HIPAA Notice of Privacy Practices

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Effective Date: January 2025

This Notice of Privacy Practices ("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.

Safe Haven Psychiatry, PLLC ("we," "our," or "us") is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this Notice.

We are required by law to:

• Maintain the privacy and security of your PHI
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of this Notice currently in effect
• Notify you following a breach of unsecured PHI

This Notice applies to all records generated or maintained by Safe Haven Psychiatry, PLLC.

The following categories describe different ways we may use and disclose your PHI without your written authorization, as permitted by HIPAA and Arkansas law.

We may use and share your PHI to provide, coordinate, or manage your mental health care. This may include sharing information with psychiatrists, therapists, primary care providers, pharmacies, laboratories, or other healthcare professionals involved in your treatment.

We may use and disclose your PHI to bill and collect payment from health plans, Medicaid, Medicare, or other third-party payers for services provided to you.

We may use and disclose your PHI for practice operations, including quality assessment, staff training, accreditation, licensing, and administrative activities.

We may also use or disclose your PHI in the following situations:

• To comply with federal or Arkansas state laws
• For public health and safety activities
• To report suspected abuse, neglect, or domestic violence as required by Arkansas law
• For health oversight activities (e.g., audits, investigations)
• For judicial or administrative proceedings when legally required
• To prevent or lessen a serious and imminent threat to health or safety
• For workers’ compensation or similar programs
• For law enforcement purposes as permitted by law

We will obtain your written authorization before using or disclosing your PHI for:

• Marketing purposes
• Sale of PHI
• Most uses and disclosures of psychotherapy notes

You may revoke your authorization in writing at any time, except to the extent that action has already been taken.

Arkansas law provides additional confidentiality protections for mental health records. In certain situations, access to mental health information—including parental access to a minor’s records—may be restricted when disclosure is determined to be clinically inappropriate or harmful, as permitted by law.

You have the right to:

• Get a copy of your medical and billing records
• Request corrections to your records
• Request confidential communications (e.g., alternative address or phone number)
• Ask us to limit what we use or share (we are not required to agree in all cases)
• Receive a list of certain disclosures of your PHI
• Get a paper or electronic copy of this Notice at any time

You have the right to be notified if a breach occurs that may compromise the privacy or security of your PHI.

We reserve the right to change this Notice and make the new Notice apply to PHI we already have as well as any information received in the future. The updated Notice will be available upon request and posted on our website.

If you believe your privacy rights have been violated, you may file a complaint with:

Safe Haven Psychiatry, PLLC
Hot Springs, Arkansas
Phone: 501-701-3076

You may also file a complaint with:

• Arkansas Department of Health
• U.S. Department of Health and Human Services, Office for Civil Rights

You will not be penalized or retaliated against for filing a complaint.

If you have questions about this Notice or your privacy rights, please contact:

Privacy Officer
Safe Haven Psychiatry, PLLC
Hot Springs, Arkansas
Phone: 501-701-3076
Website: https://www.safehavenar.org

This Notice of Privacy Practices is provided in compliance with HIPAA and applicable Arkansas law.