Oasis Therapy NJ

Effective Date: July 20256

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

Our Commitment to Your Privacy

Oasis Therapy NJ is committed to protecting the privacy of your health information. We are required by law to maintain the confidentiality of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices, and notify you following a breach of your unsecured PHI.

How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose your health information. Not every use or disclosure will be listed, but all permitted uses and disclosures will fall within one of these categories.

Treatment: We may use and disclose your health information to provide, coordinate, or manage your treatment. For example, we may share information with other healthcare providers involved in your care when clinically appropriate and with your knowledge.

Payment: We may use and disclose your health information to obtain payment for services rendered. As an out-of-network private pay practice, we may provide superbills or clinical documentation to support your insurance reimbursement requests at your direction.

Healthcare Operations: We may use and disclose your health information for practice operations, including quality assessment, clinical supervision, training, and business management activities.

Required by Law: We will disclose your health information when required by federal, state, or local law.

Abuse or Neglect: We are required by law to report suspected abuse or neglect of a child, elderly person, or dependent adult to appropriate authorities.

Serious Threat to Health or Safety: We may disclose your health information if we believe it is necessary to prevent or lessen a serious and imminent threat to your health or safety, or the health or safety of another person.

Judicial and Administrative Proceedings: We may disclose your health information in response to a court order, subpoena, or other lawful legal process.

Uses and Disclosures Requiring Your Authorization

The following uses and disclosures will only be made with your written authorization:

• Most uses and disclosures of psychotherapy notes

• Uses and disclosures for marketing purposes

• Sale of your health information

• Any other use or disclosure not described in this Notice

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

Your Rights Regarding Your Health Information

Right to Access: You have the right to inspect and receive a copy of your health information that may be used to make decisions about your care.

Right to Amend: You have the right to request an amendment to your health information if you believe it is incorrect or incomplete.

Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your health information.

Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to your request in all cases.

Right to Confidential Communications: You have the right to request that we communicate with you in a specific way or at a specific location.

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

Right to be Notified of a Breach: You have the right to be notified if your unsecured PHI is breached.

Complaints

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

Contact Information

Oasis Therapy NJ | Michelle Mouhtis, LCSW, LCADC
Matawan, NJ | oasistherapynj.com

Oasis Therapy NJ is a trade name of Michelle Mouhtis LCSW LLC, a New Jersey limited liability company.

To file a complaint with the U.S. Department of Health and Human Services:
Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Washington, D.C. 20201
Toll-free: 1-877-696-6775 | www.hhs.gov/ocr/privacy/hipaa/complaints