EAST BEACH PSYCHOLOGICAL SERVICES, P.C.

4490 Pleasant Ave., Unit B

Norfolk, VA 23518

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on September 15, 2025.

NOTICE OF PRIVACY PRACTICES

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

I. EAST BEACH PSYCHOLOGICAL SERVICES, P.C. AND ITS CLINICIANS (“Practice”) PLEDGE REGARDING HEALTH INFORMATION: Practice understands that health information about you and your health care is personal. The Practice is committed to protecting health information about you. The Practice creates a record of the care and services you receive from me. The Practice needs this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this practice. This notice will tell you about the ways in which the Practice may use and disclose health information about you. The practice also describes your rights to the health information the Practice keeps about you, and describes certain obligations the Practice has regarding the use and disclosure of your health information. The Practice and its clinicians are required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of the Practice’s legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• The Practice can change the terms of this Notice, and such changes will apply to all information the Practice has about you. The new Notice will be available upon request, in the Practice office, and on the Practice website.

II. HOW THE PRACTICE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that the Practice uses and discloses health information. For each category of uses or disclosures the Practice will explain what the Practice means and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways the Practice is permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. The Practice may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, 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 health care 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 health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, the Practice or clinicians may disclose health information in response to a court or administrative order. The Practice or its clinicians may also disclose health information 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.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. The Practice keeps “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For the Practice’s use in treating you. b. For the Practice’s use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling, assessment, or therapy. c. For the Practice’s use in defending itself in legal proceedings instituted by you or others. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes or by the State Board of Psychology. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of you or others pursuant to the Practice’s Emergency Management Policy.

2. Marketing Purposes. The Practice will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. The Practice not sell your PHI in the regular course of business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, the Practice can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, judicial or Administrative hearing, and the use or disclosure complies with and is limited to the relevant requirements of such law or regulation.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety, as well as circumstances covered under the Practice’s Emergency Management Policy.

3. For health oversight activities, including audits and investigations, including but not limited to by the State Board of Psychology or other associated Governance bodies.

4. For judicial and administrative proceedings, including responding to a court or administrative order.

5. For law enforcement purposes, including reporting crimes occurring on the Practice premises, including those that may be provisioned over a Telehealth platform.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, where PHI is de-identified in the course of the research project.

8. For workers’ compensation purposes. The Practice may provide your PHI in order to comply with workers’ compensation laws.

9. Appointment reminders and health related benefits or services. The Practice may use and disclose your PHI to contact you to remind you that you have an appointment with the Practice. The Practice may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that the Practice offers.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. Disclosures to family, friends, or others. The Practice 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 health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations pursuant to the Emergency Management Policy.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask the Practice not to use or disclose certain PHI for treatment, payment, or health care operations purposes. The Practice is not required to agree to your request, and the Practice may say “no” if the Practice believes it would affect your health care.

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 health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. The Practice is not required to agree to your request, and the Practice may say “no” at the Practice’s sole discretion.

3. The Right to Choose How The Practice Sends PHI to You. You have the right to ask the Practice to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and the Practice will agree to all reasonable requests but is not liable in the event of mistaken contact.

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 the Practice has about you. The Practice will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and the Practice may charge a reasonable, cost based fee for doing so.

5. The Right to Get a List of the Disclosures The Practice Has Made. You have the right to request a list of instances in which the Practice has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. The Practice will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list the Practice will give you will include disclosures up to the past six years. The Practice may charge you a reasonable cost based fee for each request at the Practice’s sole discretion.

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 the Practice correct the existing information or add the missing information. The Practice may say “no” to your request, but the Practice 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.

Acknowledgement of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. In your care, you will receive a copy of HIPAA Notice of Privacy Practices.