Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL AND PSYCHOLOGICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective date: November 10, 2026

Who follows this notice

This notice applies to the practice of Gustavo R. Benejam, Psy.D., licensed clinical psychologist, and to every member of his team who has access to your information (interviewers, assistants and administrative staff), in the Miami and Boca Raton offices and in telehealth sessions.

Our duties

The law requires us to keep the privacy of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, to follow the notice currently in effect, and to tell you promptly if a breach occurs that may have compromised the privacy or security of your information.

PHI is any information that identifies you and relates to your mental or physical health, the services you receive, or payment for those services. It includes intake forms, interview notes, test results, reports and billing records.

Psychological evaluations for immigration and other legal matters

Most of our services are evaluations requested to be used as evidence in an immigration or legal case. Please keep in mind:

• The purpose of the evaluation is a written report. You decide whether the report is used. We give it to you and, only with your written authorization, to the attorney or representative you name.
• We do not send your report to USCIS, the Immigration Court (EOIR) or any other agency unless you authorize it in writing or the law requires it.
• Once you or your attorney file the report with a government agency, that agency handles it under its own rules. HIPAA no longer controls what happens to that copy.
• If you authorize Dr. Benejam to testify in your case, he may discuss the evaluation and its findings in that proceeding.

How we may use and disclose your information without your written authorization

Treatment and services. To carry out your evaluation or therapy and to coordinate it among the members of our team, for example the interviewer who conducts the clinical interview and Dr. Benejam, who reviews, approves and signs the report.

Payment. To process and record your payments, for example to confirm a payment made by card, Zelle or another method. Immigration evaluations are not billed to health insurance.

Health care operations. To run the practice: scheduling, appointment reminders, quality review of reports, training of our staff, and secure record keeping.

Business associates. Some services are performed by companies that support our practice (for example secure email, cloud storage, scheduling and payment processing). They must sign an agreement to protect your information.

When the law requires or allows it, and only to the extent required:

• To prevent or lessen a serious and imminent threat to your health or safety or to the safety of another person.
• To report suspected abuse, neglect or exploitation of a child, an elderly person or a vulnerable adult, as Florida law requires.
• In response to a court order or other lawful order in a judicial or administrative proceeding.
• To health oversight agencies, such as the Florida Board of Psychology, for audits, investigations or licensing.
• To the U.S. Department of Health and Human Services when it reviews our compliance with the privacy law.
• For public health activities, workers’ compensation, coroners or medical examiners, law enforcement and specialized government functions, as permitted by federal and Florida law.

When Florida law protects your information more than federal law does (for example, the confidentiality of communications with a psychologist under section 490.0147, Florida Statutes), we follow the stricter rule.

Uses that require your written authorization

• Sending your report or records to your attorney, to a family member or to any other person or agency.
• Psychotherapy notes, if they exist, except in the limited cases the law allows.
• Marketing, and any sale of your information. We do not sell your information.
• Any other use or disclosure not described in this notice.

You may revoke an authorization in writing at any time. The revocation does not undo what we already did while the authorization was in effect.

Appointment reminders, email and text messages

We may contact you by phone, email, text message or WhatsApp to confirm or remind you of appointments, send payment links, request documents or tell you that your report is ready. We keep these messages to the minimum needed and do not include diagnoses or report content in them. Email and text messages are not completely secure. If you prefer that we contact you only in a certain way or at a certain number or address, tell us and we will follow your request when it is reasonable. Text messages are also covered by our SMS Terms.

Your rights

• Get a copy of your records. Ask in writing for a paper or electronic copy of your report and records. We will respond within 30 days and may charge a reasonable, cost-based fee.
• Ask us to correct your records. If you believe information is incorrect or incomplete, ask in writing. We may say no, and if we do we will explain why in writing.
• Ask for confidential communications. For example, that we only call your cell phone or only write to a specific email.
• Ask us to limit what we use or share. We are not always required to agree, except that we must agree not to share information with a health plan about a service you paid for in full yourself, unless the law requires it.
• Get a list of disclosures. Ask for a list of the times we shared your information in the six years before your request, with certain exceptions. One list per year is free.
• Get a paper copy of this notice at any time, even if you received it electronically.
• Choose someone to act for you. A legal guardian or a person with a valid power of attorney may exercise your rights.
• File a complaint if you believe your rights were violated (see below).

How long we keep records

We keep records for at least the period required by Florida law for psychologists, and then destroy them in a way that protects your privacy.

Changes to this notice

We may change this notice. The changes will apply to all the information we hold. The current version will always be on this page and available in our offices, with its effective date.

Complaints and questions

If you have questions or believe your privacy rights were violated, contact our Privacy Officer:

Gustavo R. Benejam, Psy.D. — Privacy Officer
2730 SW 3rd Ave, Suite 703, Miami, FL 33129
Phone: (305) 981-6434 · Email: drgustavobenejam@gmail.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.