Notice of Privacy Practices

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Effective Date: 08/01/2025

This notice describes how information about you may be used and disclosed, and how you can access this information. Please review it carefully.

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My Commitment to Your Privacy

Your privacy is deeply important to me. As a Licensed Marriage and Family Therapist, I maintain records that include personal and health-related information about you. This information is considered Protected Health Information (PHI), and I am legally and ethically committed to keeping it confidential.

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Unless you provide written permission, I will only disclose your information in situations where I am required or permitted to do so by law. This notice outlines how I may use and disclose your information and explains your rights regarding your privacy.

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How Your Information May Be Used or Disclosed

In most circumstances, everything we discuss in therapy is kept strictly confidential. However, there are a few exceptions to this rule, most of which are related to safety or legal requirements. I will always aim to talk with you first if a situation arises where I must disclose something.

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Here are some of the primary situations where disclosure may occur:

• Consultation and Supervision: I may consult with professional colleagues to ensure that you receive the best possible care. These conversations are confidential, and identifying details are minimized. All colleagues are held to the same legal and ethical standards of confidentiality.

• To Prevent Harm: If I believe you or someone else is in imminent danger, I may need to share information to protect safety. I am also required to report known or suspected abuse or neglect of children, elders, or vulnerable adults.

• Legal Requirements: If a court orders me to share information, or if I am otherwise legally required to do so (for example, in a criminal or civil case), I may need to release relevant records.

• As Required by Law: In certain situations, local, state, or federal law may require disclosure without your consent.

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These are the most common examples, but they are not exhaustive. In all other situations, I will request your written authorization before sharing any information. You can revoke your authorization at any time in writing, except where I’ve already acted on it.

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Your Rights Regarding Your Information

You have several important rights when it comes to your health and therapy information:

• Right to Inspect and Copy
  You can request to view or receive a copy of your health records. This request must be made in writing. There are some exceptions - particularly regarding psychotherapy notes, which are kept separately from the rest of your records.

• Right to Amend
  If you believe that something in your records is inaccurate or incomplete, you may request a correction or to add a written statement to your file. I will review your request and may deny it in certain cases, but I’ll explain my reasoning.

• Right to an Accounting of Disclosures
  You have the right to request a record of certain disclosures of your information made within the previous six years. Some disclosures, such as those you authorized or those made for treatment purposes, are not included in this list.

• Right to a Paper Copy
  You may request a paper copy of this notice at any time, even if you’ve previously agreed to receive it electronically.

• Right to Restrict Disclosure to Health Plans
  If you pay for services out of pocket in full, you may ask me not to share information about that service with your health insurance provider. I do not bill insurance directly, so your records will not be shared unless you specifically request documentation for reimbursement.

• Right to Designate a Representative
  If you have given someone legal authority to make health decisions on your behalf (such as a medical power of attorney), that person may exercise your privacy rights as well.

• Right to File a Complaint
  If you believe your privacy rights have been violated, you may file a complaint with me directly or with the U.S. Department of Health and Human Services:

  • Phone: 1-877-696-6775

  • Online: www.hhs.gov/ocr/privacy/hipaa/complaints

  • Mail: 200 Independence Avenue, S.W., Washington, D.C. 20201

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Filing a complaint will not affect the care you receive in any way. I will not retaliate against you for expressing concerns.

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My Responsibilities

I am legally required to:

• Protect the privacy of your PHI.

• Provide you with this notice outlining my legal duties and privacy practices.

• Follow the terms of this notice currently in effect.

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As the Privacy Officer for this practice, I maintain privacy policies and procedures and ensure that anyone working with me follows them. If this notice changes at any time, an updated version will be made available in my office and on my website.

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Electronic Records and Security

I keep your records securely on an encrypted computer, protected by passwords, firewalls, and antivirus software. I also maintain daily encrypted backups, which are stored securely in my office.

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While I make every reasonable effort to protect your information, no system is immune from risk. If there is ever a breach involving your protected health information, I will notify you promptly as required by law.

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No Marketing or Sale of Information

I do not and will never sell or market your personal information to third parties. Your confidentiality is the foundation of our work together.

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Questions or Concerns?

If you have any questions about this notice, your rights, or my privacy practices, please don’t hesitate to reach out. I’m happy to discuss any part of this with you.