applicable law and professional
duties.

- Specialized Government Functions: We may disclose PHI for military, veterans’ affairs, national security,
intelligence, protective services, or similar functions when legally permitted.

- Workers’ Compensation: We may disclose PHI as necessary to comply with workers’ compensation laws or
similar programs.

- Inmates or Individuals in Custody: If you are in a correctional facility or law enforcement custody, we may
disclose PHI as permitted or required by law.

- Business Associates: We may disclose PHI to persons or entities that perform services for NeuroEdge and require
PHI to perform those services, including EHR/practice management, scheduling, secure communication, telehealth,
billing, claims, records, technology, legal, and compliance support. We require business associates to appropriately
safeguard PHI.


C. Uses and Disclosures That May Be Made With Your Agreement or Opportunity to Object

Unless you object, we may disclose PHI to a family member, relative, close friend, caregiver, or other person you
identify, when the information is directly relevant to that person’s involvement in your care, payment for your care, or coordination of services. If you are unable to agree or object, we may use professional judgment to determine whether the disclosure is in your best interest. We may also use or disclose PHI to notify or assist in notifying a family member, personal representative, or other person responsible for your care regarding your location, condition, or status.


D. Uses and Disclosures Requiring Your Written Authorization

Psychotherapy Notes: We must obtain your written authorization for most uses and disclosures of psychotherapy notes, if applicable. Psychotherapy notes are treated differently from the general clinical record and generally refer to notes recorded by a mental health professional documenting or analyzing the contents of a counseling session and kept separate from the medical record.

Marketing: We must obtain your written authorization for most uses and disclosures of PHI for marketing purposes,
except where permitted by law.

Sale of PHI: We must obtain your written authorization for any disclosure of PHI that constitutes a sale of PHI.

Other Uses: Uses and disclosures of PHI not described in this Notice will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on it.


Telehealth-Specific Privacy and Safety Considerations

Telehealth services require additional privacy, security, and clinical appropriateness considerations. Before initiating
telehealth services, NeuroEdge will obtain and document informed consent for telehealth and may discuss risks to
confidentiality and security, technology interruptions, data storage policies and procedures specific to telehealth,
insurance coverage considerations, potential differences between telehealth and in-person services, and other issues reasonably anticipated for virtual care.

NeuroEdge may verify your physical location at the time of service, confirm emergency contact information, and
identify local emergency resources when appropriate. Telehealth may not be appropriate for every person or every
service. NeuroEdge may decline, pause, or refer services if telehealth does not appear clinically appropriate, legally
permitted, or consistent with safety needs.


Notice of Redisclosure

Once your information is shared with your consent or as otherwise permitted by law, it may be subject to redisclosure by the recipient and may no longer be protected by the same privacy laws.


Your Rights Regarding Your Health Information

You have the following rights regarding your PHI. To exercise these rights, submit a written request to our Privacy
Officer at the contact information listed below. NeuroEdge will follow applicable federal and California law. Where
California law provides a shorter response period or greater protection, NeuroEdge will evaluate the request under the applicable requirement.


A. Right to Inspect and Copy

You have the right to inspect and obtain an electronic or paper copy of PHI contained in a designated record set, such as clinical and billing records, subject to certain exceptions. Under HIPAA, we generally must provide access within 30 days after receiving your request, with a possible 30-day extension when permitted. Under California law, inspection may be required within five working days after a written request, and copies may be required within 15 days after a qualifying request. NeuroEdge will follow the applicable legal timeframe and may charge a reasonable, cost-based fee when permitted. In certain circumstances, we may deny access; depending on the reason, you may have a right to review of the denial.


B. Right to Request Restrictions

You may request that we restrict certain uses or disclosures of PHI for treatment, payment, or healthcare operations, or disclosures to individuals involved in your care. We are not required to agree to all restrictions. However, we must agree not to disclose PHI to a health plan for payment or healthcare operations if the disclosure is not otherwise required by law and the PHI relates solely to a healthcare item or service you paid for in full out of pocket.


C. Right to Request Confidential Communications

You may request that we communicate with you by alternative means or at an alternative location. We will
accommodate reasonable requests and may ask how payment will be handled or request an alternative address or
contact method.


D. Right to Request Amendment

You may request that we amend PHI in a designated record set for as long as we maintain the information. Under
HIPAA, we generally respond within 60 days, with a possible 30-day extension when permitted. We may deny a
request if, for example, we determine the information is accurate and complete. If denied, you may submit a written statement of disagreement.


E. Right to an Accounting of Certain Disclosures

You have the right to receive an accounting of certain disclosures of PHI made during a period of up to six years before your request. This right does not generally apply to disclosures for treatment, payment, healthcare operations, disclosures to you, or certain other excluded disclosures. You are entitled to one free accounting in a 12-month period; we may charge for additional requests after notifying you of the cost.


F. Right to a Paper Copy

You have the right to obtain a paper copy of this Notice at any time, even if you agreed to receive it electronically.


G. Right to Breach Notification

You have the right to be notified if you are affected by a breach of unsecured PHI when notification is required by law.


H. Right to Opt Out of Fundraising Communications

If NeuroEdge ever conducts fundraising communications, you have the right to opt out. NeuroEdge does not currently anticipate using patient information for fundraising communications unless legally permitted and ethically appropriate.


Additional Provisions: Substance Use Disorder Records

These additional provisions apply when NeuroEdge creates, receives, or maintains records relating to the diagnosis,
treatment, or referral for treatment of a substance use disorder that are protected by federal regulations. Unless
specifically indicated below, such records generally have the same protections and rights described in this Notice.

Uses and Disclosures Without Consent: We may use or disclose substance use disorder records without consent only when all conditions required by applicable law are met, such as for medical emergencies, scientific research, audits, program evaluations, or disclosures to public health authorities when records are de-identified.

Treatment, Payment, and Healthcare Operations: When required by law, we will obtain written consent for future uses and disclosures of substance use disorder records for treatment, payment, or healthcare operations. Once consent is obtained, such records may be used and disclosed as permitted by law.

Proceedings Against You: We will not use or disclose substance use disorder records or testimony based on such
records in civil, criminal, administrative, or legislative proceedings against you unless permitted by your written
consent or a special court order required by federal regulations.


Record Retention

NeuroEdge maintains records according to applicable federal and California laws, professional standards, payer
requirements, and risk-management considerations. For California psychologists, patient health service records
generally must be retained for at least seven years from discharge; if the patient is a minor, records generally must be retained for at least seven years after the minor reaches age 18, subject to applicable law and any longer retention obligations.


Complaints

If you believe your privacy rights have been violated, you may file a complaint with NeuroEdge by contacting the
Privacy Officer in writing. NeuroEdge will not retaliate against you for filing a complaint. You may also file a
complaint with the Secretary of the U.S. Department of Health and Human Services.

NeuroEdge Psychological Services

Service Area: California; Ventura County

Virtual-only practice; no walk-in or in-person services are available unless expressly arranged in writing.

Mailing Address: [FINAL BUSINESS ADDRESS OR MAILING ADDRESS]

Phone: [PHONE NUMBER]

General Administrative Email: info@NeuroEdgePsych.com

Privacy/Complaint Email: [PRIVACY/COMPLAINT EMAIL ADDRESS]

Website: www.neuroedgepsych.com

Privacy Officer: [PRIVACY OFFICER NAME/TITLE]