As mandated by the Health Insurance Portability and Accountability Act (HIPAA), you are entitled to specific rights concerning the privacy and use of your Protected Health Information (PHI). HIPAA also requires that I provide you with a document outlining how your PHI may be used or shared for treatment, billing, and healthcare operations. Your signature is required to confirm that you have received this notice.

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• All communication between a patient and provider is confidential and cannot be shared without your verbal or written consent—except in specific situations, including:

• If a court issues an order requesting information.

• If you bring up your mental or emotional health in a legal case, like a workers’ compensation claim.

• If I believe there is a risk that you might harm yourself or someone else.

• If there is suspicion of abuse or neglect involving a child or elderly individual.

• If you submit a treatment claim to your insurance provider, they will be given your diagnosis.

• If you fail to pay your account and no payment arrangement is made, a collections agency will receive limited billing information.

In such cases, I will inform you of the legal requirements and discuss the matter with you before any information is disclosed. Occasionally, I may consult with other professionals or staff—all of whom are bound by the same confidentiality rules and have received privacy training.

You consent to allow open communication with other professionals involved in your care. For adolescents, I may discuss general treatment topics with parents, but specific details will only be shared with the adolescent’s permission.

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Medical Records

Your electronic medical file will include your diagnosis, treatment goals and progress, personal history, and records from other providers. It may also contain billing details and permission forms. You can request to view or receive a copy of your records in writing, unless doing so might pose a risk to you. In such cases, you may receive a summary or have your records sent to another provider or your attorney.

You may opt to receive appointment reminders via text or email, though these methods are not entirely secure and may be intercepted. You can opt out of such notifications at any time. No personal mobile data will be shared with third parties for marketing or promotional purposes.

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Your Rights

Under HIPAA, you have the right to:

• Request changes to your medical record.

• Restrict the sharing of your information.

• Receive a list of disclosures made without your permission.

• Choose where your information is sent.

• File complaints about privacy policies and have them recorded.

• Request a paper copy of this policy.

I am happy to discuss these rights in detail with you.

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Minors and Parents

For patients under 18 who are not legally emancipated, parents have the right to review treatment records and control the release of that information.

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Insurance​

I do not work directly with insurance companies. If you seek reimbursement yourself, be aware that insurers often require details such as diagnoses, treatment plans, or even full records. Such information will only be released with your signed authorization specifying what is shared, with whom, for what purpose, and for how long.

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This policy follows HIPAA regulations. A copy is available upon request.