Notice of Privacy Practices

If you read only one section, read this one.

We keep what you tell us private. We use your information to care for you, to bill you, and to run the practice. We do not sell it. We do not use it for advertising. We will not share it with anyone else without your written permission, except in the specific situations listed in this Notice — situations where the law requires us to share, or where someone's safety is at stake.

We are in-network with a number of insurance plans, and for those plans we bill your insurer directly. If you use a plan we are not in-network with, or you prefer to pay out of pocket, you pay us directly and we can give you a superbill to submit to your own insurance company for possible out-of-network reimbursement. The plans we accept can change over time; we confirm your coverage with you before your first session.

Your record is yours. You can read it, get a copy, ask us to correct it, ask for a list of who we shared it with, ask us to limit what we share, and ask us to contact you in a particular way. If you paid for a service in full yourself, you can tell us not to share anything about that service with a health plan, and we will honor that.

If you ever think we mishandled your privacy, you can complain — to us, or to the federal government, or both. Nothing bad will happen to you for complaining. Your care will not change.

We do not use email for anything involving your health information. Reach us by phone, by our contact form, or by mail.

Quez Therapeutic Solutions, LLC ("the Practice," "we," "us," "our") is the solo clinical practice of Joselyn Vasquez, LISW-S. This Notice covers all information about your health and your care that we create or keep — your record, our notes, your billing — whether we see you in our Stow office or by telehealth anywhere in Ohio. In this Notice we call that information "your health information."

We are required by law to keep your health information private. Ohio law protects what you tell a licensed independent social worker as a confidential communication, and the rules of the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board require us to safeguard it. Those duties apply to us because of who we are and what we do — they do not depend on how you pay us, and they do not depend on federal law.

We also follow the privacy practices described in this Notice as a matter of firm policy and professional obligation, and consistent with the federal health privacy law known as HIPAA where HIPAA applies to our services.

We provide you with this Notice of our duties and our privacy practices. We abide by the terms of the Notice that is currently in effect. If a breach of your unsecured health information happens, we will notify you, as required by applicable breach-notification law.

The categories below are the main ways we use and share your health information without asking you each time. Not every possible use is listed, but every use we make falls into one of these categories.

To treat you. We use your health information to provide, coordinate, and manage your care. For example: we write down your history, your treatment plan, and how you are progressing, so that your care builds on itself from session to session. If you want us to talk with another professional who treats you — your physician, a psychiatrist, a prior therapist — we will ask for your consent first, and we will share only what is needed.

To be paid. We use your health information to bill for the services we provide and to be paid for them. For example: when we are in-network with your health plan, we send a claim to that plan — including your diagnosis and service codes — so it can pay for your care. When we are not in-network with your plan, or you pay out of pocket, we prepare an itemized statement or a superbill with the same information, which you can submit to your own insurance company to seek out-of-network reimbursement. Our current fees, and the plans we are in-network with, are at https://queztherapy.com/fees.

To run the practice. We use your health information for our own operations — checking our own quality of care, clinical supervision and consultation, licensing and credentialing, and administration. For example: reviewing records as part of clinical supervision, so that the care you receive is sound.

Other than as described in this Notice, we will not use or share your health information without your written authorization. In particular:

• We do not sell your health information. Not ever.
• We do not use your health information for marketing without your written permission.
• We do not use your name, image, or story in any advertising, testimonial, or promotional material without your written permission.
• Psychotherapy notes get their own, separate protection — see Section 5.

If you sign an authorization, you can revoke it at any time, in writing, and we will stop. Revoking it does not undo something we already did while relying on it.

If your clinician keeps psychotherapy notes — private notes analyzing what was said in a session, kept separate from the rest of your record — those notes get stronger protection than the rest of your record. We will not use or share psychotherapy notes without your specific written authorization, separate from any other permission you have given, except in narrow situations: your own clinician using her notes to treat you, certain training or supervision uses, defending the practice in a legal action you bring against it, or where the law requires disclosure.

Psychotherapy notes are generally not included in the copy of your record you have a right to receive. You may still ask for them, and we will consider your request.

Each situation below is limited by the law that permits it. We share the minimum necessary.

6.1 When the law requires it. We will share your health information when federal, state, or local law requires us to.

6.2 Suspected abuse or neglect of a child. Ohio law makes us a mandatory reporter. If, acting in our professional capacity, we have reasonable cause to suspect — not proof, and not certainty — that a person under eighteen, or a person under twenty-one with a developmental disability or physical impairment, has suffered abuse or neglect or faces a threat of suffering it, we must report that immediately to the county public children services agency or to a peace officer (Ohio Rev. Code § 2151.421).

6.3 Suspected abuse, neglect, or exploitation of certain older adults. Ohio law also requires us to report if we have reasonable cause to believe that an "adult," as Ohio law specifically defines that term, is being abused, neglected, or exploited. We report to the county department of job and family services (Ohio Rev. Code § 5101.63). This duty is narrower than it sounds: it reaches a person who is sixty or older, and is disabled by the infirmities of aging or has an impairment that prevents them from providing for their own care or protection, and lives in an independent living arrangement (Ohio Rev. Code § 5101.60(C)). All three must be true.

6.4 A serious threat to another person. Ohio has a specific, narrow framework here — narrower than the general "therapists have to warn people" idea you may have heard (Ohio Rev. Code § 2305.51). It applies only when all of these are true: you, or someone who knows you well, communicates to us an explicit threat of imminent and serious physical harm or death, aimed at one or more clearly identifiable people, and we have reason to believe you have both the intent and the ability to carry it out.

If that happens, the law directs us to take protective action, and it gives us several options rather than one. Depending on the circumstances and our professional judgment, that may mean notifying law enforcement and, where feasible, the person at risk; pursuing hospitalization; or putting in place a documented treatment plan designed to make sure the threat is not carried out, together with a second-opinion risk assessment. We are required to weigh each option and document why we chose or rejected it. This applies to threats against other people.

6.5 If we are worried about your safety. Talking about wanting to die, or about hurting yourself, does not by itself mean we call the police, and it does not trigger the framework in Section 6.4 — that framework is about threats to other people. Thoughts of suicide are something people bring to therapy, and bringing them to us is what therapy is for.

If we are concerned for your safety, our first response is a clinical one: we talk with you about it, and we work with you on a plan to keep you safe. If your life is in immediate danger, we may involve emergency services — and wherever we can, we do that with you, not behind your back.

6.6 Health oversight. We may share your health information with an agency that oversees us, for audits, investigations, licensing, and discipline — including the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board.

6.7 Court and administrative proceedings. We may share your health information in response to a court order or an administrative order, and in some cases in response to a subpoena or other lawful process, subject to the protections the law requires. Ohio law protects what you tell us as privileged, and we assert that protection on your behalf where it applies.

6.8 Law enforcement. We may share limited health information for law enforcement purposes where the law requires or permits it — for example, in response to a court order or warrant, or to report certain wounds or crimes that Ohio law requires us to report.

6.9 Public health. We may share your health information for public health purposes, such as reporting disease or injury, where the law permits.

6.10 Coroners, medical examiners, and funeral directors. We may share your health information to identify a person who has died or determine a cause of death, or as needed for a funeral director to do their job.

6.11 Workers' compensation. We may share your health information as needed to comply with Ohio workers' compensation law, if it applies to your care.

6.12 National security. We may share your health information with authorized federal officials for national security or protective activities, if that applies.

6.13 Research. We do not use client information for research. If that ever changes, we would do it only with your authorization or under the narrow circumstances the law allows, such as a waiver approved by an institutional review board.

6.14 People who work on our behalf. A small number of outside service providers handle information for us so that the practice can function — our client portal and record system, the secure video platform we use for telehealth, and billing and technology support. Each is bound by a written agreement to protect your information and to use it only for the work they do for us. They may not use your information for their own purposes.

If you are in crisis, please reach out right now.

• Call or text 988 — the 988 Suicide & Crisis Lifeline. Free, confidential, 24/7.
• Text HOME to 741741 — Crisis Text Line. Free, 24/7.
• Call 911 if you or someone else is in danger or needs immediate medical attention.

You can also chat with the 988 Lifeline at chat.988lifeline.org.

Quez Therapeutic Solutions, LLC is not a crisis service. Our office is open Monday through Saturday, 9:00 a.m.–9:00 p.m., and we cannot respond to emergencies. If this is an emergency, use one of the resources above. When you are safe, we are here for what comes next — call 330-203-1559 or use the contact form.

Our website has an automated chat feature that answers general, non-clinical questions — office hours, how to book, what we charge. It is a convenience, nothing more.

Please do not type symptoms, diagnoses, treatment details, crisis information, or anything else about your health into it. It is not a secure channel for health information, it is not part of your clinical record, and no one is monitoring it in real time. If you need clinical help, call 330-203-1559. If you are in crisis, use the resources in Section 7.

These are your rights over your own health information, and how to use them.

9.1 To see it and get a copy. You may look at your record and get a copy of it, with limited exceptions such as psychotherapy notes (Section 5). We may charge a reasonable, cost-based fee for copies.

9.2 To ask us to correct it. If you think something in your record is wrong or incomplete, you may ask us in writing to amend it, and tell us why. We may say no in the circumstances the law allows — for example, if we did not create the record, or if it is already accurate and complete. If we say no, we will tell you why in writing, and you have the right to file a statement of disagreement that becomes part of your record.

9.3 To get a list of who we shared it with. You may ask for an accounting of certain disclosures we made in the six years before your request. It does not include disclosures for treatment, payment, or running the practice, disclosures to you, or other categories the law excludes.

9.4 To ask us to limit what we share. You may ask us to restrict what we use or share, including with family members involved in your care. We are not required to agree to every request — but there is one we will always honor: if you paid for a service in full, out of your own pocket, you can tell us not to share information about that service with a health plan, and we will not (unless the law requires it). If you pay for a service in full out of your own pocket, this right lets you keep that service from being shared with a health plan — worth knowing whether you use insurance for some visits or pay out of pocket for others.

9.5 To be contacted a certain way. You may ask us to reach you at a particular phone number, or by mail, or to leave messages in a particular way — or not at all. We will accommodate reasonable requests, and we will not ask you why. Because we do not use email for anything involving your care, please tell us which phone number or address works.

9.6 To get a paper copy of this Notice. You may ask for a paper copy at any time, even if you already got it electronically. Just ask.

9.7 To be told if there is a breach. If a breach of your unsecured health information occurs, you have the right to be notified.

9.8 To revoke an authorization. If you signed a permission form, you can take it back in writing at any time, except as to what we already did while relying on it.

Where HIPAA applies to our practice, these are federal legal rights as well. We honor them either way.

How to use any of these rights. Put your request in writing to the Privacy Officer:

• Contact form: https://queztherapy.com/contact
• Phone: 330-203-1559
• Mail: Privacy Officer, Quez Therapeutic Solutions, LLC, 3653 Darrow Rd, Ste 5, Stow, OH 44224

We do not accept these requests by email. If you need help putting a request in writing, call us and we will help you.

We keep your health information private. We give you this Notice of our duties and our privacy practices. We follow the terms of the Notice that is in effect. We tell you if we cannot agree to a restriction or an amendment you asked for. If a breach of your unsecured health information occurs, we notify you as the law requires.

We may change this Notice. If we do, the new terms will apply to health information we already have as well as information we create later. If we make a material change, we will post the revised Notice at our office and on our website, https://queztherapy.com, and give you a copy if you ask.

If you believe we have violated your privacy rights, you may complain to us, to the federal government, or to both.

You will not be retaliated against for filing a complaint. Your care will not be affected in any way. We would rather hear from you than not.

To complain to us, contact the Privacy Officer:

• Contact form: https://queztherapy.com/contact
• Phone: 330-203-1559
• Mail: Privacy Officer, Quez Therapeutic Solutions, LLC, 3653 Darrow Rd, Ste 5, Stow, OH 44224

We do not accept privacy complaints by email.

To complain to the Secretary of the U.S. Department of Health and Human Services, contact its Office for Civil Rights:

• Online: https://ocrportal.hhs.gov/
• Phone: 1-877-696-6775
• Mail: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201

A complaint to the Office for Civil Rights must be filed in writing — the online portal counts — generally within 180 days of when you knew, or should have known, about what you are complaining about.

• We give you this Notice no later than your first appointment, including a first appointment held by telehealth. If your first service is delivered electronically, we provide this Notice electronically at the same time.
• We ask you to acknowledge in writing that you received it. You are not required to sign. Declining to sign does not affect your care, and we will note that we asked.
• We post it at our office, where you can take a copy.
• We post it on our website, https://queztherapy.com, where anyone can read, download, and print it at any time, free, whether or not they are a client.

The Effective Date at the top is the date this Notice was first published. By law it cannot be earlier than that.

Privacy Officer: Joselyn Vasquez, LISW-S Quez Therapeutic Solutions, LLC 3653 Darrow Rd, Ste 5, Stow, OH 44224 Phone: 330-203-1559 Contact form: https://queztherapy.com/contact

Office hours are Monday through Saturday, 9:00 a.m.–9:00 p.m. You are welcome to reach us in English or Spanish.

Joselyn Vasquez is licensed by the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board as a Licensed Independent Social Worker with Supervision Designation (LISW-S), license 1440311. You are welcome to verify this with the Board at any time.

This Notice takes effect on the Effective Date shown above and stays in effect until we amend or replace it.