ELECTRONIC SHORT-FORM NOTICE OF PRIVACY PRACTICES

SmylUSA is committed to protecting your personal health information. We are required by law to maintain the privacy of health information that could reasonably be used to identify you, known as “protected health information” or “PHI.” We are also required by law to provide a detailed Notice of Privacy Practices (“Notice”) explaining legal duties and privacy practices regarding PHI. THIS IS THE ELECTRONIC SHORT-FORM VERSION. YOU WILL ALSO RECEIVE A LONG-FORM NOTICE OF PRIVACY PRACTICES.

This Notice describes your legal rights, advises of our privacy practices, and informs how SmylUSA is permitted to use and disclose PHI about you, as well as your legal rights.

SmylUSA may use/disclose PHI without your authorization, or without providing you with an opportunity to object, for limited purposes relating to Treatment (communication with medical staff about your condition); Payment (billing); and Healthcare Operations (internal training, audits, and quality assurance).

SmylUSA is also permitted to use or disclose your PHI without your authorization in situations including fraud/abuse detection; communications with family members or other relatives/friends unless you object; public health agencies that manage pandemics, child abuse matters, or domestic violence issues; health oversight audits; law enforcement purposes and/or judicial proceedings; military/national security matters; worker’s compensation-related reasons; medical examiners and funeral homes; and organ donor programs.

Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). Specifically, we must obtain your written authorization before using or disclosing your psychotherapy notes, other than for the purpose of carrying out our own Treatment, Payment or Health Care Operations purposes; marketing when we receive payment to make a marketing communication; or when engaging in a sale of your PHI. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.

As a patient, you have a number of rights with respect to your PHI, including, right to access, copy or inspect your PHI. You also have the right to notice of a breach of unsecured protected health information, as well as the right to request confidential communications.

Legal Rights. You may complain if you believe that your privacy rights have been violated. Should you have any questions, comments or complaints, you may direct all privacy-related inquiries via E-Mail: info@smylusa.com, or call 813-521-7259.