NOTICE OF PRIVACY PRACTICES

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.

We at Mira Mace are required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide you with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care products and services to you or payment for such services.

This notice describes how we may use and disclose PHI about you, as well as how you may obtain access to such PHI. This notice also describes your rights with respect to your PHI. We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to provide this notice to you.

Mira Mace is required to follow the terms of this notice or any change to it that is in effect. We reserve the right to change our practices and this notice and to make the new notice effective for all PHI we maintain. If we do so, the updated notice will be posted on our website. Upon request, we will provide any revised notice to you.

How We May Use or Disclose Your PHI

The following categories describe different ways that we use and disclose your PHI. We have provided examples in certain categories; however, not every permissible use or disclosure will be listed in this notice.

Note that some types of PHI, such as HIV information, genetic information, alcohol and/or substance abuse records, and mental health records may be subject to special confidentiality protections under applicable state or federal law, and we will abide by these special protections.

Uses and Disclosures of PHI That Do Not Require Your Prior Authorization

Except where prohibited by federal or state laws that require special privacy protections, we may use and disclose your PHI for treatment, payment, and health care operations without your prior authorization as follows:

Treatment

We may use and disclose your PHI to provide and coordinate the treatment, medications, and services you receive. For example, we may disclose PHI to pharmacists, doctors, nurses, technicians, and other personnel involved in your health care. We may also disclose your PHI to hospitals, pharmacies, and other health care facilities and agencies to facilitate your care.

Payment

We may use and disclose your PHI to obtain payment for health care products and services we provide. This may include contacting your insurer or other payors, billing you or a third party, and disclosing information necessary for payment activities.

Health Care Operations

We may use and disclose your PHI for operational activities such as quality improvement, performance evaluation, staff training, and internal audits. We may also create de-identified data that does not identify you.

Other Uses and Disclosures Without Authorization

We may also use or disclose PHI without prior authorization for the following purposes:

  • Business Associates
  • Individuals Involved in Your Care or Payment
  • Worker’s Compensation
  • Public Health Activities
  • Law Enforcement
  • As Required by Law
  • Health Oversight Activities
  • Judicial and Administrative Proceedings
  • Research
  • Coroners, Medical Examiners, and Funeral Directors
  • Organ and Tissue Donation
  • Notification and Disaster Relief
  • Correctional Institutions
  • To Avert a Serious Threat to Health or Safety
  • Military and Veterans
  • National Security and Intelligence Activities
  • Victims of Abuse or Neglect

All disclosures are made in accordance with applicable law.

Uses and Disclosures of PHI That Require Your Prior Authorization

Specific Uses Requiring Authorization

We will obtain your written authorization for:

  • Psychotherapy notes

  • Marketing uses of PHI

  • Sale of PHI

    except where otherwise permitted by law.

Other Uses

Any other uses or disclosures not described in this Notice require your written authorization. You may revoke an authorization in writing at any time, except where we have already relied on it.

Your Health Information Rights

You have the right to:

  • Obtain a paper copy of this Notice upon request
  • Request restrictions on certain uses and disclosures
  • Inspect and obtain copies of your PHI
  • Request amendments to your PHI
  • Receive an accounting of disclosures
  • Request confidential communications
  • Receive notification of a breach of unsecured PHI

For More Information or to Report a Problem

If you have questions or would like additional information about Mira Mace’s privacy practices, you may contact us by email at info@miramace.com or by calling 732-863-2992.

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint.

Effective Date

This Notice is effective as of January 14, 2026