Privacy Notice

The Catalyst Center INC.

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION (OR “PERSONAL HEALTH INFORMATION”) ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (the “Notice“) of The Catalyst Center INC. (hereinafter “we”, “our” or “us”) contains important information regarding your Personal Health Information. Our current Notice is posted at www.catalystcenterllc.com/privacynotice. You also have the right to receive a paper copy of this Notice and may ask us to give you a copy of this Notice at any time. If you received this Notice electronically, you are entitled to a paper copy of this Notice. If you have any questions about this Notice please contact the person listed in Part 6, below.

We understand that Personal Health Information about you and your health is personal. We are committed to protecting Personal Health Information about you and will use it to the minimum extent necessary to accomplish the intended purpose of the use, disclosure, or request of it.

1. How We May Use and Disclose Personal Health Information About You. We use your Personal Health Information for the purposes of health care treatment, payment activities, and health care operations. These uses and disclosures are more fully described below. Please note that this Notice does not list every use or disclosure; instead it gives examples of the most common uses and disclosures.

• Treatment: When and as appropriate, we may use or disclose Personal Health Information about you to facilitate your psychological treatment or services. We may disclose Personal Health Information about you to other Catalyst Center providers, including doctors, therapists, technicians, students, or other clinic personnel who are involved in taking care of you. For example, we might disclose information about you with therapists who are treating you; we may review your health history form to form a diagnosis and treatment plan; we may delegate tasks to ancillary staff as necessary to provide you with treatment or call to confirm a referral.
• Alternative Appointment Options: We offer video conferencing for appointments where your personal health information may be used or disclosed.
• Communication methods: We may text or email you messages to schedule appointments or respond to your requests. You may opt out of either or both of these types of communication methods at any time by contacting us at the address listed in Part 8.
• Payment: To bill or collect payment from you or your representative.
• Manage our Practice: To run our Office, assess the quality of care our patients receive and provide you with customer service. For example, to improve efficiency and reduce costs associated with missed appointments, we may contact you by telephone, mail or otherwise remind you of scheduled appointments, we may leave messages with whomever answers your telephone or email to contact us. We may call you by name from the waiting room, we may ask you to put your name on a sign-in sheet, we may tell you about or recommend health-related products and complementary or alternative treatments that may interest you, we may review your personal health information to evaluate our staff’s performance, or our Human Resources Department may review your records to assist you with complaints.

If you have any questions about how we use your personal health information or prefer to change your permitted methods of communication for: treatment, payment, appointment reminders, the offer of treatment alternatives or additional information about health-related products and services that may be of interest to you, please notify us in writing at our address in Part 6.

OTHER PERMITTED USES AND DISCLOSURES

• Disclosure to Others Involved in Your Care: We may disclose Personal Health Information about you to a relative, a friend, or to any other person you identify, provided the information is directly relevant to that person’s involvement with your health care or payment for that care. For example, if a family member or caregiver calls us and asks us to help verify the status of a bill, we may agree to help them confirm whether or not the bill has been paid. In most cases we require your explicit permission to discuss billing with anyone you have not listed as a financially responsible party, signed a release of information for, or otherwise indicated as part of your care.
• Workers’ Compensation: We may release Personal Health Information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
• To Comply with Federal and State Requirements: We will disclose Personal Health Information about you when required to do so by federal, state, or local law. For example, we may disclose Personal Health Information when required by the U.S. Department of Labor or other government agencies that regulate us; to federal, state, and local law enforcement officials; in response to a judicial order, subpoena, or other lawful process; and to address matters of public interest as required or permitted by law (for example, reporting child abuse and neglect, threats to public health and safety, and for national security reasons). We are required to disclose Personal Health Information about you to the Secretary of the U.S. Department of Health and Human Services if the Secretary is investigating, or to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law. We may disclose your Personal Health Information to a health oversight agency for activities authorized by law (such as audits, investigations, inspections, and licensure).
• To Avert a Serious Threat to Health or Safety: We may use and disclose Personal Health Information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone who is able to help prevent the threat. For example, we may disclose Personal Health Information about you in a proceeding regarding the licensure of a physician.
• Military and Veterans: If you are a member of the armed forces, we may release Personal Health Information about you as required by military command authorities. We may also release Personal Health Information about foreign military personnel to the appropriate foreign military authority.

Uses and disclosures other than those described in this Notice will require your written authorization. Your written authorization is required for: most uses and disclosures of psychotherapy notes; uses and disclosures of Personal Health Information for marketing purposes; and disclosures that are a sale of Personal Health Information. You may revoke your authorization at any time.

The privacy laws of a particular state or other federal laws might impose a more stringent privacy standard. If these more stringent laws apply and are not superseded by federal preemption rules under the Employee Retirement Income Security Act of 1974, we will comply with the more stringent law.

2. You May Request Certain Information or Actions be Taken Regarding Personal Health Information About You.

• You May Inspect and Copy: You may inspect and obtain a copy of your Personal Health Information.

If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to Personal Health Information, you may request that the denial be reviewed by contacting us at the address provided in Part 8.

• Your May Request an Amendment: If you feel that Personal Health Information we have about you is incorrect or incomplete, you may ask us to amend the information.

You also must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend any of the following information:

• Information that is not part of the Personal Health Information kept by us.
• Information that was not created by us.
• Information that is not part of the information which you would be permitted to inspect and copy.
• Information that is accurate and complete.

Notwithstanding the foregoing, you may request an accounting of disclosures of any “electronic health record” (that is, an electronic record of personal health information about you that is created, gathered, managed, and consulted by authorized health care clinicians and staff). To do so, however, you must submit your request and state a time period, which may be no longer than seven (7 ) years prior to the date on which the accounting is requested.

• Your May Request Restrictions: You may request a restriction or limitation on the Personal Health Information we use or disclose about you for the uses and disclosures described above. You also may to request a limit on the Personal Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had a diagnosis or treatment.

We are not required to agree to your request. If we agree to a request, a restriction may later be terminated by your written request, by agreement between you and us (including orally), or unilaterally by us for personal health information created or received after we have notified you that we have removed the restrictions and for emergency treatment.

To request restrictions, you must make your request in writing and must tell us the following information:

• What information you want to limit.
• Whether you want to limit our use, disclosure, or both.
• To whom you want the limits to apply (for example, disclosures to your spouse).

• You May Request Confidential Communications: You may request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

You must make any of the requests described above, to the person listed in Part 8, below.

3. Complaints. If you believe your privacy rights have been violated, you may contact the individual listed in Part 6. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

4. Other Uses of Personal Health Information. Other uses and disclosures of Personal Health Information that are not covered by this Notice or the laws that apply to us will be made only with your written permission. If you grant us permission to use or disclose Personal Health Information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose Personal Health Information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we may be required by law to retain our records.
5. Effective Date. The effective date of this Notice is January 1, 2018.
6. Contact Information. All correspondence relating to the contents of this Notice should be directed as follows:

ATTN: Jennifer Kloewer The Catalyst Center INC. 300 S Jackson Street, Suite 520 Denver, CO 80209 720-675-7123 Fax: 888-675-3110 Email: hr@catalystcenterllc.com