love your life. live well in love.™

• THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
  
  Dr. Rae Sandler Simon at Live & Love Well Colorado LLC / Live & Love Well Hawaii LLC s committed to protecting your privacy. Dr. Simon is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. Dr. Simon is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains her legal duties and privacy practices and your rights regarding PHI that she collects and maintains.
  
  
  YOUR RIGHTS
  Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to Dr. Simon at the address noted below.
  
  To inspect and copy PHI.
  • You can ask for an electronic or paper copy of PHI. Dr. Simon may charge you a reasonable fee.
  • Dr. Simon may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.
  
  To amend PHI.
  • You can ask to correct PHI you believe is incorrect or incomplete. Dr.Simon may require you to make your request in writing and provide a reason for the request.
  • Dr.Simon may deny your request. She will send a written explanation for the denial and allow you to submit a written statement of disagreement.
  
  To request confidential communications.
  • You can ask Dr.Simon to contact you in a specific way. She will say “yes” to all reasonable requests.
  
  To limit what is used or shared.
  • You can ask Dr.Simon not to use or share PHI for treatment, payment, or business operations. She is not required to agree if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask Dr.Simon not to share PHI with your health insurer.
  • You can ask for Dr.Simon not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.
  
  To obtain a list of those with whom your PHI has been shared.
  • You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
  
  To receive a copy of this Notice.
  • You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
  
  To choose someone to act for you.
  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
  
  To file a complaint if you feel your rights are violated.
  • You can file a complaint by contacting Dr.Simon.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• The practice of licensed or registered persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Registrations. The Colorado State Board of Psychologist Examiners can be reached at 1560 Broadway, Suite 1350, Denver, Colorado 80202, (303) 894-7800. The Hawaii State Board of Psychologist Examiners can be reached at HRH King Kalakaua Building, 335 Merchant Street, Rm. 301Honolulu, Hawaii 96813, (808) 586-3000.

• Dr. Simon will not retaliate against you for filing a complaint.

To file a complaint or exercise your rights, contact the practice using the information below:

 

Live & Love Well Colorado LLC / Live & Love Well Hawaii LLC

1756 N High St, Denver, CO 80218

65-1235 Opelo Road, Suite 2, Kamuela, HI 96743
Dr. Rae Sandler Simon
303-656-0122

808-49-8469

DR SIMONʻS USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
Dr.Simon is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. Dr. Simon typically uses or shares your health information in the following ways:

To treat you.
• Dr. Simon can use and share PHI with other professionals who are treating you.
• Example: Your primary care doctor asks about your mental health treatment.

To run the health care operations.
• Dr. Simon can use and share PHI to run the business, improve your care, and contact you.
• Example: Dr. Simon uses PHI to send you appointment reminders if you choose.

To bill for your services.
• Dr. Simon can use and share PHI to bill and get payment from health plans or other entities.
• Example: Dr. Simon gives PHI to your health insurance plan so it will pay for your services.

2. Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object
Dr. Simon may use or disclose PHI without your authorization or an opportunity for you to object, including:

To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: She may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
• Serious threat to health or safety: To prevent a serious and imminent threat.
• Abuse or Neglect: To report abuse, neglect, or domestic violence.

To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law.
• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
• Law enforcement: For law locate and identify you or disclose information about a victim of a crime.
• Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
• National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
• Workers' Compensation: To comply with workers' compensation laws or support claims.

To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized duties.
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional review board.
• Inmates: Dr. Simon created or received your PHI in the course of providing care.
• Business Associates: To organizations that perform functions, activities or services on our behalf.

3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object
Unless you object, Dr. Simon may disclose PHI:

• To your family, friends, or others if PHI directly relates to that person's involvement in your care.
• If it is in your best interest because you are unable to state your preference.

4. Uses and Disclosures of PHI Based Upon Your Written Authorization
Dr. Simon must obtain your written authorization to use and/or disclose PHI for the following purposes:

• Marketing,

• Sale of PHI, or

• Psychotherapy notes.

 

5. Use and Disclosure of Substance Use Disorder Records Subject to 42 CFR Part 2:
(A) If applicable, your substance use disorder (“SUD”) records are protected by federal law under 42 C.F.R. Part 2 (“Part 2”). This law provides extra confidentiality protections and requires a separate patient consent for the use and disclosure of SUD counseling notes. Each disclosure made with patient consent must include a copy of the consent or a clear explanation of the scope of the consent. It must also be accompanied by a written notice containing the language in 42 CFR Part 2.32(a). Disclosure of these records requires your explicit written consent, except in limited circumstances such as:

• Medical Emergencies: to the extent necessary to treat you,

• Reporting Crimes on Program Premises,

• Child Abuse Reporting: In connection with incidents of suspected child abuse or neglect to appropriate state or local authorities, and

• Fundraising: We will provide you with an opportunity to decline to receive any fundraising communications prior to making such communications.

You may revoke this consent at any time.

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(B) Prohibitions on Use and Disclosure of Part 2 Records:
SUD records received from programs subject to Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested SUD record is used or disclosed. If SUD records are disclosed to us or our business associates pursuant to your written consent for treatment, payment, and healthcare operations, we or our business associates may further use and disclose such health information without your written consent to the extent that the HIPAA regulations permit such uses and disclosures, consistent with the other provisions in this Notice regarding PHI.

You may revoke your authorization, at any time, by contacting Dr. Simon in writing, using the information above. She will not use or share PHI other than as described in Notice unless you give your permission in writing.


DR SIMONʻS RESPONSIBILITIES
• Dr. Simon s required by law to maintain the privacy and security of PHI.
• Dr. Simon is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, she will abide by the more stringent law.
• Dr. Simon reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by her. Should Dr. Simon make changes, you may obtain a revised Notice by requesting a copy from Dr. Simon, using the information above, or by viewing a copy on the website www.liveandlovewell.com.
• Dr. Simon will inform you if PHI is compromised in a breach.

This Notice is effective on April 18, 2026