Notice of Privacy Practices (HIPAA & Arizona Law) Effective Date: 08/20/2026 Practice Name: Katie Burke PMHNP LLC Location: Arizona This Notice describes how medical and mental health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. We follow federal law (HIPAA) and applicable Arizona laws that give extra protection to mental health and other sensitive information. 1. Your Protected Health Information (PHI) “Protected Health Information” (PHI) is information about you that can identify you and relates to: - Your past, present, or future physical or mental health or condition - Health care services you receive - Payment for those services This includes information in your records, billing information, and any other information we keep about your care. 2. Our Responsibilities We are required by law to: - Maintain the privacy and security of your PHI - Give you this Notice of our legal duties and privacy practices - Follow the terms of this Notice currently in effect - Notify you if a breach occurs that may have compromised the privacy or security of your PHI We may have additional duties under Arizona law, especially for mental health, substance use, HIV‑related information, and information about minors. When Arizona law is more protective of your privacy than federal law, we follow Arizona law.

How We May Use and Disclose Your PHI We may use and share your PHI in the following ways, as allowed by federal and Arizona law: a. For Treatment - To provide, coordinate, or manage your mental health care and related services - To consult with or refer you to another provider involved in your care For certain sensitive information (such as some mental health records, substance use treatment, or HIV‑related information), Arizona law may require your written permission before we share it, except in limited situations required by law. b. For Payment - To bill and collect payment from you, your insurance company, or another third party - To verify coverage, obtain prior authorization, or determine benefits c. For Health Care Operations - To run our practice, improve quality of care, and manage our services - For training, licensing, auditing, and quality improvement d. As Required or Permitted by Law We may also use or disclose your PHI without your written authorization in situations such as: - Public health and safety: - To prevent or reduce a serious and imminent threat to your health or safety or the health or safety of others - To help with product recalls, disease reporting, or public health activities - Abuse, neglect, or exploitation: - To report suspected abuse, neglect, or exploitation of a child, vulnerable adult, or elderly person, as required by Arizona law - Health oversight activities: - To agencies that oversee the health care system, such as licensing boards or government programs - Legal proceedings and law enforcement: - In response to a court order, warrant, or as otherwise required by law - To comply with certain law enforcement requests, consistent with Arizona and federal law - Coroners, medical examiners, and funeral directors: - To help them carry out their duties - Research: - In limited cases, when approved by an institutional review board or privacy board and when privacy protections are in place - Specialized government functions: - Such as military or national security activities, if applicable - Workers’ compensation: - As authorized by workers’ compensation or similar laws When Arizona law gives extra protection (for example, for certain mental health, substance use, or HIV‑related information), we will follow those stricter rules. 4. Uses and Disclosures Requiring Your Written Authorization In all other situations, we will obtain your written permission (authorization) before using or disclosing your PHI. This includes, when applicable: - Most uses and disclosures of psychotherapy notes (if kept separately) - Most uses and disclosures of PHI for marketing purposes - Sale of your PHI If you give us written authorization, you may revoke it at any time in writing. Revoking authorization will not affect any use or disclosure that has already occurred based on your prior permission. 5. Your Rights Regarding Your PHI You have the following rights, subject to certain limits under federal and Arizona law: a. Right to Access - You may request to see or get a copy of your PHI in our records, usually within 30 days. - This includes most of your medical and billing records. - We may charge a reasonable fee for copies, mailing, or other supplies. - In some cases, we may deny your request, but you may have the right to have the denial reviewed. b. Right to Request an Amendment - If you believe your PHI is incorrect or incomplete, you may request that we correct it. - Your request must be in writing and explain why the information should be changed. - We may deny your request in certain situations, but we will explain why in writing and tell you about your rights to disagree. c. Right to an Accounting of Disclosures - You may request a list (“accounting”) of certain disclosures of your PHI made in the past six years. - This list will not include disclosures for treatment, payment, and health care operations, and certain other disclosures. d. Right to Request Restrictions - You may ask us to limit how we use or disclose your PHI for treatment, payment, or health care operations. - You may also ask us to limit what we share with certain people involved in your care or payment. - We are not required to agree to all requested restrictions. - If we do agree, we will comply except in emergencies or when required by law. - You also have the right to request that we not disclose PHI to your health plan for services you pay for in full out of pocket, if the disclosure is only for payment or health care operations. In most cases, we must agree to this type of restriction. e. Right to Request Confidential Communications - You may request that we contact you in a specific way (for example, at a different address, phone number, or email). - We will accommodate reasonable requests. f. Right to a Paper or Electronic Copy of This Notice - You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically. - You may also request an electronic copy.

6. Mental Health and Sensitive Information in Arizona Mental health information is especially sensitive. We follow all applicable federal and Arizona laws that provide extra protection for: - Mental health treatment records - Substance use treatment information - HIV‑related information - Information about minors In some cases, we may need your written permission before sharing this information, even for treatment, payment, or health care operations, except when disclosure is required or allowed by law (for example, to prevent serious harm, or to report abuse or neglect). 7. Changes to This Notice We may change this Notice at any time. The revised Notice will apply to all PHI we maintain and will be available on our website and in our office. The effective date at the top of the Notice will be updated. 8. Questions, Concerns, or Complaints If you have questions about this Notice or how your PHI is used, or if you believe your privacy rights have been violated, you may contact us: Effective Mental Health Care [Street Address] [City], Arizona [ZIP] Phone: [Phone Number] Email: [Email Address] You may also file a complaint with: U.S. Department of Health and Human Services, Office for Civil Rights Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/ You may also have the right to file a complaint with the appropriate Arizona state agency. You will not be retaliated against for filing a complaint.