NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Alexis Herman, PsyD L.L.C.

1600 Wilson Blvd, Suite 702

Arlington, VA 22209

Phone: 202-656-1008

Email: Alexis@alexishermanpsyd.com

Effective Date 2.17.26

I. MY DUTIES REGARDING YOUR HEALTH INFORMATION

I am required by law to maintain the privacy of your protected health information (“PHI”) and to provide you with notice of my legal duties and privacy practices. This notice applies to all PHI about you that I create or maintain.

I am required to:

Keep your PHI private
Provide you with this notice of my legal duties and privacy practices
Follow the terms of the notice currently in effect

I reserve the right to change the terms of this Notice. Any changes will apply to all PHI I maintain about you. A revised notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE YOUR PHI

For Treatment

I may use and disclose your PHI to provide, coordinate, or manage your mental health care. This may include consultations with other licensed health care providers involved in your care.

For Payment

I may use and disclose your PHI to obtain payment for services provided to you. This may include disclosures to your health insurance plan (including United Healthcare Student Resources, when applicable) or to billing services.

For Health Care Operations

I may use and disclose your PHI for practice operations, such as quality assessment, training, licensing, supervision, and compliance activities.

Except for disclosures for treatment, I will make reasonable efforts to limit PHI to the minimum necessary to accomplish the intended purpose.

Substance Use Disorder (SUD) Treatment Information

Federal law provides additional protections for records related to Substance Use Disorder (SUD) treatment under 42 C.F.R. Part 2. If I create or maintain records relating to the diagnosis, treatment, or referral for treatment of a substance use disorder, those records are protected by federal law.

In accordance with current federal regulations, SUD treatment records may be used or disclosed for treatment, payment, and health care operations as permitted by HIPAA, once appropriate consent has been obtained when required.

Once disclosed to a HIPAA-covered entity or business associate in accordance with applicable law, SUD treatment information may be redisclosed in accordance with HIPAA and other applicable laws. However, recipients may not use or disclose the information in any manner inconsistent with federal law.

Certain uses and disclosures may still require your written authorization or consent, consistent with 42 C.F.R. Part 2 and HIPAA.

III. USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

Psychotherapy Notes

I maintain psychotherapy notes as defined by federal law. Psychotherapy notes are kept separate from your medical record. I will not use or disclose psychotherapy notes without your written authorization, except:

For my use in treating you
For training or supervising mental health practitioners
To defend myself in a legal action brought by you
For health oversight activities required by law
When required by law
To avert a serious threat to health or safety
To the Secretary of Health and Human Services for HIPAA compliance investigations

You may revoke an authorization for psychotherapy notes at any time in writing, except to the extent action has already been taken.

Marketing and Sale of PHI

I do not use or disclose your PHI for marketing purposes, and I do not sell your PHI.

Fundraising

I do not engage in fundraising activities. If I were to engage in fundraising in the future, you would have the right to opt out of receiving fundraising communications.

IV. USES AND DISCLOSURES THAT DO NOT REQUIRE AUTHORIZATION

Subject to applicable law, I may use or disclose your PHI without authorization:

When required by federal or state law
For public health and safety activities, including reporting abuse or neglect
For health oversight activities such as audits or investigations
For judicial or administrative proceedings pursuant to lawful process
For law enforcement purposes
To coroners or medical examiners
For approved research purposes
To avert a serious and imminent threat to health or safety
For workers’ compensation purposes
To business associates who perform services for me and are required to safeguard your PHI
For appointment reminders and to inform you of treatment alternatives or health-related services

Redisclosure of Information

Once your protected health information is disclosed to another person or organization, it may no longer be protected by HIPAA if the recipient is not subject to HIPAA. For example, information disclosed to a family member or other individual not covered by HIPAA may no longer be protected under federal privacy law.

Substance Use Disorder treatment records disclosed with appropriate consent may be redisclosed in accordance with HIPAA and applicable federal law.

V. DISCLOSURES TO FAMILY AND OTHERS

I may disclose PHI to a family member, friend, or other person involved in your care or payment for your care if you do not object. If you are not present or are unable to agree or object, I may use professional judgment to determine whether disclosure is in your best interest.

VI. YOUR RIGHTS REGARDING YOUR PHI

You have the right to:

Request restrictions on uses and disclosures of your PHI (I am not required to agree, except as noted below)
Request restrictions on disclosures to health plans if you pay for services out-of-pocket in full
Request confidential communications (e.g., alternate address or phone)
Inspect and receive a copy of your medical record (excluding psychotherapy notes) within 30 days
Request an amendment to your PHI
Receive an accounting of disclosures made in the past six years
Receive notice of a breach of unsecured PHI
Obtain a paper or electronic copy of this Notice
File a complaint if you believe your privacy rights have been violated

You may file a complaint with me or with the U.S. Department of Health and Human Services Office for Civil Rights. I will not retaliate against you for filing a complaint.

U.S. Department of Health and Human Services

Office for Civil Rights

www.hhs.gov/ocr/privacy/hipaa/complaints/

1-877-696-6775

VII. APPLICABLE LAW

This Notice complies with federal HIPAA regulations and applicable state laws governing confidentiality of mental health records. Where state law provides greater privacy protection, I will follow state law.