Notice of Privacy Practices

Levi Lipovenko PSYD PLLC dba N-Psych

Effective Date: December 1, 2025

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

Our Pledge Regarding Your Protected Health Information (PHI)

We understand that information about you and your mental health is personal. We are committed to protecting the privacy of your Protected Health Information (PHI). PHI includes identifiable health information related to your past, present, or future physical or mental health or condition, and related health care services.

We are required by law to:

I. How We May Use and Disclose Your PHI Without Your Authorization

We may use or disclose your PHI without your written authorization for the purpose of Treatment, Payment, and Health Care Operations (TPO), and for certain public policy purposes:

Treatment: We may use and disclose your PHI to provide, coordinate, and manage your health care. Example: We may share your neuropsychological evaluation report with your psychiatrist, referring physician, or school personnel to coordinate appropriate academic or medical care, but only with your consent or direction where required.

Payment: We may use and disclose your PHI to obtain payment for our services. Example: We may disclose PHI to your health plan to determine coverage eligibility, submit claims, or obtain pre-authorization for your evaluation.

Health Care Operations: We may use and disclose your PHI to run our practice, improve quality of care, and contact you when necessary. Example: We use your PHI for quality assessment, for business management, or to remind you of an appointment via our approved SMS system.

Required By Law: We will disclose PHI when required by federal, state, or local law.

Public Health Activities: We may disclose PHI to public health authorities to prevent or control disease, injury, or disability, or to report reactions to medications.

Judicial and Administrative Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to a court order, or in response to a subpoena or discovery request, if we follow applicable legal requirements.

Law Enforcement: We may release PHI to a law enforcement official, for example, to identify or locate a suspect, fugitive, witness, or missing person.

Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious and imminent threat to your health and safety or the health and safety of the public or another person.

Victims of Abuse, Neglect, or Domestic Violence: We may disclose PHI to the appropriate government authority if we reasonably believe you are a victim of abuse, neglect, or domestic violence.

Health Oversight Activities: We may disclose PHI to health oversight agencies for activities authorized by law, such as audits, civil, administrative, or criminal investigations.

Coroners, Medical Examiners, and Funeral Directors: We may disclose PHI to identify a deceased person or determine the cause of death.

Business Associates: We share your PHI with third-party vendors (called Business Associates) who perform services on our behalf (e.g., electronic health records, billing, or text messaging platforms). We require these partners to protect your PHI under a Business Associate Agreement (BAA).

II. Uses and Disclosures Requiring Your Written Authorization

We must obtain your written Authorization for the following uses and disclosures:

You have the right to revoke your Authorization at any time, in writing, except to the extent that we have already acted in reliance on the authorization.

III. Your Rights Regarding Your PHI

You have the following rights concerning your PHI. To exercise any of these rights, you must submit a written request to the Privacy Officer listed below.

Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI in the designated record set (e.g., your evaluation report and billing records). We may charge a reasonable, cost-based fee for copying. Note: HIPAA excludes the right to access psychotherapy notes.

Right to Amend: You have the right to request an amendment (correction) of your PHI if you believe it is incorrect or incomplete. We may deny the request, but we will provide you with a written explanation of the denial.

Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI for purposes other than TPO and those authorized by you.

Right to Request Restrictions: You have the right to request that we restrict the use or disclosure of your PHI for TPO purposes. We are not required to agree, except where: 1) The disclosure is to a health plan for payment or health care operations, and 2) The item or service has been paid for out-of-pocket in full.

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 (e.g., only calling your work number or only sending mail to a P.O. Box). We will accommodate reasonable requests.

Right to a Paper Copy of this Notice: You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Breach Notification: You have the right to be notified following a breach of your unsecured PHI.

IV. Changes to This Notice

We reserve the right to change the terms of this Notice at any time. The revised Notice will be effective for all PHI we maintain, including information we already have and any information we receive in the future. We will post the most current Notice on our website at n-psych.com and have copies available in our office.

V. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

To file a complaint with us:

Please contact the Privacy Officer listed below: