NOTICE OF PRIVACY PRACTICES
Effective Date: June 28, 2025

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

Leaf Psychiatry is committed to protecting your privacy. The Practice is required by federal and applicable state laws to maintain the privacy and security of your Protected Health Information (“PHI”), which is information that identifies you or could be used to identify you. This Notice of Privacy Practices (the “Notice”) describes our legal duties, privacy practices, and your rights regarding the PHI we collect and maintain.

YOUR RIGHTS

You have the following rights regarding your PHI. To exercise any of these rights, please submit a written request to the Practice at the contact information below.

Inspect and Copy PHI

· You may request an electronic or paper copy of your PHI. Reasonable fees may apply, but we will comply with state and federal fee limits.

· Your request may be denied if access is reasonably likely to endanger the life or physical safety of you or another person. In most cases, you may request a review of that denial.

· For Michigan Patients: Under Michigan law (MCL 333.20175), we must respond to your records request within 30 days. If we need more time, we will notify you in writing.

Amend PHI

· You may request correction of PHI you believe is incorrect or incomplete. We may require your request in writing and an explanation.

· If we deny your request, we will provide a written explanation and permit you to submit a written statement of disagreement.

Request Confidential Communications

· You may request that we contact you in a specific way (e.g., home phone, office phone, alternate address), and we will accommodate reasonable requests.

Request Restrictions

· You may request restrictions on how we use or share your PHI for treatment, payment, or operations. While we are not required to agree, we will honor reasonable requests whenever possible.

· If you pay for a service or healthcare item out-of-pocket in full, you may request that PHI about that item not be shared with your health plan, and we must honor this request.

· You may request limits on disclosures to family or friends involved in your care.

Get a List of Disclosures

· You may request an “accounting of disclosures” – a list of certain disclosures we’ve made of your PHI over the past 6 years. One copy is free per 12-month period; additional requests may result in a reasonable fee.

Receive a Copy of This Notice

· You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

Choose Someone to Act for You

· If you have given someone medical power of attorney or have a legal guardian, that person may exercise your rights on your behalf.

Mental Health Records - Special Michigan Protections

Special protections for mental health records under Michigan law (mcl 330.1748), mental health records receive additional protections beyond HIPAA. We must obtain your specific written authorization before releasing mental health records unless:

· required for emergency treatment

· necessary for coordination of care between treating providers

· required by court order or subpoena

· needed to prevent serious harm to you or others

· otherwise permitted by law

Psychotherapy Notes

Psychotherapy notes (the provider's personal notes kept separate from your medical record) have the highest protection and will not be released without your specific authorization except for limited circumstances under federal law.

File a Complaint

· If you believe your rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services (HHS):

Leaf Psychiatry
450 S. Maple Rd

STE 866
Ann Arbor, MI 48103
Privacy Officer: Carter Doyle
Email: records@leafpsychiatry.com

Or with HHS at:
www.hhs.gov/ocr/privacy/hipaa/complaints
Phone: 1-877-696-6775

· We will not retaliate against you for filing a complaint.

OUR USES AND DISCLOSURES

We typically use or share your PHI in the following ways:

For Treatment

· We can use and share your PHI with other professionals involved in your care.

o Example: Your primary care doctor contacts us to coordinate your treatment.

For Health Care Operations

· We may use your PHI to manage our practice and improve your care.

o Example: We use PHI to send appointment reminders or improve quality of care.

For Payment

· We may use and share your PHI to bill and obtain payment from health plans or other payers.

o Example: We send information to your health insurer to receive payment for services provided.

We make every effort to limit the use or disclosure of your PHI to the minimum necessary required to accomplish the intended purpose.

OTHER USES AND DISCLOSURES THAT MAY OCCUR WITHOUT YOUR AUTHORIZATION

We may use or disclose your PHI without your written authorization in the following circumstances:

For Public Health and Safety

· To report disease, injury, or vital events (e.g., births, deaths)

· To report adverse reactions or product recalls

· To prevent or reduce a serious and imminent threat to anyone’s health or safety

· To report suspected abuse, neglect, or domestic violence as required by law

For Health Oversight

· To government agencies for audits, investigations, inspections, and licensure

As Required by Law

· To comply with legal obligations (e.g., laws, court orders, subpoenas)

For Law Enforcement

· To locate or identify a suspect, witness, or missing person

· To report a crime, or information about a crime victim

For Judicial and Administrative Proceedings

· To respond to subpoenas, discovery requests, or other lawful processes

For Specialized Government Functions

· For military or national security activities, intelligence purposes, protective services, or evaluations for security clearances

For Workers’ Compensation

· To comply with workers' compensation or similar programs

For Coroners, Medical Examiners, and Funeral Directors

· To perform legally authorized duties

For Organ and Tissue Donation

· To facilitate donation and transplantation

For Research

· If approved by an institutional review board or privacy board, with appropriate safeguards

For Inmates

· If you are an inmate, your PHI may be disclosed to the correctional institution or its agents as necessary for your care and safety or that of others

To Business Associates

· We may share PHI with third parties (business associates) who perform services on our behalf, only under a written contract requiring them to protect your privacy and security

Michigan Patient Specific Disclosures:

We may disclose the PHI of patients receiving services in Michigan:

· to the Michigan department of licensing and regulatory affairs (LARA) for professional licensing investigations

· for psychiatric hospitalization proceedings under mcl 330.1427

· to comply with Michigan’s mental health code requirements

· for communicable disease reporting to Michigan department of health and human services

USES AND DISCLOSURES WITH YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT

Unless you object, we may share your PHI:

· With family members or others involved in your care, when the PHI is directly relevant to their involvement

· In emergency situations, if it is in your best interest and you are unable to adequately communicate

Breach Notification:

If there is a breach of your unsecured protected health information, we will notify you in writing within 60 days of discovering the breach. The notification will include what happened, what information was involved, steps you can take to protect yourself, what we are doing in response, and contact information for questions.

Record Retention

We retain adult patient records for a minimum of 7 years from the last date of service. Minor patient records are retained for 7 years after the last treatment or until one year after the patient reaches 18, whichever is longer.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

We must obtain your written authorization to use or disclose your PHI for:

· Marketing purposes

· Sale of your PHI

· Psychotherapy notes, except for treatment, payment, or legal compliance

You may revoke any authorization at any time in writing. Revocation will not affect any prior use or disclosure made in reliance on your authorization.

STATE-SPECIFIC PRIVACY CONSIDERATIONS

We comply with state laws that provide additional privacy protections:

· Michigan: Patients aged 14 and older may consent to mental health treatment, and confidentiality must be maintained unless safety concerns require disclosure (MCL 330.1707).

· Hawaii: Minors 14 and older may also consent to mental health care without parental involvement (HRS §577-26). Fees for records are limited to actual costs.

· Arizona: Providers may use discretion in treating minors 12 and older who are deemed mature. Records access fees are capped under ARS §12-2295.

In all cases, we follow the law that provides the greatest protection for your privacy.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this Notice at any time. Any changes will apply to PHI we already have. The revised Notice will be available upon request, in our office, and on our website at www.leafpsychiatry.com.