Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

Effective Date: February 6, 2026

HIPAA NOTICE OF PRIVACY PRACTICES

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. MY PLEDGE REGARDING HEALTH INFORMATION

I understand that health information about you and your health care is personal. I am committed to protecting the health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements.

This Notice applies to all records of your care generated by this private psychotherapy practice. It describes the ways in which I may use and disclose health information about you, your rights regarding that information, and my legal obligations related to the use and disclosure of your health information.

I am required by law to:

  • Ensure that protected health information (“PHI”) that identifies you is kept private

  • Provide you with this Notice of my legal duties and privacy practices

  • Follow the terms of the Notice currently in effect

I reserve the right to change the terms of this Notice, and such changes will apply to all information I maintain about you. The updated Notice will be available upon request and on my website.

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

The following categories describe different ways that I may use and disclose health information. Not every possible use or disclosure is listed; however, all permitted uses and disclosures fall within these categories.

Except for disclosures made for treatment purposes, I make reasonable efforts to limit the use and disclosure of protected health information to the minimum necessary to accomplish the intended purpose.

For Treatment, Payment, or Health Care Operations

Federal privacy regulations allow health care providers with a direct treatment relationship to use or disclose protected health information without written authorization for treatment, payment, or health care operations.

For example, I may consult with another licensed health care provider regarding your condition to assist in diagnosis or treatment. Disclosures for treatment purposes are not limited to the minimum necessary standard, as providers require access to complete information in order to provide quality care.

Lawsuits and Disputes

If you are involved in a lawsuit or legal proceeding, I may disclose health information in response to a court or administrative order. I may also disclose information in response to a subpoena or other lawful process if efforts have been made to notify you or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

Psychotherapy Notes

Psychotherapy notes receive special protection under federal law. I do not use or disclose psychotherapy notes without your written authorization, except as permitted by law, including:

  • For my use in treating you

  • For training or supervising mental health practitioners

  • For my defense in legal proceedings initiated by you

  • For investigations by the Secretary of Health and Human Services

  • When required by law

  • To avert a serious threat to health or safety

Marketing Purposes

I do not use or disclose your protected health information for marketing purposes.

Sale of PHI

I do not sell your protected health information.

Fundraising

This practice does not engage in fundraising activities using protected health information.

IV. SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS

If your treatment includes services related to substance use, federal law provides additional protections for records identifying you as having or having had a substance use disorder.

Substance use disorder records may be used and disclosed for treatment, payment, and health care operations in accordance with federal law, including HIPAA and 42 C.F.R. Part 2.

These records may not be used or disclosed in criminal, civil, or administrative proceedings against you without a court order, except as permitted by law.

You have the right to revoke consent for disclosure of substance use disorder records at any time, unless the disclosure has already occurred.

Federal law prohibits discrimination against individuals based on the use of substance use disorder information.

V. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

Subject to legal limitations, I may use or disclose your protected health information without authorization for:

  • Compliance with state or federal law

  • Public health and safety activities, including mandatory reporting

  • Health oversight activities

  • Judicial and administrative proceedings

  • Law enforcement purposes

  • Coroners or medical examiners

  • Workers’ compensation claims

  • Appointment reminders and treatment-related communications

VI. YOUR RIGHTS REGARDING YOUR PHI

You have the right to:

  • Request limits on uses and disclosures of your PHI (I am not required to agree in all cases)

  • Request restrictions for services paid for in full out-of-pocket

  • Request confidential communications

  • Inspect and obtain a paper or electronic copy of your record (excluding psychotherapy notes) within 30 days

  • Request corrections to your PHI

  • Receive an accounting of certain disclosures

  • Receive a paper or electronic copy of this Notice

  • Be notified if a breach occurs that may have compromised your information

VII. COMPLAINTS

If you believe your privacy rights have been violated, you may contact:

Grief Counseling and Therapeutic Services, LLC
Phone: (563) 343-0500
Email: QCgriefcounseling@proton.me

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

This Notice of Privacy Practices is available on this website and upon request.