Notice of Privacy Practices

This Notice applies to Axon Psychiatry Group and Dr. Senay Tedla, DNP, PMHNP, APRN, and describes how we may use and disclose your protected health information (PHI) and your rights regarding that information.

Treatment: We may use and disclose your PHI to provide, coordinate, or manage your psychiatric care and related services. For example, we may share information with other healthcare providers involved in your care.

Payment: We may use and disclose your PHI to obtain payment for services provided to you, including submitting claims to your insurance company.

Healthcare Operations: We may use and disclose your PHI for our healthcare operations, including quality assessment, training, and administrative functions necessary to operate our practice.

As Required by Law: We may disclose your PHI when required to do so by federal, state, or local law.

Public Health Activities: We may disclose your PHI for public health activities as permitted or required by law.

Serious Threats to Health or Safety: We may use or disclose your PHI when necessary to prevent a serious and imminent threat to your health or safety or the health or safety of others.

Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization, including:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures of PHI for marketing purposes
• Sale of PHI
• Other uses and disclosures not permitted or required by law

You may revoke an authorization at any time in writing, except to the extent that we have already taken action in reliance on the authorization.

You have the following rights regarding your PHI:

• Right to Access: You have the right to inspect and obtain a copy of your PHI that we maintain in a designated record set, subject to certain exceptions.
• Right to Request Amendment: You have the right to request that we amend your PHI if you believe it is incorrect or incomplete.
• Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your PHI made by us.
• Right to Request Restrictions: You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations.
• Right to Request Confidential Communications: You have the right to request that we communicate with you about your PHI in a certain way or at a certain location.
• Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice upon request.
• Right to Notification of Breach: You have the right to be notified in the event of a breach of your unsecured PHI.

We are required by law to:

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

We reserve the right to change our privacy practices and the terms of this Notice. Changes will apply to PHI we already hold as well as PHI we receive in the future. We will post the revised Notice on our website and make it available in our office.

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

To file a complaint with HHS: www.hhs.gov/ocr/privacy/hipaa/complaints

For questions about this Notice or to exercise your rights, please contact our office through the information provided on our Contact page.

Axon Psychiatry Group — Dr. Senay Tedla, DNP, PMHNP, APRN — Maryland & Washington, DC — axonpsychiatrygroup.com