Notice of Privacy Practices

This Notice of Privacy Practices (the "Notice") describes how Ruach Counseling and Annu Vijayvargiya, LPC ("Ruach Counseling," "we," "us," or "our") may use and disclose your protected health information to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. It also explains how you can obtain access to this information. This Notice applies to the online (telehealth) mental health counseling services we provide to clients located in the State of Georgia.

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.

How is your privacy protected?

We understand that information about you and your health is personal. By "health information," we mean protected health information ("PHI") as defined under federal law (HIPAA and its implementing regulations). This Notice does not apply to information that is not covered by HIPAA. Maintaining the privacy and security of your health information is both our legal obligation and a core value of our practice. We continuously safeguard your health information through administrative, physical, and technical measures, and we abide by applicable federal and Georgia state laws. We will notify you promptly if a breach occurs that may have compromised the privacy or security of your health information.

What health information do we collect?

The health information we collect or maintain may include:

• Your name, date of birth, email address, phone number, and other registration and contact information.
• Health information you provide to us, including information or records relating to your mental health history, symptoms, health status, and other health-related information.
• Health information prepared or obtained in the course of your care, such as intake documents, clinical assessments, treatment plans, and session (progress) notes.
• Billing information you provide, such as payment-card, HSA, or FSA details, and any billing statements we prepare so that you may seek reimbursement from your health plan.

How do we use and disclose health information?

We use and disclose your health information for the ordinary activities the law describes as treatment, payment, and health care operations. Generally, we do not need your permission for these disclosures. Below are examples, although not every use or disclosure within each category is listed:

• Treatment — We keep a record of the health information you provide and the care we deliver. We may disclose this information to other health professionals involved in your care — for example, a psychiatrist, primary-care provider, or another therapist — so that they can meet your health care needs, with your consent where required.
• Payment — We document the services you receive so that you may pay us or seek reimbursement. As a self-pay practice, we may provide you with a billing statement (a "superbill") to submit to your insurance for possible reimbursement.
• Health Care Operations — We use health information to run the practice — for example, for scheduling, quality improvement, professional consultation and supervision, business management, and responding to your questions.

We may also use or disclose your health information, without your authorization, to:

• Comply with federal, state, or local laws that require disclosure;
• Assist in public health activities;
• Report information to authorities to protect victims of abuse, neglect, or domestic violence, as required or permitted by Georgia law;
• Comply with health-oversight activities such as audits or investigations;
• Respond to a court order, subpoena, or other lawful process;
• Avert a serious and imminent threat to your health or safety or the health or safety of others;
• Assist coroners, medical examiners, or funeral directors, as permitted by law;
• Perform specialized government functions, or respond to military, veteran, or workers'-compensation requirements where applicable;
• Communicate with people involved in your care or payment for your care, such as a family member or guardian, where you agree or where permitted by law; and
• Send you appointment reminders and information about treatment alternatives.

Where we engage a business associate (such as our HIPAA-compliant practice-management and telehealth platform, SimplePractice) to perform services on our behalf, we require that associate to safeguard your information under a written business associate agreement.

All other uses and disclosures not described in this Notice will be made only with your written authorization. In particular, we will obtain your authorization before we:

• Use or disclose your health information for marketing purposes;
• Sell your health information; or
• Use or disclose your psychotherapy (session) notes, except in the limited circumstances permitted by law.

You may revoke an authorization at any time in writing; this will not affect uses or disclosures we already made in reliance on it. Some information may be subject to additional protections under Georgia law.

How are substance use disorder records handled?

Substance use disorder treatment records received from programs subject to 42 C.F.R. Part 2 may be subject to stricter limitations on how we may use and disclose them. Where we receive such records, we will comply with those stricter standards. Such records, or testimony relaying their content, will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent or a court order issued after notice and an opportunity to be heard. A court order authorizing use or disclosure must also be accompanied by a subpoena or other legal requirement compelling disclosure.

What are our responsibilities?

We are required by law to:

• Maintain the privacy and security of your health information;
• Provide you with this Notice of our legal duties and privacy practices;
• Abide by the terms of the Notice currently in effect; and
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your health information.

We reserve the right to change this Notice and to make the revised terms effective for all health information we maintain. Revised notices will be posted on this website.

What are your rights?

You have the right to:

• Inspect and receive a copy of your health information, including in an electronic format. We may deny a request in limited circumstances permitted by law.
• Request an amendment to your health information if you believe it is incorrect or incomplete. We may deny the request under certain circumstances.
• Receive an accounting of certain disclosures of your health information made in the prior six (6) years, excluding disclosures for treatment, payment, and health care operations. A reasonable fee may apply.
• Request that we restrict how we use or disclose your health information. We are not required to agree, except that we must honor a request to restrict disclosure to a health plan for payment or operations when you have paid for the service in full out of pocket.
• Request that we communicate with you by a specific method or at a specific phone number or address.
• Obtain a paper copy of this Notice, even if you agreed to receive it electronically.
• Have someone act on your behalf, such as a person with medical power of attorney or a legal guardian. We will confirm that person's authority before acting.
• File a complaint if you believe your privacy rights have been violated (see below).

We may ask you to make some of these requests in writing.

What if I have a complaint?

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.

To file a complaint with us, or to ask a question about this Notice, contact our Privacy Officer, Annu Vijayvargiya, LPC, using the details below.

To file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, write to 200 Independence Avenue, S.W., Washington, D.C. 20201, call 1-800-368-1019, or file an online complaint here.

Who follows this Notice?

This Notice describes the privacy practices of Ruach Counseling and Annu Vijayvargiya, LPC, together with any supervisees, staff, or business associates authorized to access your health record in the course of providing or supporting your care.

Contact Us

To exercise any of the rights described in this Notice, request a paper copy, or raise a privacy concern, please contact our Privacy Officer:

• Ruach Counseling
• Annu Vijayvargiya, LPC — Privacy Officer
• Email: admin@ruach-counseling.com
• Phone: 229.515.2046
• Sessions: Online across Georgia