Notice of Privacy Practices

I. Our Pledge Regarding Health Information

Rock Coastal Therapy LLC is committed to protecting your child's protected health information ("PHI"). We create a record of the care and services your child receives in order to provide quality care and comply with legal requirements. This notice applies to the records of care generated by this practice and describes how your child's health information may be used and disclosed, as well as your rights as the child's parent or personal representative.

We are required by law to:

• Keep protected health information that identifies your child private.
• Give you this notice of our legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.

We can change the terms of this Notice, and such changes will apply to all information we have about your child. The new Notice will be available upon request and on our website at www.rockcoastaltherapy.com.

II. How We May Use and Disclose Health Information

For Treatment, Payment, or Health Care Operations: Federal privacy rules allow health care providers with a direct treatment relationship to use or disclose a patient's personal health information without written authorization to carry out treatment, payment, or health care operations. For example, if we consult with another licensed health care provider about your child's condition, we may use and disclose your child's PHI to assist in diagnosis and treatment.

Disclosures for treatment purposes are not limited to the minimum necessary standard, as other providers need access to full information to provide quality care. "Treatment" includes coordination and management of health care, consultations between providers, and referrals.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order, subpoena, discovery request, or other lawful process, but only if efforts have been made to notify you or obtain a protective order.

III. Certain Uses and Disclosures Require Your Authorization

Session Notes: We keep session notes, and any use or disclosure of such notes requires your authorization unless the use or disclosure is:

1. For our use in treating your child.
2. For training or supervising associates to improve their clinical skills.
3. For defending ourselves in legal proceedings instituted by you.
4. For use by the Secretary of Health and Human Services to investigate HIPAA compliance.
5. Required by law and limited to the requirements of such law.
6. Required by law for certain health oversight activities.
7. Required by a coroner performing duties authorized by law.
8. Required to help avert a serious threat to the health and safety of others.

Marketing Purposes: We will not use or disclose your PHI for marketing purposes.

Sale of PHI: We will not sell your PHI in the regular course of our business.

IV. Certain Uses and Disclosures Do Not Require Your Authorization

Subject to certain limitations in the law, we can use and disclose your child's PHI without authorization for the following reasons:

• When disclosure is required by state or federal law.
• For public health activities, including reporting suspected child abuse or preventing a serious threat to health or safety.
• For health oversight activities, including audits and investigations.
• For judicial and administrative proceedings, including responding to a court or administrative order.
• For law enforcement purposes, including reporting crimes occurring on our premises.
• To coroners or medical examiners performing duties authorized by law.
• For research purposes, including studying outcomes across different forms of care.
• For specialized government functions, including military missions or intelligence operations.
• For workers' compensation purposes, to comply with applicable laws.
• For appointment reminders and information about health related benefits or services we offer.

V. Certain Uses and Disclosures Require Your Opportunity to Object

Disclosures to family, friends, or others: We may provide your child's PHI to a family member, friend, or other person you indicate is involved in your child's care or payment for care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. Your Rights Regarding Your Child's PHI

The Right to Request Limits on Uses and Disclosures. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree, and may say no if we believe it would affect your child's health care.

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

The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way or to send mail to a different address, and we will agree to all reasonable requests.

The Right to See and Get Copies of Your Child's PHI. Other than session notes, you have the right to get an electronic or paper copy of your child's medical record and other information we have about your child. We will provide a copy or summary within 30 days of receiving your written request, and may charge a reasonable, cost-based fee.

The Right to Get a List of Disclosures. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations. We will respond within 60 days. The list will include disclosures made in the last six years. We will provide the list at no charge for the first request each year; additional requests in the same year may incur a reasonable cost-based fee.

The Right to Correct or Update Your Child's PHI. If you believe there is a mistake or missing information in your child's PHI, you have the right to request a correction. We may say no, but will tell you why in writing within 60 days.

The Right to Get a Paper or Electronic Copy of This Notice. You have the right to get a paper copy of this Notice at any time, and to request a copy by email even if you have already agreed to receive it electronically.