Telepsychiatry Provider:

The content provided on wv.psychiatric.com is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

Nothing in this medical disclaimer will limit any of our liabilities in any way that is not permitted under applicable law.

The owner of this site makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site. The owner will not be liable for any errors or omission in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information. These terms and conditions of use are subject to change at any time and without notice.

Privacy Practices Statement for WV Psychiatric Services, LLC

Introduction

At wvpsychiatric.com, we respect your privacy and are committed to protecting it. This Privacy Practices Statement outlines how we handle and safeguard the personal information you provide to us. By using this website, you consent to the data practices described in this statement.

Information We Collect:

Automatically Collected Data: When you visit our website, we may collect certain information automatically, such as your IP address, browser type, and access times.

Provided Data: Information you provide voluntarily, such as your name, email address, and other contact details when registering or filling out a form. This practice collects personally identifiable information and anonymous demographic information, which is not unique to you, such as your ZIP code, age, gender, preferences, interests and favorites.

Use of Your Information

We use the data we collect for purposes such as:

Enhancing your user experience

Responding to inquiries and feedback

Providing personalized content and information

Monitoring and analyzing usage and trends

Sharing of Your Information:

We will not sell or rent your personal information to third parties. We might share your information with trusted partners for operational purposes, always under strict confidentiality terms.

Security

We employ security measures to protect your information from unauthorized access, theft, or loss. However, no online system is entirely secure, and we cannot guarantee absolute security.

Cookies:

Our website may use cookies to enhance your experience. You have the option to decline cookies through your browser settings, though this may affect website functionality.

Links to Other Sites:

Our website may contain links to external sites. We are not responsible for the privacy practices of such sites. We recommend you review their privacy policies.

Changes to This Statement:

We may update this Privacy Practices Statement periodically. Any changes will be posted on this page with an updated revision date.

Contact Us:

For questions regarding this statement or our privacy practices, please contact us at psams@wvpsychiatric.com.

Your Rights

Your Information. Your Rights.

Our Responsibilities.

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.

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

Ask us to correct your medical record

Request confidential communications

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

• We will say “yes” to all reasonable requests.

Notice of Privacy Practices • Page 1

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Your Rights continued Ask us to limit what

we use or share

Get a list of those with whom we’ve shared information

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you feel your rights are violated

• You can ask us not to use or share certain health information for treatment, payment, or our operations.

• We are not required to agree to your request, and we may say “no” if it would affect your care.

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.

• We will say “yes” unless a law requires us to share that information.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a complaint.

Notice of Privacy Practices • Page 2

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

In these cases we never share your information unless you give us written permission:

In the case of fundraising:

• Share information with your family, close friends, or others involved in your care

• Share information in a disaster relief situation • Include your information in a hospital directory • Contact you for fundraising efforts

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

• Marketing purposes

• Sale of your information

• Most sharing of psychotherapy notes instead of actual notes, we may prepare a treatment summary.

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Treat you

Run our organization

Bill for your services

• We can use your health information and share it with other professionals who are treating you.

• We can use and share your health information to run our practice, improve your care,

and contact you when necessary.

• We can use and share your health information to bill and get payment from health plans or other entities.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Example: We use health information about you to manage your treatment and services.

Example: We give information about you to your health insurance plan so it will pay for your services.

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Notice of Privacy Practices • Page 3

How else can we use or share your health information? We are allowed or required to share

your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

Comply with the law

Work with a medical examiner or funeral director

Address workers’ compensation, law enforcement, and other government requests

Respond to lawsuits and legal actions

• We can share health information about you for certain situations such as:

• Preventing disease

• Helping with product recalls

• Reporting adverse reactions to medications

• Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing a serious threat to anyone’s health or safety

• We can use or share your information for health research.

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• We can share health information about you with organ procurement organizations.

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

• We can use or share health information about you:

• For workers’ compensation claims

• For law enforcement purposes or with a law enforcement official

• With health oversight agencies for activities authorized by law

• For special government functions such as military, national security,

and presidential protective services

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Notice of Privacy Practices • Page 4

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of

your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

This Notice of Privacy Practices applies to the following organizations.

Notice of Privacy Practices • Page 5

Spanish:

Sus derechos

Su información. Sus derechos. Nuestras responsabilidades.

Esta notificación describe cómo puede utilizarse y divulgarse su información médica, y cómo puede acceder usted a esta información. Revísela con cuidado.

Cuando se trata de su información médica, usted tiene ciertos derechos. Esta sección explica sus derechos y algunas de nuestras responsabilidades para ayudarlo.

Obtener una copia en formato electrónico o en papel de su historial médico

Solicitarnos que corrijamos su historial médico

Solicitar comunicaciones confidenciales

• Puede solicitar que le muestren o le entreguen una copia en formato electrónico o en papel de su historial médico y otra información médica que tengamos de usted. Pregúntenos cómo hacerlo.

• Le entregaremos una copia o un resumen de su información médica, generalmente dentro de 30 días de su solicitud. Podemos cobrar un cargo razonable en base al costo.

• Puede solicitarnos que corrijamos la información médica sobre usted que piensa que es incorrecta o está incompleta. Pregúntenos cómo hacerlo.

• Podemos decir “no” a su solicitud, pero le daremos una razón por escrito dentro de 60 días.

• Puede solicitarnos que nos comuniquemos con usted de una manera específica (por ejemplo, por teléfono particular o laboral) o que enviemos la correspondencia a una dirección diferente.

• Le diremos “sí” a todas las solicitudes razonables.

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Notificación de Prácticas de Privacidad • Página 1

Sus derechos continuado

Solicitarnos que limitemos lo que utilizamos o compartimos

Recibir una lista de aquellos con quienes hemos compartido información

Obtener una copia de esta notificación de privacidad

Elegir a alguien para que actúe en su nombre

Presentar una queja si considera que se violaron sus derechos

• Puede solicitarnos que no utilicemos ni compartamos determinada información médica para el tratamiento, pago o para nuestras operaciones. No estamos obligados a aceptar su solicitud, y podemos decir “no” si esto afectara su atención.

• Si paga por un servicio o artículo de atención médica por cuenta propia

en su totalidad, puede solicitarnos que no compartamos esa información con el propósito de pago o nuestras operaciones con su aseguradora médica. Diremos “sí” a menos que una ley requiera que compartamos dicha información.

• Puede solicitar una lista (informe) de las veces que hemos compartido su información médica durante los seis años previos a la fecha de su solicitud, con quién la hemos compartido y por qué.

• Incluiremos todas las divulgaciones excepto aquellas sobre el tratamiento, pago y operaciones de atención médica, y otras divulgaciones determinadas (como cualquiera de las que usted nos haya solicitado hacer). Le proporcionaremos un informe gratis por año pero cobraremos un cargo razonable en base al costo si usted solicita otro dentro de los 12 meses.

• Puede solicitar una copia en papel de esta notificación en cualquier momento, incluso si acordó recibir la notificación de forma electrónica. Le proporcionaremos una copia en papel de inmediato.

• Si usted le ha otorgado a alguien la representación médica o si alguien es su tutor legal, aquella persona puede ejercer sus derechos y tomar decisiones sobre su información médica.

• Nos aseguraremos de que la persona tenga esta autoridad y pueda actuar en su nombre antes de tomar cualquier medida.

• Si considera que hemos violado sus derechos, puede presentar una queja comunicándose con nosotros por medio de la información de la página 1.

• Puede presentar una queja en la Oficina de Derechos Civiles del Departamento de Salud y Servicios Humanos enviando una carta a: Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201, llamando al 1-800-368-1019 o visitando www.hhs.gov/ocr/privacy/hipaa/ understanding/consumers/factsheets_spanish.html, los últimos dos disponibles en español.

• No tomaremos represalias en su contra por la presentación de una queja.

Notificación de Prácticas de Privacidad • Página 2

Sus opciones

Para determinada información médica, puede decirnos sus decisiones sobre qué compartimos. Si tiene una preferencia clara de cómo compartimos su información en las situaciones descritas debajo, comuníquese con nosotros. Díganos qué quiere que hagamos, y seguiremos sus instrucciones.

En estos casos, tiene tanto el derecho como la opción de pedirnos que:

En estos casos, nunca compartiremos su in- formación a menos que nos entregue un permiso por escrito:

En el caso de recaudación de fondos:

• Compartamos información con su familia, amigos cercanos u otras personas involucradas en su atención.

• Compartamos información en una situación de alivio en caso de una catástrofe.

• Incluyamos su información en un directorio hospitalario.

Si no puede decirnos su preferencia, por ejemplo, si se encuentra inconsciente, podemos seguir adelante y compartir su información si creemos que es para beneficio propio. También podemos compartir su información cuando sea necesario para reducir una amenaza grave e inminente a la salud o seguridad.

• Propósitos de mercadeo.

• Venta de su información.

• La mayoría de los casos en que se comparten notas de psicoterapia.

• Podemos comunicarnos con usted por temas de recaudación, pero puede pedirnos que no lo volvamos a contactar.

Nuestros usos y divulgaciones

Por lo general, ¿cómo utilizamos o compartimos su información médica? Por lo general, utilizamos o compartimos su información médica de las siguientes maneras.

Tratamiento

Dirigir nuestra organización

Facturar por sus servicios

• Podemos utilizar su información médica y compartirla con otros profesionales que lo estén tratando.

• Podemos utilizar y divulgar su información

para llevar a cabo nuestra práctica, mejorar su atención y comunicarnos con usted cuando sea necesario.

• Podemos utilizar y compartir su información para facturar y obtener el pago de los planes de salud y otras entidades.

Ejemplo: Un médico que lo está tratando por una lesión le consulta a otro doctor sobre su estado de salud general.

Ejemplo: Utilizamos información médica sobre usted para administrar su tratamiento y servicios.

Ejemplo: Entregamos información acerca de usted a su plan de seguro médico para que éste pague por sus servicios.

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Notificación de Prácticas de Privacidad • Página 3

¿De qué otra manera podemos utilizar o compartir su información médica? Se nos permite o exige compartir su información de otras maneras (por lo general, de maneras que contribuyan al bien público, como la salud pública e investigaciones médicas). Tenemos que reunir muchas condiciones legales antes de poder compartir su información con dichos propósitos. Para más información, visite: www.hhs.gov/ocr/privacy/ hipaa/understanding/consumers/factsheets_spanish.html, disponible en español.

Ayudar con asuntos de salud pública y seguridad

Realizar investigaciones médicas

Cumplir con la ley

Responder a las solicitudes de donación de órganos y tejidos

Trabajar con un médico forense o director funerario

Tratar la compensación de trabajadores, el cumplimiento de la

ley y otras solicitudes gubernamentales

Responder a demandas y acciones legales

• Podemos compartir su información médica en determinadas situaciones, como:

• Prevención de enfermedades.

• Ayuda con el retiro de productos del mercado.

• Informe de reacciones adversas a los medicamentos.

• Informe de sospecha de abuso, negligencia o violencia doméstica.

• Prevención o reducción de amenaza grave hacia la salud o seguridad

de alguien.

• Podemos utilizar o compartir su información para investigación de salud.

• Podemos compartir su información si las leyes federales o estatales lo requieren, incluyendo compartir la información con el Departamento de Salud y Servicios Humanos si éste quiere comprobar que cumplimos con la Ley de Privacidad Federal.

• Podemos compartir su información médica con las organizaciones de procuración de órganos.

• Podemos compartir información médica con un oficial de investigación forense, médico forense o director funerario cuando un individuo fallece.

• Podemos utilizar o compartir su información médica:

• En reclamos de compensación de trabajadores.

• A los fines de cumplir con la ley o con un personal de las fuerzas de seguridad. • Con agencias de supervisión sanitaria para las actividades autorizadas por ley. • En el caso de funciones gubernamentales especiales, como los servicios de

protección presidencial, seguridad nacional y servicios militares

• Podemos compartir su información médica en respuesta a una orden administrativa o de un tribunal o en respuesta a una citación.

Notificación de Prácticas de Privacidad • Página 4

Nuestras responsabilidades

• Estamos obligados por ley a mantener la privacidad y seguridad de su información médica protegida.

• Le haremos saber de inmediato si ocurre un incumplimiento que pueda haber comprometido la privacidad o

seguridad de su información.

• Debemos seguir los deberes y prácticas de privacidad descritas en esta notificación y entregarle una copia de la misma.

• No utilizaremos ni compartiremos su información de otra manera distinta a la aquí descrita, a menos que usted nos diga por escrito que podemos hacerlo. Si nos dice que podemos, puede cambiar de parecer en cualquier momento. Háganos saber por escrito si usted cambia de parecer.

Para mayor información, visite: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/ factsheets_spanish.html, disponible en español.

Cambios a los términos de esta notificación

Podemos modificar los términos de esta notificación, y los cambios se aplicarán a toda la información que tenemos sobre usted. La nueva notificación estará disponible según se solicite, en nuestra oficina, y en nuestro sitio web.

Esta Notificación de Prácticas de Privacidad se aplica a las siguientes organizaciones.

Notificación de Prácticas de Privacidad • Página 5

PURPOSE: To establish and publish the official policy of WV Psychiatric Services, LLC regarding the organization’s corporate compliance program.

POLICY: WV Psychiatric Services, LLC is dedicated to the delivery of behavioral healthcare in an environment characterized by strict conformance with the highest standards for accountability for administration, clinical, business, marketing and financial management. Leadership is fully committed to the need to prevent and detect fraud, fiscal mismanagement and misappropriation of funds and therefore, to the development of a formal corporate compliance program to ensure ongoing monitoring and conformance with all legal and regulatory requirements. Further, the organization is committed to the establishment, implementation and maintenance of a corporate compliance program that emphasizes (1) prevention of wrongdoing – whether intention or unintentional, (2) immediate reporting and investigation of questionable activities and practices without consequences to the reporting party, and (3) timely correction of any situation which puts the organization, its leadership or staff, funding sources or consumers at risk.

PROCEDURE/PLAN:

1. By formal resolution, the WV Psychiatric Services, LLS has delegated overall responsibility for the Corporate Compliance Program to the Owner. The Owner will be formally designated as the Corporate Compliance Officer, monitor the organization’s corporate compliance program and provide periodic and regular reports when indicated (if a violation occurs) to the appropriate legal bodies.

2. The Corporate Compliance Officer (CCO) shall serve as the organization’s primary point of contact for all corporate compliance issues, including scheduling interventions, policy changes, develop, implement and monitor – on a regular and consistent basis – the organization’s corporate compliance plan, including all internal and external monitoring, auditing, investigative and reporting processes, procedures and systems.

3. The CCO shall submit an annual report to the agency records. Annual reports will include, at a minimum: (1) a summary of allegations, investigations, and/or complaints processed in the preceding 12 months in conjunction with the corporate compliance program; (2) a complete description of all corrective action(s) taken; and (3) any recommendations for changes to the organization’s policies and/or procedures.

4. In the performance of his/her duties, the CCO shall have direct and unimpeded access to all relevant information including third party contracts.

5. As part of corporate compliance plan development, the CCO shall schedule, coordinate and monitor regular and periodic reviews of risk areas by competent persons external to the organization. Such reviews will be conducted as a way to ensure ongoing conformance with billing, accounting and collection regulations imposed by the federal government. More critically, these reviews will augment the organization’s annual audit of its accounting system and provide an additional, internal measure to ensure conformance with billing and coding policies and practice that will withstand the scrutiny of any regulatory audit or examination.

6. As a part of corporate compliance, WV Psychiatric Services, LLC, will not bill or cause a bill to be submitted to any Federally Funded Health Care Programs; including Medicaid, Medicare, or TriCare.

7. Call 1-800-HHS-TIPS to report suspect practice behaviors.