HIPAA

THIS NOTICE DESCRIBES HOW WELLMIND.ONLINE, INC., WELLMIND.ONLINE CA LICENSED CLINICAL SOCIAL WORKER PROF CORP, WELLMIND LICENSED CLINICAL SOCIAL WORKER PC, AND THEIR ASSOCIATED CLINICIANS (“WE”, “US” or “WELLMIND”) MAY USE AND DISCLOSE YOUR HEALTH INFORMATION. THIS NOTICE ALSO DESCRIBES YOUR RIGHTS AND ACCESS TO THE HEALTH INFORMATION WE KEEP ABOUT YOU AND CERTAIN OBLIGATIONS WE HAVE REGARDING ITS USE AND DISCLOSURE. PLEASE REVIEW IT CAREFULLY.

We understand that health information about you and your healthcare is personal and are committed to protecting this information. We create a record of the care and services you receive from Wellmind. We need this record to provide you with quality care and to comply with certain legal requirements.

We are required by law to:

• Maintain the privacy and security of protected health information (“PHI”) that identifies you.
• Let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• Give you this Notice of Wellmind’s legal duties and privacy practices with respect to your PHI.
• Follow the terms of the Notice that is currently in effect.
• Not use or share your PHI other than as described in this Notice unless you tell Wellmind in writing that we can. If you tell Wellmind we can, you can always change your mind at any time by again notifying us in writing.
• Wellmind can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, at our office, and on our website.
• For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

The following categories describe different ways that we use and disclose PHI. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Healthcare Operations: Federal privacy rules (regulations) allow healthcare providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s PHI without the patient’s written authorization to carry out the healthcare provider’s own treatment of the patient/client, to bill and get payment from health plans and other entities for services provided to the patient/client, or the provider’s healthcare operations, including running our practice, improving your care, and contacting you when necessary. We may also disclose your PHI for the treatment activities of any healthcare provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed healthcare provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard because therapists and other healthcare providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of healthcare providers with a third party, consultations between healthcare providers, and referrals of a patient from one healthcare provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose your PHI in response to a court or administrative order. We may also disclose PHI about you or your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

1. Chart Notes. We do keep “psychotherapy notes” as defined in 45 C.F.R. § 164.501, and any use or disclosure of such notes requires your authorization unless the use or disclosure is:
   1. For Wellmind’s use in treating you.
   2. For Wellmind’s use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
   3. For Wellmind’s use in defending itself in legal proceedings brought by you.
   4. For Wellmind's use in defending itself should you dispute a payment made to Wellmind.
   5. For Wellmind to collect a debt.
   6. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
   7. Required by law and the use or disclosure is limited to the requirements of such law.
   8. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
   9. Required by a coroner who is performing duties authorized by law.
   10. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. As licensed providers, we will not use or disclose your PHI for marketing purposes. You may, however, at your own discretion, opt-in to Wellmind’s email list, which may be managed by a third party. If you choose to opt-in to this list, your name and email address may be shared with a third party.
3. Sale of PHI. As licensed providers, we will not sell your PHI in the regular course of Wellmind’s business.
4. 42 CFR Part 2 Records. If PHI is provided to us by a Part 2 Program (a federally assisted program that provides substance use disorder services), we may use that information as permitted by HIPAA. But we will not further use or disclose those Part 2 Program records without your authorization or a valid court order for the purpose of (1) initiating or substantiating criminal charges against you, (2) conducting any criminal investigation against you, or (3) using the records in any civil, criminal, administrative, or legislative proceedings against you.

Subject to certain limitations in the law, we can use and disclose your PHI without your authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health and safety activities, including reporting suspected child, elder, or dependent adult abuse, neglect, or domestic violence; preventing or reducing a serious threat to anyone’s health or safety; reporting adverse reactions to medication; helping with product recalls; or preventing disease.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although Wellmind’s preference is to obtain an authorization from you before doing so.
5. For law enforcement purposes or with a law enforcement official, including reporting crimes occurring on our premises.
6. To coroners, funeral directors, or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although Wellmind’s preference is to obtain an authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
10. Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with Wellmind. We may also use and disclose your PHI to tell you about treatment alternatives, or other healthcare services or benefits that we offer.
11. For organ and tissue donation requests from organ procurement organizations.

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.

1. Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your healthcare, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
2. You have the right and choice to tell us to share your information in a disaster relief situation.

Wellmind must also protect your medical information, including sensitive services information, in compliance with the California Confidentiality of Medical Information Act (“CMIA”), located at Civil Code § 56 et seq. Sensitive services are health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender-affirming care, and intimate partner violence and include minor consent services, as further described in California Civil Code § 56.05(s).

We will not use or share your medical information, including sensitive services information, except as described in this Notice and as permitted by law. If we receive or create information given special protection under the CMIA, we will comply with the limitations imposed on such information.

We will not share your information related to abortion services or gender affirming care in response to requests when those requests are based on a non-California law that would interfere with your rights in California without your authorization. For example, we will not share your information related to gender-affirming care without your authorization if we receive a subpoena from an agency in another state that would punish a person receiving or providing gender affirming care that is legal in California.

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask Wellmind not to use, share, or disclose certain PHI for treatment, payment, or healthcare operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your healthcare.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or healthcare operations purposes if the PHI pertains solely to a healthcare item or a healthcare service that you have paid for out-of-pocket in full. We will say “yes” to such requests unless a law requires us to share that information.
3. The Right to Choose How We Send PHI to You. You have the right to ask Wellmind to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that we have about you. Ask Wellmind how to submit such requests. We will provide you with a copy of your record, or a summary of it if you prefer, within 30 days of receiving your written request, and we will charge $.50 per page fee for doing so. Your provider may charge you $150 hour for office work related to your requests for medical records.
5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or healthcare operations, or for which you provided us with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge $.50 per page fee for the additional requests.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. Ask Wellmind how to submit such requests. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this Notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it. We will provide you with a paper copy promptly.
8. The Right to Choose Someone to Act for You. 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 PHI. We will make sure the person has this authority and can act for you before we take any action.
9. The Right to File a Complaint if You Feel Your Rights Are Violated. You can complain if you feel we have violated your rights by contacting us using the information on page 1 of this Notice. 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 /https://www.hhs.gov/hipaa/filing-a-complaint/index.html . We will not retaliate against you for filing a complaint.

Information disclosed by Wellmind, either authorized by you (or your personal representative) or permitted by applicable privacy laws, may be redisclosed by the person receiving your information if that person is not required by law to protect your information.

If you have any questions regarding this Notice or would like to file a complaint with Wellmind, please contact us at:

Wellmind.Online, Inc.
2100 Geng Rd Ste 210
Palo Alto, California 94303

Email Address:

Telephone number:
(833) 646-3243

EFFECTIVE DATE OF THIS NOTICE
September 09, 2026