Hummingbird Therapy Group, 7465 Mission Gorge Road #120, San Diego, CA 92120,

(619) 663-7069

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.

Hummingbird Therapy Group is required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices (“Notice”). Therapists must abide by the terms of this Notice and must notify you if a breach of your unsecured PHI occurs. Hummingbird Therapy Group can change the terms of this Notice, and such changes will apply to all information Hummingbird Therapy Group has about you. The new Notice will be available upon request and on the website.

Except for the specific purposes set forth below, Hummingbird Therapy Group will use and disclose your PHI only with your written authorization (“Authorization”). It is your right to revoke such Authorization at any time by providing written notice of your revocation.

Uses (Inside Practice) and Disclosures (Outside Practice) Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Written Consent. Hummingbird Therapy Group can use and disclose your PHI without your Authorization for the following reasons:

1. For your treatment. Hummingbird Therapy Group can use and disclose your PHI to treat you, which may include disclosing your PHI to another health care professional with your authorization to do so.

2. To obtain payment for your treatment. Hummingbird Therapy Group can use and disclose your PHI to bill and collect payment for the treatment and services provided by Hummingbird Therapy Group to you with your authorization. For example, Hummingbird Therapy Group might send your PHI to your insurance company to get paid for the health care services that have been provided to you, although our preference is for you to provide Authorization to do so.

3. For health care operations. Hummingbird Therapy Group can use and disclose your PHI for purposes of conducting health care operations pertaining to the practice, including contacting you when necessary.

Certain Uses and Disclosures Require Your Authorization.

1. Psychotherapy Notes. Therapists at Hummingbird Therapy Group do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

   a. For your therapist’s use in treating you.

   b. For your therapist’s use in training or supervising other mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

   c. For your therapist’s use in defending themselves in legal proceedings instituted by you.

   d. For use by the Secretary of Health and Human Services to investigate the practice’s compliance with HIPAA.

   e. Required by law, and the use or disclosure is limited to the requirements of such law.

   f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

   g. Required by a coroner who is performing duties authorized by law.

   h. Required to help avert a serious threat to the health and safety of others.

2. Marketing Purposes.Your therapist will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. Your therapist will not sell your PHI in the regular course of business.

Certain Uses and Disclosures Do Not Require Your Authorization. Subject to certain limitations in the law, Hummingbird Therapy Group can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although Hummingbird Therapy Group’s preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on Hummingbird Therapy Group premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. Specialized government functions including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

8. For workers' compensation purposes. Although Hummingbird Therapy Group preference is to obtain an Authorization from you, Hummingbird Therapy Group may provide your PHI in order to comply with workers' compensation laws.

9. Appointment reminders and health related benefits or services. Hummingbird Therapy Group may use and disclose your PHI to contact you to remind you that you have an appointment. Hummingbird Therapy Group may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits.

Certain Uses and Disclosures Require You to Have the Opportunity to Object.

1. Disclosures to family, friends, or others. Hummingbird Therapy Group may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights with respect to your PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask Hummingbird Therapy Group not to use or disclose certain PHI for treatment, payment, or health care operations purposes. Hummingbird Therapy Group is not required to agree to your request, and Hummingbird Therapy Group may say “no” if Hummingbird Therapy Group believes it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How Hummingbird Therapy Group Sends PHI to You. You have the right to ask Hummingbird Therapy Group to contact you in a specific way (for example, phone call, text or email) or to send mail to a different address, and Hummingbird Therapy Group will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that Hummingbird Therapy Group has about you.

   Hummingbird Therapy Group will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and Hummingbird Therapy Group may charge a reasonable, cost-based fee for doing so.

5. The Right to Get a List of the Disclosures Hummingbird Therapy Group Has Made. You have the right to request a list of instances in which Hummingbird Therapy Group has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided Hummingbird Therapy Group with an Authorization.

   Hummingbird Therapy Group will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list provided will include disclosures made in the last six years unless you request a shorter time. Hummingbird Therapy Group will provide the list to you at no charge, but if you make more than one request in the same year, Hummingbird Therapy Group will charge you a reasonable cost based fee for each additional request.

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that Hummingbird Therapy Group correct the existing information or add the missing information. Hummingbird Therapy Group may say “no” to your request but will tell you why in writing within 60 days of receiving your request.

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it.

HOW TO COMPLAIN ABOUT PRIVACY PRACTICES

If you think Hummingbird Therapy Group may have violated your privacy rights, you may file a complaint with Meredith Mauzé, as the Privacy Officer for Hummingbird Therapy Group. The address and phone number are:

7465 Mission Gorge Road #120, San Diego, CA 92120; 619-663-7069

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:

1. Sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201;

2. Calling 1-877-696-6775; or,

3. Visiting www.hhs.gov/ocr/privacy/hipaa/complaints.

Hummingbird Therapy Group will not retaliate against you if you file a complaint about these privacy practices.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on January 13, 2025.