Notice of Privacy Practices

This Notice of Privacy Practices is provided by Clear Ketamine Therapy in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulation at 45 CFR 164.520. It applies to all records of your care created or maintained by this practice, whether made by our physicians, advanced practice providers, nurses, therapists, or staff.

Effective date: August 14, 2026.

Privacy Officer contact: privacy@clearketaminetherapy.com. You may also reach us in writing at 27724 Cashford Circle, Suite 102, Wesley Chapel, FL 33544, or by phone at (813) 851-5045. Privacy requests are accepted at the email address above.

We understand that information about you and your health is personal, and that people seeking ketamine therapy are often sharing some of the most sensitive information they have. We are committed to protecting it.

We create a record of the care and services you receive so that we can provide you with quality care and comply with legal requirements. This notice tells you how we may use and disclose that information, and describes your rights and our obligations regarding it.

For treatment. We may use your health information to provide and coordinate your care. For example, the clinician supervising your treatment may review your medical history, medication list, blood pressure readings, and prior response to treatment. We may disclose information to other providers involved in your care, such as your prescribing psychiatrist, primary care physician, referring clinician, laboratory, or pharmacy.

For payment. We may use and disclose your health information to bill and collect payment for services. For example, we may provide information to a health plan, or to a financing provider you have chosen to use.

For healthcare operations. We may use and disclose your health information for activities necessary to run the practice and maintain quality of care — including quality assessment, clinician review and training, credentialing, accreditation, licensing, and compliance auditing.

Appointment reminders and health-related communications. We may contact you to remind you of a scheduled treatment session or follow-up, or to tell you about treatment alternatives or health-related services that may interest you.

Individuals involved in your care. Because ketamine treatment requires that you arrange a ride home, we may need to confirm timing with the person accompanying you. Unless you object, we may disclose information directly relevant to that person's involvement in your care or transportation.

As required by law. We will disclose your health information when federal, state, or local law requires it.

To avert a serious threat. We may use and disclose your health information when necessary to prevent a serious and imminent threat to your health or safety, or to the health or safety of the public or another person.

We will obtain your written authorization before using or disclosing your PHI for any purpose not described in this notice. In particular, the following always require your written authorization:

You may revoke an authorization in writing at any time. Revocation will not affect uses or disclosures we already made in reliance on it.

Ketamine therapy is frequently sought for depression, treatment-resistant depression, anxiety, PTSD, and chronic pain. Records relating to that care may receive protection beyond the HIPAA baseline.

Psychotherapy notes. Notes recorded by a therapist during or after a counseling session that are kept separate from the medical record receive heightened protection under HIPAA. We will not use or disclose them without your written authorization, except in the narrow circumstances the law permits.

Substance use disorder records. Where applicable, records relating to substance use disorder treatment are protected by 42 CFR Part 2 and may not be disclosed without your specific written consent, except as that regulation otherwise permits.

Florida mental health law. Florida Statutes Chapter 394 (the Baker Act) and Chapter 397 (the Marchman Act) may govern certain disclosures of mental health and substance use information. We comply with applicable Florida law regarding these records.

You have the following rights over the health information we maintain about you. To exercise any of them, submit a written request to our Privacy Officer at privacy@clearketaminetherapy.com.

Right to access your records. You may inspect and obtain a copy of your medical and billing records, including an electronic copy where we maintain them electronically. We may charge a reasonable, cost-based fee. We will respond within 30 days. If we deny a request, we will explain why in writing and tell you how to have the denial reviewed.

Right to request an amendment. If you believe information in your record is incorrect or incomplete, you may ask us to amend it. We may deny the request if the information was not created by us, is not part of the records we maintain, or is accurate and complete — and if we do, you may submit a statement of disagreement.

Right to an accounting of disclosures. You may request a list of certain disclosures we made of your health information. The accounting excludes disclosures for treatment, payment, healthcare operations, and those you authorized. We provide one accounting per 12-month period at no charge.

Right to request restrictions. You may ask us to restrict how we use or disclose your information for treatment, payment, or healthcare operations. We are not required to agree — except in one case: if you pay for a service in full out of pocket and ask us not to disclose information about that service to your health plan, we must honor that request.

Right to request confidential communications. You may ask us to contact you in a specific way or at a specific location — for example, only by mobile phone, or by mail sent to an address other than your home. We will accommodate all reasonable requests and will not ask you why.

Right to a paper copy of this notice. You may request a paper copy at any time, even if you agreed to receive it electronically.

Right to be notified of a breach. You have the right to be notified if a breach of your unsecured PHI occurs. We will notify you in writing without unreasonable delay and no later than 60 days after discovery, as HIPAA requires, and within 30 days where the Florida Information Protection Act applies.

We are required by law to maintain the privacy and security of your PHI, to give you notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

We limit uses and disclosures of PHI to the minimum necessary to accomplish the intended purpose, except for disclosures for treatment and disclosures you have authorized. Every vendor that handles PHI on our behalf is engaged under a written Business Associate Agreement as required by 45 CFR 164.502(e).

We will not use or disclose your PHI without your written authorization except as described in this notice or as otherwise permitted or required by law. We will never sell your PHI, and we will not use it for marketing without your authorization.

We reserve the right to change the terms of this notice and to make the revised notice effective for all PHI we already maintain as well as information we receive in the future. The current notice is posted in our office and on this website at clearketaminetherapy.com/notice-of-privacy-practices/, with its effective date shown at the top. You may request a copy of the current notice at any time.

If you believe your privacy rights have been violated, you may file a complaint with us or with the federal government. We will not penalize or retaliate against you in any way for filing a complaint.

To file a complaint with our practice, contact our Privacy Officer at privacy@clearketaminetherapy.com.

To file a complaint with the federal government, contact the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/hipaa/filing-a-complaint or (800) 368-1019.

This notice is not a substitute for emergency care. If you are in crisis or having thoughts of self-harm, call or text 988 (Suicide & Crisis Lifeline) or call 911 now — our forms and inboxes are not monitored for emergencies.