This notice went into effect on Sept. 1, 2024. Revised November 2, 2026.

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

I. OUR PLEDGE REGARDING HEALTH INFORMATION:

We recognize that your health information is personal and are committed to protecting it.  We maintain records of the care and services you receive to provide quality care and meet legal requirements. This notice applies to all records created by this practice. It explains how we may use and disclose your health information, your rights regarding this information, and our legal obligations.

Our goal is to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Provide you with this notice of our legal duties and privacy practices regarding health information so you are aware of your rights and our legal obligations.

• Follow the terms of the current notice to uphold your privacy to the highest standard.

• Notify you of any changes to this Notice that apply to your information. The revised Notice will be provided immediately upon revision and will be available upon request, in our office, and on our website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

Federal privacy rules allow health care providers with a direct treatment relationship to use or disclose your personal health information without your written authorization for treatment, payment, or health care operations. The following categories describe how we may use and disclose your health information. While we do not list every example, all permitted uses and disclosures fall within these categories.

• Treatment: Sharing information with other doctors, therapists, psychiatrists, or pharmacies involved in coordinating or managing your care. For example, with your written consent, a clinician may contact your psychiatrist to coordinate your care.

• Payment: Sharing details with insurance companies, third-party payers, or billing services to obtain payment or authorization for services. For example, if a claim is denied, a clinician may contact your insurance company to discuss refiling and benefit details.

• Healthcare Operations: Using information for internal activities such as quality assessment, staff review, and business planning. For example, a clinician may consult another licensed provider about your condition to assist with diagnosis and treatment.

Disclosure

1.         For treatment purposes, providers require full access to your record to deliver quality care. “Treatment” includes coordinating and managing care, consultations between providers, and referrals.

Lawsuits and Disputes

1.         If you are involved in a lawsuit, we may disclose health information in response to a court order signed by a judge.

2.         We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if we have made efforts to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1.         Psychotherapy Notes. We do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

a. For use in treating you.

b. For use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

c. For use in defending myself in legal proceedings instituted by you.

d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

e. Required by law and the use or disclosure is limited to the requirements of such law.

f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

g. Required by a coroner who is performing duties authorized by law.

h. Required to help avert a serious threat to the health and safety of others.

2. Marketing Purposes. As mental health providers, we will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. As mental health providers, we will not sell your PHI in the regular course of our business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.

Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:

1.         When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2.         For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3.         For health oversight activities, including audits and investigations.

4.         For judicial proceedings, including responding to a court order signed by a judge, although our preference is to obtain an Authorization from you before doing so.

5.         For law enforcement purposes, including reporting crimes occurring on our premises.

6.         To coroners or medical examiners, when such individuals are performing duties authorized by law.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1.         Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate in writing is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1.         The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us in writing not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.

2.         The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request in writing restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3.         The Right to Choose How We Send PHI to You. You have the right to ask us in writing to contact you in a specific way (for example, home or office phone, text or call) or to send mail to a different address, and we will agree to all reasonable requests.

4.         The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that we have about you. Upon written request. We will provide you with a copy of your record, or a summary of it (if you agree to receive a summary), within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee to do so.

5.         The Right to Get a List of the Disclosures We Have Made. You have the right to request in writing a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we provide will include disclosures made in the last six years unless you request a shorter time. We will provide the list at no charge, but if you make more than one request in the same year, we will charge a reasonable, cost-based fee for each additional request.

6.         The Right to Correct or Update Your PHI. If you believe there is a mistake in your PHI, or that important information is missing, you have the right to request in writing that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.

7.         The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this Notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.