NOTICE OF PRIVACY PRACTICES

The Aviation Therapist & Coach | Dr. Abigail Powell, PhD, LP theaviationtherapist.com | Virtual Across Texas

YOUR HEALTH INFORMATION RIGHTS

This notice is required by law. As our client, you have rights regarding your health information, and we have obligations to protect it. This Notice of Privacy Practices describes how The Aviation Therapist & Coach ("the Practice") — operated by Dr. Abigail Powell, PhD, LP — may use and disclose your protected health information (PHI) to carry out treatment, payment, and health care operations, and for other purposes permitted or required by law. It also describes your rights to access and control your health information.

"Health information," as used in this notice, includes any information that identifies you and relates to your physical or mental health condition, the provision of health care to you, or payment for that care.

HOW WE MAY USE AND SHARE YOUR HEALTH INFORMATION

We may use or share your health information in the following ways:

Treatment (Necessary for your care) We may use your health information to provide, coordinate, or manage your mental health treatment and related services. For example, we may share information with other treating clinicians (such as your primary care physician or psychiatrist) when coordinating care, or with your Aviation Medical Examiner (AME) only with your explicit written authorization. We may also consult with other licensed professionals as clinically appropriate.

Payment (To obtain payment for services rendered) We may use and disclose your health information to obtain payment for the services we provide. For example, if you use a Health Savings Account (HSA) or Flexible Spending Account (FSA), we may share information as needed to process reimbursement. As a private-pay, out-of-network practice, we do not bill insurance companies directly; however, we may provide superbills upon request, which you may submit to your insurer.

Health Care Operations (To run our practice efficiently) We may use and disclose your health information for practice operations.

This includes:

Quality assessment and improvement activities

Training, supervision, and professional development

Conducting compliance reviews and legal services

Business planning and management

Securing business associates under confidentiality agreements

We will not use or share your information for any purpose other than those described above without your written permission.

We will never sell your health information. We will never share your information with your employer, airline, or the FAA without your explicit written authorization.

OTHER WAYS WE MAY USE OR SHARE YOUR HEALTH INFORMATION

We are permitted or required to share your health information in the following situations, even without your permission:

Circumstance-Description

When required by law We may disclose your health information when required to do so by federal, state, or local law.

To report suspected child abuse or neglect We may disclose your health information to appropriate authorities if we believe a child is being abused or neglected.

To address serious threats to health or safety We may disclose your health information if we believe it is necessary to prevent or lessen a serious and imminent threat to your health or safety, or the health or safety of the public or another person.

For public health activities We may disclose your health information to public health authorities for activities such as preventing or controlling disease or injury, as authorized by law.

For health oversight activities We may disclose your health information to a government agency for oversight activities, such as audits or investigations related to the health care system or government benefit programs.

Judicial and administrative proceedings We may disclose your health information in response to a court or administrative order. We may also disclose information in response to a subpoena, discovery request, or other lawful process with appropriate assurances.

For law enforcement purposes We may disclose your health information to law enforcement officials under limited circumstances required by law.

For research We may use or disclose your health information for research purposes when a proper research review process has been completed and safeguards are in place.

Coroners and medical examiners We may disclose your health information to a coroner or medical examiner as authorized by law.

To the U.S. Secretary of Health and Human Services We must disclose your health information to the Secretary of the U.S. Department of Health and Human Services (HHS) when required to investigate or determine compliance with HIPAA privacy rules.

Health Information Exchanges ("HIE")If applicable, we may share your health information through a Health Information Exchange. You may opt out of this sharing in writing.

SPECIAL PROTECTIONS FOR MENTAL HEALTH RECORDS

Mental health records, including psychotherapy notes, receive heightened protection under federal and state law. The Aviation Therapist & Coach will not disclose your psychotherapy notes without your specific written authorization, except as required by law (e.g., to avert a serious threat to your safety or the safety of another, or as required in mandatory reporting).

SPECIAL PROTECTIONS FOR AVIATION PROFESSIONALS

We understand the unique and sensitive nature of your career. Our practice is built on the principle of confidentiality and discretion. As a private-pay, out-of-network provider:

No diagnosis is required to receive care, and no diagnosis will be assigned unless clinically warranted.

Your records are held strictly between you and your provider.

We do not report to the FAA, your airline, your employer, or any aviation authority without your explicit, voluntary, written authorization — except as strictly required by law.

We will work with you and, when appropriate, your AME, only as you direct and authorize.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights with respect to your health information:

Right to Inspect and Copy You have the right to inspect and obtain a copy of your health information, including your medical record and billing records. To do so, submit a written request to Dr. Abigail Powell. We may charge a reasonable fee for copies. We may deny your request in limited circumstances; if denied, you may request a review.

Right to Request Amendments You have the right to request that we amend your health information if you believe it is incorrect or incomplete. Your request must be in writing and include a reason supporting the amendment. We may deny your request if the information was not created by us, is not part of our records, or is accurate and complete.

Right to an Accounting of Disclosures You have the right to request a list of certain disclosures we have made of your health information within the past six years. This list will not include disclosures made for treatment, payment, or health care operations, or disclosures you authorized.

Right to Request Restrictions You have the right to request restrictions on certain uses and disclosures of your health information. While we are not always required to agree to your request, we will comply when feasible and when the restriction is in your interest.

Right to Request Confidential Communications You have the right to request that we communicate with you about health matters in a certain way or at a certain location. We will accommodate reasonable requests. For example, you may request that we contact you only via a specific phone number or email address.

Right to Receive a Paper Copy of This Notice You have the right to receive a paper copy of this Notice upon request, even if you received it electronically. Contact us at the information below to request one.

Right to Notification of a Breach You have the right to be notified if there is a breach of your unsecured health information, as required by law.

OUR RESPONSIBILITIES

The Aviation Therapist & Coach is required by law to:

Maintain the privacy and security of your health information

Provide you with this notice of our legal duties and privacy practices

Abide by the terms of the notice currently in effect

Notify you if we are unable to agree to a requested restriction

Notify you if a breach of your health information occurs

We reserve the right to change our privacy practices and the terms of this notice at any time. Changes will apply to health information we already hold about you, as well as new information. We will post the revised notice on our website at theaviationtherapist.com and make it available upon request.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

The Aviation Therapist & Coach Dr. Abigail Powell, PhD, LP theaviationtherapist.com

U.S. Department of Health & Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 1-877-696-6775 | www.hhs.gov/ocr/privacy

You will not be retaliated against for filing a complaint.

CONTACT INFORMATION

For questions about this notice or to exercise any of your rights, please contact:

Dr. Abigail Powell, PhD, LP The Aviation Therapist & Coach Website: theaviationtherapist.com Serving clients virtually across Texas; coaching available nationwide.

Effective Date: [Insert Date] Last Reviewed: [Insert Date]