Notice of Privacy Practices

Miralife Tele-Therapist LLC (“we,” “us,” or “our”) operates MiralifeOnline, a behavioral health telehealth platform. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your protected health information (PHI) and your rights regarding that information. We are required by law to maintain the privacy of PHI, to provide you with this Notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI.

Treatment: We may use and share PHI to provide, coordinate, or manage your care. Example: your clinician reviews your appointment details and prior session notes before your telehealth visit, or consults with another authorized clinician involved in your care.

Payment: We may use and share PHI to bill and collect payment for services. Example: we may share limited billing information with you or with a payer when payment arrangements apply. When payment applies, our operations team confirms arrangements with you before your session.

Health care operations: We may use and share PHI for quality improvement, training, scheduling, customer service, and other operational activities. Example: operations staff confirm your appointment time and attach a secure external telehealth join link for your session.

We may use or disclose PHI without your written authorization when permitted or required by law, including (as applicable): public health activities; health oversight activities; judicial and administrative proceedings; law enforcement purposes as allowed by law; to avert a serious threat to health or safety; for workers’ compensation as required by law; for research under privacy safeguards; to coroners, medical examiners, or funeral directors as allowed by law; organ/tissue donation as allowed by law; and as otherwise required by federal or state law. Each disclosure is limited to what the law allows.

If a use or disclosure described in this Notice is prohibited or materially limited by other applicable law that is more stringent than the HIPAA Privacy Rule — including 42 CFR Part 2 for certain substance use disorder (SUD) records — we will follow the more protective law. Whether Miralife Tele-Therapist LLC is a Part 2 program, a lawful holder of Part 2 records, or neither, and the exact Part 2 notice language that must appear here, requires professional legal determination before production reliance.

Most uses and disclosures of psychotherapy notes (where applicable), uses and disclosures of PHI for marketing that require authorization under HIPAA, and sales of PHI require your written authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing except to the extent we have already acted in reliance on it.

We will not use or disclose PHI for certain prohibited purposes related to investigating or imposing liability for seeking, obtaining, providing, or facilitating lawful reproductive health care, as restricted under the HIPAA Privacy Rule (including 45 CFR 164.502(a)(5)(iii)), when those prohibitions apply. Example: we would not disclose PHI solely to help someone investigate whether you obtained lawful reproductive health care in another state, when such disclosure is prohibited.

For certain requests for PHI (for example, some requests potentially related to reproductive health care), we may be required to obtain an attestation from the requester affirming that the use or disclosure is not for a prohibited purpose, as required by 45 CFR 164.509 when applicable. Example: before responding to a subpoena that may implicate those rules, we may require a compliant attestation.

Information we disclose as permitted by this Notice may be subject to redisclosure by the recipient and may no longer be protected by the HIPAA Privacy Rule.

Substance use disorder treatment records received from programs subject to 42 CFR Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the individual unless based on written consent, or a court order after notice and an opportunity to be heard is provided to the individual or the holder of the record, as provided in 42 CFR Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed. Applicability of this statement to our practice depends on whether we create, receive, or maintain Part 2 records — professional review required.

We do not currently use PHI to contact you for fundraising. If that changes, we will provide any required notice and an opportunity to opt out of fundraising communications, including any additional Part 2 fundraising opt-out requirements that apply.

You have the right to:

• Request restrictions on certain uses and disclosures of PHI. We are not required to agree to every request, except we must agree to a restriction on disclosure to a health plan for payment or health care operations when you pay out of pocket in full for the item or service and the disclosure is not otherwise required by law (45 CFR 164.522(a)(1)(vi)).

• Request confidential communications of PHI by alternative means or at alternative locations (for example, a different phone or email), when reasonable.

• Inspect and obtain a copy of PHI in a designated record set, with limited exceptions.

• Request an amendment of PHI you believe is incorrect or incomplete.

• Receive an accounting of certain disclosures of PHI.

• Obtain a paper copy of this Notice upon request, even if you agreed to receive it electronically.

To exercise these rights, contact the Privacy Officer using the contact information below.

We are required by law to maintain the privacy of PHI, provide you with notice of our legal duties and privacy practices, and notify affected individuals following a breach of unsecured PHI. We are required to abide by the terms of the Notice currently in effect. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI we maintain. If we revise this Notice, we will post the revised Notice on MiralifeOnline and make it available upon request.

If you believe your privacy rights have been violated, you may file a complaint with us and/or with the U.S. Department of Health and Human Services, Office for Civil Rights. To file a complaint with us, contact the Privacy Officer below. You will not be retaliated against for filing a complaint.

Privacy Officer: Dr. Janny Jinor

Miralife Tele-Therapist LLC

9715 Capitol View Ave, Silver Spring, MD 20910

Telephone: (910) 805-2740

Email: drjanny.jinor@miralifeonline.com

This document applies to care you receive through MiralifeOnline.