Privacy Statement

NOTICE OF PRIVACY PRACTICES

Effective Date: March 1, 2025

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

Our Commitment to Your Privacy

At Luma Via Mental Health, we are dedicated to maintaining the privacy and integrity of your protected health information (PHI). PHI includes information that can identify you and relates to your past, present, or future physical or mental health, the provision of health care to you, or the payment for such care. We are required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices concerning your PHI.

Services Offered

Luma Via Mental Health provides both therapeutic services and co-parenting mediation services. It is essential to understand that these services are distinct, and the handling of information differs between them:

• Therapeutic Services: Involves mental health counseling and treatment, where PHI is collected, used, and disclosed in accordance with HIPAA regulations as detailed in this notice.

• Co-Parenting Mediation Services: Focuses on facilitating communication and agreements between co-parents. While confidentiality is respected, information shared during mediation may not be protected under HIPAA in the same manner as therapeutic services. Specific confidentiality agreements will be discussed and provided prior to the commencement of mediation services.

Uses and Disclosures of Your PHI

We may use and disclose your PHI for the following purposes without your authorization:

1. Treatment: To provide, coordinate, or manage your health care and related services. For example, we may share information with other health care providers involved in your care.

2. Payment: To obtain payment for services provided to you. For instance, we may disclose PHI to your health insurer to determine eligibility or coverage.

3. Health Care Operations: For activities necessary to run our practice and ensure quality care. This includes quality assessments, employee reviews, and training.

Other Uses and Disclosures

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

• As Required by Law: When disclosure is mandated by federal, state, or local law.

• Public Health Activities: For public health purposes, such as reporting communicable diseases.

• Health Oversight Activities: To agencies responsible for overseeing the health care system.

• Judicial and Administrative Proceedings: In response to a court order or subpoena.

• Law Enforcement: For law enforcement purposes as required by law or in response to a valid subpoena.

• To Avert a Serious Threat to Health or Safety: To prevent a serious threat to your health and safety or that of others.

Your Rights Regarding Your PHI

You have the following rights concerning your PHI:

1. Right to Access: You can inspect and obtain a copy of your PHI.

2. Right to Amend: You may request corrections to your PHI if you believe it is incorrect or incomplete.

3. Right to an Accounting of Disclosures: You can request a list of certain disclosures we have made of your PHI.

4. Right to Request Restrictions: You may ask us to limit how we use or disclose your PHI. While we are not required to agree, we will consider your request.

5. Right to Request Confidential Communications: You can request that we communicate with you in a specific way or at a specific location.

6. Right to a Paper Copy of This Notice: You are entitled to a paper copy of this Notice at any time.

Co-Parenting Mediation Services and Privacy

Please be aware that co-parenting mediation services are distinct from therapeutic services. While we strive to maintain confidentiality in all our services, information shared during mediation sessions may not be protected under HIPAA in the same manner as therapeutic services. Specific confidentiality terms for mediation services will be provided and agreed upon prior to the commencement of such services.

Changes to This Notice

We reserve the right to change this Notice and make the new provisions effective for all PHI we maintain. The current Notice will be available in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you can file a complaint with us at:

Luma Via Mental Health
4302 Honeypie Dr
Madison, WI 53718
Phone: 608-676-0629
Email: info@lumaviamentalhealth.com

You can also file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Contact Information

For questions or further information regarding this Notice, please contact:

Rupa Nataraj
Luma Via Mental Health
4302 Honeypie Dr
Madison, WI 53718
Phone: 608-676-0629
Email: info@lumaviamentalhealth.com