NOTICE OF PRIVACY PRACTICES

Covered entity: Obsidian Psychiatry LLC

Effective date: July 30, 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. This Notice applies to Obsidian Psychiatry LLC ("Obsidian") and its workforce. It explains our duties and privacy practices concerning protected health information, also called PHI.

You have the following rights concerning health information we maintain about you. Contact the Privacy Officer using the information at the end of this Notice to exercise a right.

Get an electronic or paper copy of your record

You may ask to inspect or receive an electronic or paper copy of your medical record and other health information we maintain about you. We generally will provide a copy or a summary within 30 days after receiving your request. We may charge a reasonable, cost-based fee as permitted by law.

Ask us to correct your record

You may ask us to correct health information that you believe is incorrect or incomplete. We may deny the request in circumstances allowed by law, but we will explain the denial in writing, generally within 60 days.

Request confidential communications

You may ask us to contact you in a particular way or at a different address. We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or disclose certain information for treatment, payment, or health care operations. We are not always required to agree. If we agree, we may still disclose the information when needed for emergency treatment or as otherwise required by law.

If you pay in full out of pocket for a service or health care item, you may ask us not to disclose information about that service or item to your health plan for payment or health care operations. We will agree unless the disclosure is required by law.

Receive an accounting of disclosures

You may ask for a list of certain disclosures we made during the six years before your request. The accounting does not include disclosures for treatment, payment, or health care operations and certain other disclosures excluded by law. One accounting in a 12-month period is free. We may charge a reasonable, cost-based fee for an additional request during that period.

Receive a copy of this Notice

You may request a paper copy at any time, even if you agreed to receive the Notice electronically. We will provide it promptly.

Choose someone to act for you

A person with legal authority to act for you, such as a personal representative, guardian, or person holding an applicable medical power of attorney, may exercise your rights. We will verify that authority before acting.

File a complaint

You may complain to Obsidian if you believe your privacy rights were violated by contacting the Privacy Officer.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mailing 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/hipaa/filing-a-complaint.

We will not retaliate against you for filing a complaint.

YOUR CHOICES

In certain situations, you may tell us whether and how to share information. If you have a clear preference, tell us and we will follow your instructions when the law allows.

We may share relevant information with family members, close friends, or others involved in your care or payment for your care, unless you object or the law requires a different approach.
We may share information for disaster-relief purposes. If you cannot tell us your preference, we may act in your best interest or share information needed to lessen a serious and imminent threat to health or safety.

We will obtain your written authorization before using or disclosing PHI for marketing, selling your PHI, or most disclosures of psychotherapy notes. Obsidian does not sell PHI and does not use PHI or substance use disorder records for fundraising.

Other uses and disclosures not described in this Notice will be made only with your written authorization unless otherwise permitted or required by law. You may revoke an authorization in writing at any time, except to the extent we already relied on it.

HOW WE TYPICALLY USE AND DISCLOSE YOUR INFORMATION

Treatment

We may use your information and share it with health professionals involved in your care. For example, we may share relevant medication and diagnostic information with another clinician who is treating you.

Health care operations

We may use and disclose your information to operate the practice, improve care, coordinate services, train staff, manage quality and safety, and contact you when necessary. For example, we may review records to evaluate the quality of services.

Payment

We may use and disclose your information to bill and obtain payment from you, a health plan, or another responsible party. For example, we may send diagnosis and service information to your health plan so it can process a claim.

OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW

We may use or disclose health information for the following purposes only when applicable legal conditions are met:

Public health and safety activities, including preventing disease, reporting adverse reactions, reporting suspected abuse or neglect, and preventing or reducing a serious threat to health or safety.
Health research when permitted by law and required protections are in place.
Compliance with federal or state law, including disclosures to the U.S. Department of Health and Human Services to demonstrate compliance with federal privacy law.
Organ and tissue donation requests.
Coroners, medical examiners, and funeral directors when an individual dies.
Workers' compensation claims, health oversight activities, limited law-enforcement purposes, and special government functions authorized by law.
Court or administrative orders, subpoenas, lawsuits, and other legal proceedings as permitted by law.

MENTAL HEALTH, STATE LAW, AND SUBSTANCE USE DISORDER RECORDS

Oregon, Washington, and other applicable laws may provide added protection for certain information, including mental health records, substance use disorder records, HIV-related information, genetic information, reproductive or sexual health information, and records concerning minors. When a law is more protective than HIPAA, we will follow the more protective law.

To the extent we maintain substance use disorder patient records that are subject to 42 CFR Part 2, we will not use or disclose those records in any civil, criminal, administrative, or legislative investigation or proceeding against you unless you give written consent or a court issues the order and subpoena required by law.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your PHI.
We will notify you as required if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in the Notice currently in effect and provide you a copy.
We will not use or disclose your information other than as described in this Notice unless you authorize us in writing or the law permits or requires it.

CHANGES TO THIS NOTICE

We may change this Notice and make the revised terms effective for all health information we maintain, including information created or received before the change. The current Notice will be available on our website, at our office, and upon request.

QUESTIONS, REQUESTS, OR COMPLAINTS

Obsidian Psychiatry LLC
2863 NW Crossing Drive, Suite 140
Bend, OR 97703
Phone: (541) 876-5803
Fax: (541) 237-1824
Email: info@obsidianpsych.com