Notice of Privacy Practices

Effective Date: 09/01/2024

This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully. You may have additional rights under state and local laws. If you have questions regarding your healthcare information rights, please consult with legal counsel licensed in your state.

Acknowledgment of Receipt of Privacy Notice

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

I. My Pledge Regarding Your Health Information

Your health information is personal, and protecting it is my commitment. I maintain records of the services you receive to ensure quality care and legal compliance. This notice applies to all care records generated by this mental health practice.

  • Privacy: Your PHI will be safeguarded.

  • Transparency: This notice outlines my privacy practices.

  • Legal Compliance: I will follow the terms of this notice and provide updates when necessary.

II. How I May Use and Disclose Health Information

1. Treatment, Payment, and Healthcare Operations

HIPAA allows the use or disclosure of PHI without written authorization for:

  • Treatment: Including consultations with other healthcare providers.

  • Payment: Billing and insurance purposes.

  • Operations: Administrative tasks like appointment reminders.

2. Legal Situations

PHI may be disclosed in response to a court order, subpoena, or as required by law.

III. Uses and Disclosures That Require Authorization

Certain uses require your written permission:

  • Psychotherapy Notes: Except for treatment or legal compliance.

  • Marketing: Your PHI will not be used for marketing without consent.

  • Sale of PHI: I do not sell your PHI.

IV. Uses and Disclosures That Do Not Require Authorization

PHI may be disclosed without authorization for:

  • Appointment reminders.

  • Public health and oversight activities.

  • Legal requirements or law enforcement purposes.

  • Research and specialized government functions.

V. Your Rights Regarding Your PHI

You have the right to:

  • Request Restrictions: Limit how your PHI is used and disclosed.

  • Limit Disclosures for Out-of-Pocket Payments: Prevent disclosure to health plans for self-paid services.

  • Request Communication Preferences: Choose how I contact you.

  • Access Your PHI: Obtain a copy of your records.

  • Request an Accounting of Disclosures: Receive a list of non-treatment-related disclosures.

  • Amend Your PHI: Request corrections to your records.

  • Obtain a Copy of This Notice: Available in paper or digital format.

  • Appoint a Representative: Authorize someone to act on your behalf.

  • Revoke an Authorization: Withdraw permissions at any time.

  • Opt Out of Communication: Limit how you receive updates.

  • File a Complaint: Report HIPAA violations to the Department of Health and Human Services (HHS).

VI. Changes to This Notice

This policy may be updated as needed. The latest version will be available upon request, at the office, and on the website.

If you have any questions or need further assistance, please reach out.