NOTICE OF PRIVACY PRACTICES

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS IT. PLEASE REVIEW CAREFULLY. 

I. MY COMMITMENT TO YOUR PRIVACY

Your privacy is extremely important to me. As part of providing quality care, I create a record of our work together that includes personal and health information. This information, known as Protected Health Information (PHI), is safeguarded in accordance with federal and state laws, including the Health Insurance Portability and Accountability Act (HIPAA). This notice explains how your PHI may be used or shared and describes your rights regarding that information. 

II. USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

Federal law (HIPAA) allows health care providers to use or disclose your Protected Health Information (PHI) for specific purposes without requiring your written authorization. These permitted uses are limited to the following: 

  • Treatment: Coordinating or managing your care, consulting with other providers (e.g., your physician or another therapist), or discussing your care with authorized family members. Note: The full record may be shared when necessary for treatment.

  • Payment: Submitting claims to your insurance, determining eligibility, or billing-related matters.

  • Health Care Operations: Administrative tasks that support the functioning of my practice, such as quality review, licensing, and case coordination.

III. OTHER USES AND DISCLOSURES REQUIRING AUTHORIZATION

Any other use or disclosure of your PHI, including release of Psychotherapy Notes (notes from sessions kept separate from your clinical record), requires your explicit written authorization. You may revoke your authorization in writing at any time, unless I’ve already acted on it or it was a condition of obtaining insurance.

IV. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Some uses of PHI require your written permission, including:

  • Psychotherapy Notes (except for limited uses such as treatment, legal defense, or required oversight)

  • Marketing: I do not use your PHI for marketing

  • Sale of PHI: I do not sell your PHI


V. USES AND DISCLOSURES WITHOUT AUTHORIZATION

There are specific situations where I may be legally permitted or required to disclose your PHI without your written consent:

  • Suspected Abuse or Neglect: If I believe a child, dependent adult, or elder is being abused or neglected.

  • Health Oversight: For audits or investigations by regulatory agencies.

  • Legal Proceedings: If required by court order or subpoena, unless protected by privilege (with effort to notify you or protect the data).

  • Serious Threats: To prevent or lessen a serious and imminent threat to your safety or the safety of others.

  • Government Functions: For military, national security, or other legally mandated uses.

  • Coroner or Medical Examiner: For identification or determining cause of death.

Whenever possible, I will discuss these situations with you before disclosing information.


VI. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding your PHI:

  • Right to Request Restrictions: You may ask me to limit what I disclose. I’m not required to agree, and may decline if it affects care, but I will do my best to accommodate.

  • Right to Confidential Communications: You may request that I contact you at specific locations or via certain methods (e.g., by phone, email, or mail).

  • Right to Access Records: You can inspect or request a copy of your clinical or billing records (excluding psychotherapy notes), delivered within 30 days. Reasonable fees may apply. I may deny requests under limited circumstances, and we can discuss any denial.

  • Right to Amend: You can request corrections to your record if you believe it is inaccurate or incomplete. Denials will be explained in writing within 60 days.

  • Right to an Accounting of Disclosures: You can request a list of times your PHI has been shared, excluding those related to treatment, payment, or health care operations. You may receive a list of non-routine disclosures made in the past six years (free once per year; fees may apply for additional requests).

  • Right to a Paper Copy: You can request a paper or electronic copy of this notice at any time.

  • Right to Breach Notification: You will be notified if your unsecured PHI is breached in a way that may compromise your privacy.


VII. MY LEGAL DUTIES

I am required by law to maintain the privacy of your PHI and to provide this notice of my legal duties and privacy practices.

I reserve the right to change these privacy practices and will notify you of any significant changes.

This notice went into effect on 05/26/2025