NOTICE OF PRIVACY PRACTICES

Effective January 31, 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.

Steffani Kizziar, LLC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could reasonably be used to identify you. The Practice is also required to provide you with this Notice of Privacy Practices (this “Notice”), which explains our legal duties and privacy practices and your rights regarding PHI that we collect and maintain.

In certain circumstances, your information may also be protected by additional federal or state laws, including 42 CFR Part 2, which provides heightened protections for substance use disorder (SUD) treatment records. When multiple laws apply, the Practice follows the most protective standard.

YOUR RIGHTS

Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.

Inspect and Copy PHI

  • You may ask for an electronic or paper copy of your PHI. The Practice may charge a reasonable fee.

  • The Practice may deny your request in limited circumstances, including if access could endanger your life or the safety of another person. If denied, you may request a review of the decision.

Amend PHI

  • You may ask to correct PHI you believe is incorrect or incomplete. The Practice may require that your request be made in writing and that you provide a reason.

  • The Practice may deny your request and will provide a written explanation and allow you to submit a written statement of disagreement.

Request Confidential Communications

  • You may ask the Practice to contact you in a specific way. All reasonable requests will be accommodated.

Limit What Is Used or Shared

  • You may ask the Practice not to use or share PHI for treatment, payment, or health care operations. The Practice is not required to agree if it would affect your care.

  • If you pay for a service or health care item out of pocket in full, you may request that PHI not be shared with your health insurer.

  • You may request restrictions on sharing PHI with family members or friends by stating the specific restriction and to whom it applies.

Receive an Accounting of Disclosures

  • You may request a list (an accounting) of times your PHI has been shared. One accounting is provided every 12 months at no charge. Reasonable fees may apply for additional requests.

Receive a Copy of This Notice

  • You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Choose Someone to Act for You

  • If you have granted medical power of attorney or have a legal guardian, that person may exercise your rights.

File a Complaint

If you believe your rights have been violated, you may file a complaint with the Practice using the following contact information:

Steffani Kizziar, PsyD
Email: steffani@kizziarpsyd.com
Phone: (503) 877-9615

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by:

  • Mail: 200 Independence Avenue, S.W., Washington, D.C. 20201

  • Phone: 1-877-696-6775

  • Website: www.hhs.gov/ocr/privacy/hipaa/complaints/

The Practice will not retaliate against you for filing a complaint.

Opt Out of Fundraising Communications

  • The Practice may contact you for fundraising purposes, but you may request not to receive such communications.

OUR USES AND DISCLOSURES

1. Routine Uses and Disclosures of PHI

The Practice may use and disclose PHI without your written authorization for treatment, payment, and health care operations. Examples include:

Treatment

  • Sharing PHI with other professionals involved in your care.
    Example: Your primary care provider requests information about your mental health treatment.

Health Care Operations

  • Using PHI to run the business, improve care, and contact you.
    Example: Appointment reminders, if you choose to receive them.

2. Uses and Disclosures Without Authorization or Opportunity to Object

The Practice may disclose PHI as permitted or required by law, including:

  • Public health activities (disease prevention, product recalls, reporting adverse reactions)

  • Health oversight activities (audits, investigations, inspections)

  • Compliance with the Secretary of Health and Human Services

  • Preventing a serious and imminent threat to health or safety

  • Reporting abuse, neglect, or domestic violence

  • Compliance with federal, state, or local law

  • Judicial and administrative proceedings (court orders, subpoenas)

  • Law enforcement purposes

  • Specialized government functions (military, national security, intelligence)

  • Workers’ compensation

  • Coroners and funeral directors

  • Organ donation and transplantation

  • Approved research

  • Inmates

  • Business associates performing services on behalf of the Practice

3. Uses and Disclosures With Opportunity to Object

Unless you object, PHI may be disclosed:

  • To family members, friends, or others involved in your care

  • When it is in your best interest and you are unable to state your preference

4. Uses and Disclosures Requiring Written Authorization

Written authorization is required for:

  • Marketing

  • Sale of PHI

  • Psychotherapy notes

You may revoke authorization at any time in writing. The Practice will not use or disclose PHI beyond what is described in this Notice without your written permission.

SUBSTANCE USE DISORDER (SUD) RECORDS – SPECIAL PROTECTIONS

Certain health information may be protected under 42 CFR Part 2, which provides additional confidentiality protections for substance use disorder treatment records.

How SUD Records May Be Used or Disclosed

  • SUD records may be used or disclosed for treatment, payment, and health care operations as permitted by law.

  • Some disclosures require your written consent.

  • All redisclosures must comply with federal law.

Prohibition on Redisclosure

Recipients of SUD records are prohibited from redisclosing them unless permitted by law. Unauthorized redisclosure is prohibited.

Law Enforcement and Legal Requests

SUD records generally may not be disclosed for civil, criminal, administrative, or legislative proceedings without a court order that complies with 42 CFR Part 2.

Your Rights Related to SUD Records

You have the right to:

  • Request restrictions on disclosure

  • Receive an accounting of disclosures

  • Revoke consent (when applicable)

  • File a complaint if your Part 2 rights are violated

USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

Written authorization is required for:

  • Marketing

  • Sale of PHI

  • Psychotherapy notes (with limited legal exceptions)

Authorization may be revoked at any time in writing.

REPRODUCTIVE HEALTH CARE INFORMATION

The Practice will not use or disclose PHI related to lawful reproductive health care for prohibited purposes, including investigations or liability related to obtaining or providing such care, without a valid signed attestation as required by law. Additional safeguards apply to judicial, administrative, and law enforcement requests.

OUR RESPONSIBILITIES

  • The Practice is required by law to maintain the privacy and security of PHI.

  • The Practice must follow the terms of this Notice currently in effect.

  • Where more stringent state or federal laws apply, the Practice will comply with the more protective standard.

  • The Practice reserves the right to amend this Notice. Changes apply to all PHI maintained by the Practice.

  • Revised Notices may be obtained by contacting the Practice or visiting kizziarpsyd.com.

  • The Practice will notify you if a breach of unsecured PHI occurs.

This Notice is effective January 31, 2026.