Notice of Privacy Practices

1. Our responsibilities

Blooming Behavioral Health is required by law to:

• Maintain the privacy and security of your Protected Health Information (PHI)
• Provide you this Notice describing our legal duties and privacy practices
• Follow the terms of the Notice currently in effect
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your PHI

2. How we may use and disclose your PHI

2.1 Treatment

We may use and disclose your PHI to provide, coordinate, and manage your ABA services — including communication with your child's pediatrician, school, or other treating professionals.

2.2 Payment

We may use and disclose your PHI to obtain payment for services, including verifying insurance benefits, obtaining prior authorizations, and submitting claims to Medicaid, Medicaid HMO plans, or commercial insurers.

2.3 Health care operations

We may use and disclose your PHI for operations such as quality assessment, staff training and supervision, business planning, and compliance activities.

3. Other uses and disclosures we may make without your authorization

• As required by law (including mandatory reporting of suspected child abuse or neglect under Florida law)
• Public health activities, including disease reporting and vital statistics
• Health oversight activities by government agencies
• Judicial or administrative proceedings (in response to a court order, subpoena, or similar legal process, consistent with HIPAA)
• Law enforcement purposes, as permitted by HIPAA
• To avert a serious threat to health or safety
• Workers' compensation, if applicable
• Military command authorities, national security, or correctional institutions, if applicable

4. Uses and disclosures that require your authorization

Uses and disclosures not described in this Notice will be made only with your written authorization, except where permitted or required by law. Specifically, we will obtain your written authorization for:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures for marketing purposes
• Any sale of your PHI

You may revoke an authorization in writing at any time, except where we have already acted in reliance on it.

5. Your rights regarding your PHI

5.1 Right to request access

You have the right to inspect and obtain a copy of your PHI maintained in our designated record set. Requests must be in writing.

5.2 Right to request amendment

You have the right to request an amendment of your PHI if you believe it is inaccurate or incomplete. We may deny the request under certain circumstances permitted by law.

5.3 Right to an accounting of disclosures

You have the right to request a list of certain disclosures we have made of your PHI during the six years preceding the request.

5.4 Right to request restrictions

You have the right to request a restriction on certain uses and disclosures. We are not required to agree except when you request a restriction on disclosures to a health plan for payment or operations for services you paid for out of pocket in full.

5.5 Right to request confidential communications

You have the right to request that we communicate with you in a specific way (e.g., only by phone, only at a specific address).

5.6 Right to receive a paper copy of this Notice

You have the right to a paper copy of this Notice, even if you agreed to receive it electronically.

5.7 Right to be notified of a breach

You have the right to be notified if we discover a breach of unsecured PHI that may have compromised your privacy.

6. Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

• Blooming Behavioral Health, Privacy Officer — 3600 S State Rd 7, STE 344, Miramar, FL 33023 — info@blooming-aba.com — (754) 799-3780
• U.S. Department of Health and Human Services, Office for Civil Rights — 200 Independence Avenue, SW, Washington, DC 20201 — www.hhs.gov/ocr/privacy

We will not retaliate against you for filing a complaint.

7. Changes to this Notice

We reserve the right to change this Notice. We will post a revised Notice on our Website and provide a copy at your next visit. The effective date at the top of this Notice reflects the most recent version.

8. Contact

Privacy Officer:

• Blooming Behavioral Health — 3600 S State Rd 7, STE 344, Miramar, FL 33023
• Email: info@blooming-aba.com
• Phone: (754) 799-3780