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- <p align="center"><strong><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">HIPAA NOTICE OF LYRA CLINICAL ASSOCIATES P.C. PRIVACY PRACTICES</span></span></strong></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Effective date: January _, 2016.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">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.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to ask each of our patients to acknowledge receipt of our Notice of Privacy Practices, which discloses our personal information gathering and dissemination practices. Please note that by using this website (the “Site”) or the services provided by Lyra Clinical Associates P.C., together with its independent contracted affiliates including Lyra Health, Inc. (together “Lyra”, “we”, “our” or “us”), you accept the practices described in this Privacy Policy.<sup>1</sup> If you do not agree to this Privacy Policy, please do not use the Site or Lyra’s services. IF YOU ARE UNDER 13 YEARS OF AGE, PLEASE DO NOT USE OR ACCESS OUR SITE.</span></span><sup><span style="font-family: arial, helvetica, sans-serif; font-size: 11.6667px;">2</span></sup></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">What information do we collect from users and how is it used?</span></span></p>
- <p> </p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><em>Registration</em></strong><em>.</em> Before using some of our offerings, we need you to register with the Site and provide your name, email address, a password, and other personal details. We request this information for identification purposes, to communicate with you, and to improve the functioning of certain services. We may keep this information indefinitely.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><em>Forms</em></strong><em>.</em> To fully use our offerings, you may need to fill out forms that ask for or contain personal information such as your name, contact information, health, and other personal information.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><em>Medical Records</em></strong><em>.</em> In order for us to get you the best care, you may be asked to provide us with your medical records, description of symptoms, a medical history and life-style descriptions.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><em>Correspondence</em></strong><em>.</em> If you correspond with us via email, we may gather in a file specific to you the information that you submit. We may keep this information indefinitely.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">How does Lyra use and disclose protected health information about you that we collect?</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Lyra will collect protected health information (“PHI”) from you and will use or share it for the following purposes:</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><em>Treatment</em></strong>. We can use your PHI and share it with other professionals who are treating you, such as when you are referred to another mental health professional for further treatment.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><em>Business Operations</em></strong>. We can use and share your PHI to run our practice, improve your care, and contact you when necessary, such as using your PHI to manage your treatment and services.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><em>Billing and Payment</em></strong>. We can use and share your PHI to bill and get payment from health plans or other entities. For example, we may submit you PHI to your health insurance plan so that it will pay for your treatment.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Lyra is also permitted and/or required to use and disclose your PHI for: public health and safety issues; health research; compliance with law enforcement; responses to lawsuits and legal actions or legal requests; organ and tissue donation requests; work with medical examiners or funeral directors; statistical analysis (Lyra will de-identify and/or aggregate your PHI for statistical analysis, and in these situations, we do not disclose any information that can personally identify you); and when we use third-party contractors in order to provide certain services or to complete or confirm a transaction that you conduct with us.</span></span></p>
- <p> </p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">You have both the right and the choice to tell us to share your PHI with your family, close friends, or others involved in your care; share your PHI in a disaster relief situation; and whether to contact you for fundraising efforts. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in <em>your</em> best interest. We may also share your information when needed to lessen a serious and imminent thereat to health or safety.</span></span></p>
- <p> </p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">We will never share your PHI, unless you give us written permission to, for marketing purposes, for sale of your information, and for any sharing of most psychotherapy notes. You may revoke the authorization to disclose your PHI for these purposes at any time.</span></span></p>
- <p> </p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Lyra reserves the right to release collected information to law enforcement or other government officials, as we, in our sole and absolute discretion, deem necessary or appropriate. If you use our Site outside of the United States, you consent to the transfer and processing of your information out of your locale, to servers inside the United States and maintained indefinitely.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">What are your rights regarding your protected health information?</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">You have certain rights regarding protected health information that we maintain about you, including rights to:</span></span></p>
- <ul>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Get an electronic or paper copy of your medical record. </strong>You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Contact us at the information below to ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.</span></span></li>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Ask us to correct your medical and other records. </strong>You can ask us to correct health or other information about you that you think is incorrect or incomplete. Contact us at the information below to ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within 60 days.</span></span></li>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Request confidential communications. </strong>You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say, “yes” to all reasonable requests.</span></span></li>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Ask us to limit what we use or share. </strong>You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.</span></span></li>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Get a list of those with whom we’ve shared information. </strong>You can ask for a list (accounting) of the times we’ve shared your health information for 6 years prior to the date you ask, who we shared it with, and why. We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.</span></span></li>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Get a copy of this privacy notice. </strong>You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.</span></span></li>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Choose someone to act for you. </strong>If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.</span></span></li>
- <li><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>File a complaint if you feel your rights are violated. </strong>You can complain if you feel we have violated your rights by contacting us using the information below. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting <a href="http://www.hhs.gov/ocr/privacy/hipaa/complaints/"><strong>www.hhs.gov/ocr/privacy/hipaa/complaints/</strong></a><strong>. </strong>We will not retaliate against you for filing a complaint.</span></span></li>
- </ul>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">What are Lyra’s responsibilities with my information?</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. </strong> <strong>For more information see: </strong><a href="http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html">www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html</a><strong>.</strong></span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">How will I know about changes in the Privacy Policy?</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Lyra reserves the right to update this Privacy Policy from time to time. Please visit this page periodically so that you will be apprised of any changes. The policies indicated in this Privacy Policy will remain effective, even if you are no longer using our Site or services.</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">How to contact us?</span></span></p>
- <p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">If you have questions, or need to reach us for any other reason, you may contact the Chief Privacy Officer at (650) 477</span>-2991 or at <a href="mailto:privacy@lyraclinical.com">privacy@lyraclinical.com</a></span></p>
- <p><span style="font-size:10px;"><span style="font-family:arial,helvetica,sans-serif;"><sup><sup>[1]</sup></sup> You should be aware that when you are on the Site, you can be directed to other websites that are beyond our control, and Lyra is not responsible for the privacy practices of third parties or the content of linked websites</span></span></p>
- <p><span style="font-size:10px;"><span style="font-family:arial,helvetica,sans-serif;"><sup><sup>[2]</sup></sup> We do not knowingly collect or maintain personally identifiable information from persons under 13 years old, and no part of our Site is directed to persons under 13. If Lyra learns that personally identifiable information of persons less than 13 years old has been collected without verifiable parental consent, then Lyra will take the appropriate steps to delete this information. If you are a parent or guardian and discover that your child under the age of 13 has obtained a Lyra account, then you may alert Lyra at the address below.</span></span></p>
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