NOTICE OF PRIVACY PRACTICES

This is required by HIPAA for all healthcare providers. This document outlines the Notice of Privacy Practices for Dr. Mariya, PsyD.

Effective Date: April 2026

This notice describes how medical and psychological information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights
You have the right to request a copy of your health information. You may ask to see or receive a copy of your health record and other health information. You have the right to request a correction if you believe information in your record is incorrect or incomplete. You have the right to request that your information not be shared in certain ways. You have the right to receive a list of instances where your information has been shared. You have the right to receive a paper copy of this notice upon request.

How Your Information May Be Used
Your health information may be used for treatment purposes, to coordinate care with other providers involved in your treatment with your consent, for payment purposes including submitting claims to insurance, and for healthcare operations including quality improvement and licensing requirements.

When Your Information May Be Shared Without Your Consent
As required by law your health information may be shared without your authorization in the following circumstances. When there is a serious and imminent threat to your safety or the safety of another person. When required by a court order or law enforcement under specific legal conditions. When required for mandatory reporting obligations under Florida law. When required for public health activities as defined by law.

Psychotherapy Notes
Psychotherapy notes receive special protection under HIPAA and Florida law. These notes are kept separately from the general medical record and require your specific written authorization to be released except in limited circumstances defined by law.

Your Choices
You may authorize the sharing of your health information with others by signing a release of information. You may revoke that authorization at any time in writing except where action has already been taken based on your authorization.

How to Exercise Your Rights
To exercise any of the rights described in this notice please contact Dr. Mariya, PsyD at hi@drmariyapsyd.com. Requests will be responded to within 30 days.

Complaints
If you believe your privacy rights have been violated you may file a complaint with Dr. Mariya, PsyD or with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr. Filing a complaint will not affect the care you receive.

Contact
Dr. Mariya, PsyD
hi@drmariyapsyd.com
www.drmariyapsyd.com
Licensed Psychologist · Florida · License No. FL PY11721