Effective Date: May 1, 2026

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.

If you have any questions about this notice, please contact: Amanda K. Reilly, Privacy Officer In Good Energytherapy@ingoodenergy.com

My commitment to your privacy

I am required by law to:

• Maintain the privacy of your protected health information (PHI)

• Provide you with this notice of my legal duties and privacy practices regarding PHI

• Notify you following a breach of unsecured PHI

• Abide by the terms of the notice currently in effect

How I may use and disclose your protected health information

The following describes the ways I may use and disclose information about you. Examples are provided for clarity; not every use or disclosure that falls within each category is listed.

For treatment. I may use your PHI to provide and coordinate your care, including consultations with other clinicians (such as your prescribing provider or KAP clinic) when you have authorized such coordination.

For payment. I may use and disclose PHI to obtain payment for services. For clients seeking out-of-network reimbursement, this typically includes generating superbills containing diagnosis codes and dates of service.

For health care operations. I may use PHI for activities necessary to operate my practice, including quality assessment, credentialing, and consultation with other licensed clinicians for case-related guidance, with PHI minimized when possible.

With your authorization. For any use or disclosure not described in this notice — including most uses and disclosures of psychotherapy notes, marketing communications, and any sale of your information — I will obtain your written authorization. You may revoke this authorization at any time, in writing, except to the extent action has already been taken in reliance on it.

Uses and disclosures required or permitted by law without your authorization

I may use or disclose your PHI without your authorization in the following circumstances:

• Required by law. Where federal, state, or local law requires disclosure.

• Public health activities. Reporting to public health authorities to prevent or control disease, injury, or disability.

• Abuse, neglect, or domestic violence. Reporting suspected abuse or neglect in accordance with New York mandated-reporter laws, including the reporting of suspected child abuse or maltreatment.

• Health oversight. For audits, investigations, inspections, or licensure activities.

• Judicial or administrative proceedings. In response to a court order, subpoena, or other lawful process, with appropriate notice to you when required by law.

• Law enforcement. In limited circumstances permitted by law, such as identifying or locating a suspect or reporting certain crimes.

• Serious threat to health or safety. Where disclosure is necessary to prevent or lessen a serious and imminent threat to you or others. This includes my duty to warn or protect identifiable third parties under New York law.

• Coroners, medical examiners, and funeral directors. For their authorized duties.

• Workers' compensation. Where required by workers' compensation laws.

Special protections for psychotherapy notes

Psychotherapy notes — process notes I keep separate from your medical record — receive heightened protection under HIPAA. I will not disclose psychotherapy notes without your specific written authorization, except in the limited circumstances permitted by law.

Your rights

You have the right to:

• Access your PHI. You may inspect and obtain a copy of PHI in your designated record set, with limited exceptions. Requests must be made in writing.

• Request an amendment. If you believe information in your record is incorrect or incomplete, you may request an amendment. I may deny your request under certain circumstances; if denied, you may submit a statement of disagreement that becomes part of your record.

• Receive an accounting of disclosures. You have the right to a list of certain disclosures of your PHI made over the previous six years.

• Request restrictions. You may request that I limit how I use or disclose your PHI for treatment, payment, or health care operations. I am not required to agree to every request, except where required by law — such as a disclosure to a health plan for a service you have paid for in full out of pocket.

• Request confidential communications. You may ask that I contact you only by certain means or at certain locations.

• Receive a paper copy of this notice even if you have agreed to receive it electronically.

• Be notified of a breach of unsecured PHI affecting your information.

To exercise any of these rights, please submit your request in writing to the Privacy Officer at the email above.

Complaints

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

To file a complaint with In Good Energy, contact the Privacy Officer at therapy@ingoodenergy.com.

To file a complaint with HHS, contact the Office for Civil Rights:

• Online: hhs.gov/ocr

• Phone: 1-800-368-1019

Changes to this notice

I reserve the right to change this notice and to make the new notice apply to PHI I already have about you, as well as to any information I receive in the future. The effective date of any revised notice will be at the top of the document. The current notice is available at all times on this website.