I. OUR COMMITMENT TO YOUR HEALTH AND PRIVACY: We understand that your health information is personal and private. We are committed to protecting your health information and will create a record of the care and services you receive from us to provide you with quality care and to comply with certain legal requirements. This Notice (“Notice”) applies to all of the records of your care generated by this practice and details how we may use and disclose health information about you. This notice will also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:


● Make sure that protected health information (“PHI”) that identifies you is kept private.
● Give you this notice of our legal duties and privacy practices with respect to health information.
● Follow the terms of the notice that is currently in effect.

● We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office.

The following describes some of the different ways that we use and disclose health information. Although we will explain and give examples of each, not every use or disclosure permitted by law will be listed or addressed.
A. Use/Disclosure For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of any healthcare provider without your written authorization. For example, if a health care provider were to consult with another licensed healthcare provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the health care provider in diagnosis and treatment of your condition. Disclosures for treatment purposes are not limited to the minimum necessary standard. Because other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

B. Use/Disclosure for Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. 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 efforts have been made to tell you about the request or to obtain an order protecting the information requested.


1. Session Notes: We do keep “Session notes” and any use or disclosure of such notes requires yourAuthorization, unless the use or disclosure is:
a. For our use in treating you.
b. For our use in training or supervising associates to help them improve their clinical skills.c. For our use in defending ourselves in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate our compliance withHIPAA.
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 session 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 yourself and/or others.
‍2. Marketing Purposes. We will not use or disclose your PHI for marketing purposes.
3. Sale of PHI Prohibited. We will not sell your PHI in the regular course of our business.

Subject to certain limitations, we can use and disclose your PHI without your Authorization and may even be compelled to do by law, 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 and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
5. For law enforcement purposes, including reporting crimes occurring on the premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the patients who received one form of care versus those who received another form of care for the same condition.
8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although we seek to obtain notice and prior authorization from you, we may provide your PHI in order to comply with workers’ compensation laws .
10. Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with me. We may also use and disclose yourPHI to tell you about treatment alternatives, or other health care services or benefits that we offer.

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us to cease use or disclosure of certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request and may refuse your request, including if necessary to comply with enforceable legal order or directive.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request 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 to contact you in a specific way (for example, home or office phone) 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 “session notes,” you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30days of receiving your written request, and we may charge a reasonable, cost based fee for doing so.
5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or healthcare operations, or for which you provided me with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that apiece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. We may say refuse your request and provide a written explanation of that decision within 60 days of receipt of the request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to a paper copy or e-mail copy of this Notice available upon written request, regardless of method of initial delivery.