Notice of Privacy Practices

Hayden Psychology, LLC – Eric Hayden, Ph.D.
3632 W. Market St., Suite 103, Fairlawn, OH 44333
Phone: (330) 778-8870 | Fax: (330) 625-5331

How Your Health Information Is Protected

This notice explains how mental health and medical information about you may be used and disclosed—and how you can access it. Please review carefully.

I. How Your Information May Be Used

We may use or disclose your Protected Health Information (PHI) for:

Treatment – Coordination or management of your care (e.g., consultations with your physician).
Payment – Billing, reimbursement, or verifying coverage with your insurance provider.
Health Care Operations – Quality assessment, audits, administrative functions, or care coordination.

“Use” refers to sharing information within this practice.
“Disclosure” refers to sharing information outside the practice.

II. Disclosures Requiring Your Authorization

Outside of treatment, payment, and operations, we’ll request written authorization before sharing your PHI. This includes:

  • Disclosures to family, spouse, or partners

  • Uses for marketing

  • Any sale of PHI

You may revoke any authorization in writing unless we’ve already relied on it.

III. Disclosures Without Consent or Authorization

We may share your PHI without consent in the following situations:

  • Child Abuse or Neglect – Required reporting to child protective services

  • Elder or Dependent Adult Abuse – Required reporting to appropriate agencies

  • Serious Threat to Health or Safety – To protect you or others from harm

  • Legal Proceedings – If ordered by a court

  • Worker’s Compensation Claims – If related to your claim

  • Public Health or Government Requirements – Such as FDA regulations, VA eligibility, national security, or military duties

IV. Your Rights as a Patient

  • Request Restrictions – You may request limits on how we use your PHI

  • Limit Disclosure to Insurers – If you’ve paid out of pocket in full

  • Request Confidential Communication – Alternate methods or locations (e.g., a separate billing address)

  • Inspect and Copy Records – Including PHI and psychotherapy notes

  • Request Amendments – To correct or clarify your records

  • Receive an Accounting – Of non-consensual disclosures

  • Be Notified of a Breach – If your unsecured PHI is compromised

  • Request a Paper Copy – Even if you receive this notice electronically

V. Our Responsibilities

  • We are legally required to protect your PHI and provide this notice.

  • We reserve the right to update our privacy practices. Any changes will be posted in our office and online.

VI. Filing a Complaint

If you believe your rights have been violated, you may contact:

Privacy Officer: Eric Hayden, Ph.D.
Phone: (330) 778-8870

Or file directly with:

U.S. Department of Health and Human Services
Centralized Case Management Operations
200 Independence Avenue, S.W., Room 509F
Washington, D.C. 20201
Phone: (800) 368-1019 | TDD: (800) 537-7697 | Fax: (202) 619-3818

There is no retaliation for filing a complaint.

VII. Effective Date

This notice is effective as of September 23, 2013.

VIII. Privacy and Security Officer

Dr. Eric Hayden acts as his own Privacy and Security Officer. Contact information is listed above.