Notice of Privacy Practices

JAL Practice LLC d/b/a Emerge Therapies is required by law to maintain the privacy of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, to follow the notice currently in effect, and to notify you if a breach of your unsecured PHI occurs. Where Massachusetts law protects your information more than federal law does (for example, mental health, HIV, and genetic information), we follow Massachusetts law.

• Treatment — to provide and coordinate your care, including with your other providers, pharmacies, and laboratories.
• Payment — to bill and collect from you, your health plan, or others, including prior authorization requests.
• Health care operations — to run our practice, review quality, train staff, and conduct audits, including through vendors (business associates) who agree in writing to protect your information.
• Reminders and care information — appointment reminders and information about your treatment, using the contact methods you authorize.
• People involved in your care — with a family member, friend, or the person giving you a ride home whom you identify, unless you object.
• As required or permitted by law — public health and safety (including reporting abuse or neglect and preventing a serious threat to health or safety); health oversight (such as licensing boards and audits); lawsuits and legal proceedings (court orders and certain subpoenas); law enforcement in limited circumstances; coroners, medical examiners, and funeral directors; organ and tissue donation; research approved under privacy rules; workers' compensation; specialized government functions; and the FDA, including the Spravato® REMS program.

Marketing, sale of your PHI, most uses of psychotherapy notes, and any use or disclosure not described in this notice. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

You have the right to:

• get a copy of your paper or electronic medical record (we may charge a reasonable, cost-based fee);
• ask us to correct your record;
• ask us to contact you in a specific way or at a specific address or phone number (confidential communications);
• ask us to limit what we use or share — we are not required to agree, except that we must agree not to share information with your health plan about a service you paid for in full out of pocket, if you ask;
• get a list of certain disclosures we made in the past six years;
• get a paper copy of this notice at any time; and
• choose someone to act for you, such as a health care agent or legal guardian.

We may change this notice, and the changes will apply to all information we have about you. The current notice is available in our offices, at emergetherapies.health, and on request.

If you believe your privacy rights have been violated, contact our Privacy Officer at (781) 776-1944 or support@emergetherapies.health, or file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/ocr/complaints or 1-800-368-1019. We will not retaliate against you for filing a complaint.

Emerge Therapies complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex. Emerge Therapies does not exclude people or treat them differently because of these characteristics.

We provide free help to people with disabilities so they can communicate with us, such as qualified sign language interpreters and written information in other formats (large print or accessible electronic formats), and free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. To ask for these services, call (781) 776-1944 or email support@emergetherapies.health.

If you believe we have failed to provide these services or have discriminated in another way, you can file a grievance with our Civil Rights Coordinator at (781) 776-1944 or support@emergetherapies.health. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at ocrportal.hhs.gov, by mail at 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, or by phone at 1-800-368-1019 (TDD 1-800-537-7697).