HIPAA Notice of Privacy Practices
Effective Date: 9/1/2107
This Notice describes how medical and mental health information about you may be used and disclosed, and how you can access this information. Please review it carefully.
Our Responsibilities
We are required by law to:
Maintain the privacy of your protected health information (PHI)
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of this Notice currently in effect
Notify you if a breach occurs that may compromise your information
How We May Use and Disclose Your Information
We may use or disclose your PHI without your written authorization for the following purposes:
Treatment
To provide, coordinate, or manage your mental health care, including telehealth services and consultation with other providers involved in your care.
Payment
To bill and collect payment from insurance companies, third-party payers, or you directly for services rendered.
Health Care Operations
For practice operations such as documentation, supervision, quality review, billing support, and legal compliance.
Other Uses and Disclosures Permitted or Required by Law
We may disclose your information without your authorization when required or permitted by law, including:
To prevent a serious and imminent threat to your safety or others
Reports of abuse, neglect, or domestic violence
Court orders, subpoenas, or lawful requests
Workers’ compensation claims
Public health and law enforcement activities
Uses Requiring Written Authorization
All other uses or disclosures of your PHI require your written authorization, including:
Release of records to third parties not involved in treatment or payment
Marketing purposes
You may revoke your authorization at any time in writing.
Your Rights
You have the right to:
Access and obtain a copy of your records
Request corrections to your records
Request restrictions on certain uses or disclosures
Request confidential communications
Receive a paper copy of this Notice
Be notified of a breach
File a complaint without retaliation
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Practice Contact:
Sally Bennett, LCSW
Email: sally@therapywithsallyb.com
U.S. Department of Health & Human Services (HHS):
https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Changes to This Notice
We reserve the right to change this Notice. Any changes will apply to all information we maintain and will be posted on this website.