NOTICE OF PRIVACY PRACTICES
Effective Date: 4/1/26
My Commitment to Your Privacy
Your health information is personal, and I take that seriously. I create records of your care in order to provide quality treatment and meet legal requirements. I am required by law to:
- Keep your protected health information (PHI) private.
- Give you this Notice explaining how I use it.
- Follow the terms of this Notice while it is in effect.
I may update this Notice at any time. Changes apply to all existing records. The current version is always available in my office and on my website.
How I Use Your Health Information
For Your Care: I use your information to treat you and coordinate your care. For example, I may consult with another provider about your condition. Providers involved in your care may access your full record — this is necessary to give you quality treatment.
For Billing and Operations: I use your information to bill your insurance, process payments, send appointment reminders, and handle routine practice operations like sending invoices.
When the Law Requires It: I may share your information without your permission when legally required, including,
- Reporting suspected child, elder, or dependent adult abuse.
- Responding to a court order, subpoena, or law enforcement request.
- Public health and safety activities (e.g., preventing a serious threat to someone’s life).
- Government oversight, audits, or investigations of my practice.
- Workers’ compensation (I prefer to get your permission first).
- Coroners or medical examiners performing their lawful duties.
- Research (subject to privacy protections and ethical review).
With People Involved in Your Care: I may share relevant information with a family member, friend, or caregiver you identify — unless you tell me not to. In an emergency, I may share what is necessary to protect your safety and ask your permission afterward.
What Always Requires Your Written Permission
Psychotherapy Notes: I keep detailed psychotherapy notes separate from your general record. I will not share these without your written authorization, except in a narrow set of situations required by law — such as a serious safety threat, a court order, or a government audit of my HIPAA compliance.
Marketing: I will never use your information for marketing without your signed authorization. If I ever ask to use a review or testimonial publicly, I will send you a HIPAA authorization form first — even if you don’t think your review contains personal health details.
Sale of Your Information: I will never sell your health information.
Your Rights
You have the right to:
- See and get a copy of your records.
- Ask me to correct errors in your records. I will respond within 60 days.
- Request limits on how I use or share your information. I may not always agree, but I must honor your request for services you paid for fully out-of-pocket.
- Choose how I contact you (e.g., only by email, or at a specific address).
- Get a list of disclosures I have made outside of treatment and billing. I will respond within 60 days (free once per year).
- Appoint someone to act on your behalf if you have given them medical power of attorney or legal guardianship.
- Revoke a permission you previously gave me — in writing. This won’t undo what was already shared.
- Opt out of non-essential communications from my practice.
- Get a paper or email copy of this Notice at any time.
- File a complaint if you feel your rights were violated (see Section 6). I will never retaliate against you for doing so.
If you believe your privacy rights have been violated, please contact me first using the information at the top of this Notice. You may also file a complaint directly with U.S. Dept. of Health and Human Services:
U.S. Dept. of Health & Human Services — Office for Civil Rights 200 Independence Ave. S.W., Washington, D.C. 20201 Phone: (877) 696-6775 | hhs.gov/ocr/privacy/hipaa/complaints |
I will never retaliate against you for filing a complaint.
Acknowledgment of Receipt
By signing below, I confirm that:
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