HIPAA Notice of Privacy Practices

About Bloom Psych

Bloom Psych, LLC (“Bloom Psych,” “we,” “us,” or “our”) is a HIPAA-covered entity providing outpatient psychiatric and mental health services in New Jersey. This Notice of Privacy Practices describes our legal obligations and your privacy rights with respect to protected health information (PHI).

We are required by law to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices, and to abide by the terms of the Notice currently in effect.

What Is Protected Health Information?

Protected Health Information (PHI) is individually identifiable information — including demographic data — that relates to your past, present, or future physical or mental health or condition; the provision of health care to you; or the past, present, or future payment for your health care. PHI includes information in any form: oral, written, or electronic.

Examples of PHI we may hold include:

• Your name, address, date of birth, Social Security number, and insurance ID
• Psychiatric diagnoses, treatment plans, and progress notes
• Prescription records and medication history
• Billing records, claims submissions, and payment information
• Records of appointments, referrals, and prior authorizations
• Communications between you and our clinical or administrative staff

How We May Use & Disclose Your Information

HIPAA permits us to use and disclose your PHI without your written authorization for the following purposes:

Treatment — We may use your PHI to provide, coordinate, or manage your psychiatric care and related services. For example, we may share information with a referring physician, a pharmacy, or a specialist involved in your care.

Payment — We may use or disclose your PHI to obtain payment for services rendered, including submitting claims to your health insurance plan, verifying coverage, and processing billing.

Healthcare Operations — We may use or disclose your PHI for internal operations such as quality assessment, staff training, scheduling, audits, legal compliance, and business planning activities necessary to run our practice.

Other Permitted Disclosures:

• As Required by Law: We will disclose PHI when required to do so by federal, state, or local law, including in response to a valid court order or subpoena
• Public Health Activities: To authorized public health authorities for disease reporting, product recalls, or other public health purposes permitted by law
• Abuse or Neglect: To government authorities authorized to receive reports of abuse, neglect, or domestic violence, consistent with applicable state law
• Health Oversight Activities: To health oversight agencies such as licensing boards and government auditors for activities authorized by law
• Law Enforcement: In limited circumstances required or permitted by law to law enforcement officials
• Serious Threats to Health or Safety: To prevent or lessen a serious and imminent threat to the health or safety of a person or the public, consistent with applicable law and ethical standards
• Workers’ Compensation: As necessary to comply with workers’ compensation and similar programs established by law
• Decedents: To a medical examiner, coroner, or funeral director as necessary to carry out their duties
• Research: Under limited circumstances, with a waiver from an institutional review board or when the research involves only de-identified information
• Business Associates: To contractors and vendors who perform functions on our behalf — such as our EHR vendor and billing service — under written Business Associate Agreements requiring equivalent protections

When We Need Your Written Authorization

For all uses and disclosures not described above, we are required to obtain your signed written authorization before using or disclosing your PHI. This includes, but is not limited to:

• Most uses and disclosures of psychotherapy notes
• Uses of PHI for marketing purposes
• Sales of PHI for any purpose
• Disclosures to employers, schools, or other third parties not involved in your care
• Disclosures to family members, friends, or personal representatives beyond what is necessary for your treatment

Your Privacy Rights

As our patient, you have the following rights with respect to your PHI. To exercise any of these rights, please submit a written request to our Privacy Officer at the contact information below.

• Right to Access Your PHI: You have the right to inspect and obtain a copy of PHI we maintain in a designated record set, which includes your medical and billing records. We may charge a reasonable, cost-based fee for copies. We will respond within 30 days.
• Right to Request Amendment: If you believe PHI we hold is inaccurate or incomplete, you may request that we amend it. If we deny your request, you have the right to submit a statement of disagreement.
• Right to an Accounting of Disclosures: You have the right to receive a list of certain disclosures we have made of your PHI during the six years prior to your request, with limited exceptions. We will provide the first accounting each year at no charge.
• Right to Request Restrictions: You may request that we restrict certain uses or disclosures of your PHI. You have the absolute right to restrict disclosure to a health plan for a service you paid for out-of-pocket in full.
• Right to Request Confidential Communications: You may request that we communicate with you through alternative means or at alternative locations — for example, by calling only a mobile number or sending mail to a P.O. box. We will accommodate reasonable requests.
• Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice at any time, even if you previously agreed to receive it electronically. Contact our office to request one.
• Right to Be Notified of a Breach: You have the right to receive timely notification if your unsecured PHI is involved in a breach, in accordance with HIPAA’s Breach Notification Rule.

Our Legal Obligations

Bloom Psych is required by law to:

• Maintain the privacy and security of your protected health information
• Follow the duties and privacy practices described in this Notice
• Provide you with notice of our legal duties and privacy practices
• Notify you promptly in the event of a breach of your unsecured PHI
• Not use or disclose your PHI other than as described in this Notice or as otherwise authorized by you in writing
• Train all workforce members with access to PHI on our privacy and security policies
• Enter into Business Associate Agreements with any vendor or contractor who handles PHI on our behalf

How to File a Privacy Complaint

If you believe your privacy rights have been violated, or if you are concerned about our privacy practices, you have the right to file a complaint. We take all privacy concerns seriously and will not retaliate against you for filing a complaint.

With Bloom Psych: Submit your complaint in writing to our Privacy Officer at privacy@bloompsych.com or by mail to the address below. We will acknowledge your complaint within 5 business days and respond fully within 30 days.

With the U.S. Department of Health & Human Services: You may file a complaint directly with the HHS Office for Civil Rights (OCR):

• Online: hhs.gov/ocr/complaints
• Phone: 1-800-368-1019 (TDD: 1-800-537-7697)
• Mail: U.S. Department of Health & Human Services, 200 Independence Avenue SW, Washington, DC 20201

Changes to This Notice

We reserve the right to change this Notice at any time and to make the revised Notice effective for PHI we already have about you as well as any PHI we receive in the future. The effective date of any revision will appear at the top of the revised Notice.

We will post the current version of this Notice prominently in our office and on our website at bloompsych.com/hipaa-notice. You may request a paper copy at any time by contacting our office or Privacy Officer.

Contact Us

For questions, requests, or concerns related to this HIPAA Notice or the privacy of your health information, please contact our Privacy Officer through any of the following channels: