Notice of Privacy Practices (HIPAA)

As a Licensed Professional Counselor in Virginia, Maine, Connecticut, and Vermont, I create and maintain treatment records that contain individually identifiable health information about you. This Notice describes how your information is protected, used, and disclosed. I reserve the right to change the terms of this Notice at any time. Any updated Notice will apply to all information I maintain and will be made available on my website or by request.

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Uses and Disclosures of Information Without Your Authorization

 

Federal privacy rules allow me to use or disclose your protected health information (PHI) without written authorization in order to provide treatment, obtain payment, conduct healthcare operations, and facilitate coordination with other providers involved in your care.

 

This practice operates exclusively via secure telehealth. Electronic transmission of health information (video, audio, electronic health records, and billing systems) is protected under HIPAA. While all reasonable safeguards are used, no electronic system can guarantee absolute confidentiality.

 

 

Notice of Privacy Practices – How We May Use or Share Your PHI

 

PHI may be used or shared for:

 

• Treatment and care coordination
• Billing, insurance reimbursement, and claim processing
• Healthcare operations such as quality review, supervision, or auditing

 

PHI may be shared when required by law, including:

 

• Mandated reporting of abuse or neglect
• Serious threats of harm to self or others
• Court orders or legal processes
• Public health or government agency requests

 

Psychotherapy Notes:

 

Psychotherapy notes are kept separate from the general clinical record and have additional protections under HIPAA. They will not be released without your written authorization unless required by law.

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Minimum Necessary Standard:

For non-treatment-related disclosures, only the minimum necessary information will be shared.

 

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State-Specific Confidentiality Requirements

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Virginia – Minor Consent (§54.1-2969)

 

Minors may consent to outpatient mental health treatment in certain circumstances. When minors consent independently, parental access to records may be limited.

 

Maine – Title 34-B §1207

 

Maine provides enhanced protection for mental health records. Some disclosures require written authorization even when HIPAA would otherwise allow them.

 

Connecticut

 

Connecticut law includes additional confidentiality protections for reproductive health information, HIV-related information, and mental health records. Additional consent may be required before disclosure.

 

Vermont – 18 V.S.A. §7103

 

Vermont law imposes heightened confidentiality protections that may limit disclosures beyond HIPAA requirements.

 

 

Your Right to Request Restrictions

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You may request limits on how your PHI is used or shared. I am not required to agree unless the service is paid in full out-of-pocket and you request that related information not be sent to your insurer.

 

 

Other Uses and Disclosures Requiring Authorization

 

For any purpose not described in this Notice, your written authorization is required before releasing PHI.
You may revoke authorization at any time in writing, and revocation applies to future disclosures only.

 

 

Client Rights and Therapist Responsibilities

 

You Have the Right To:

 

• Receive a copy of your paper or electronic mental health record
• Request corrections to your record
• Request confidential or alternative forms of communication
• Ask us to limit the information we share
• Obtain a list of disclosures made (excluding routine treatment, billing, operations, or psychotherapy notes)
• Receive a copy of this Notice
• Choose someone to act on your behalf (healthcare proxy or legal guardian)
• File a complaint if you believe your privacy rights have been violated

 

My Responsibilities:

 

• Maintain the privacy and security of your PHI
• Notify you promptly if a breach occurs that may compromise your information
• Follow the practices described in this Notice
• Provide you with a copy of this Notice upon request

 

 

Electronic Communications Outside the Telehealth Platform

 

Email, text messaging, and other non-encrypted communication methods may not be fully secure. You may request alternative methods of confidential communication at any time.

 

 

Substance Use Disorder (SUD) Information – 42 CFR Part 2

 

If applicable, SUD treatment records are protected by strict federal law and cannot be released without your written consent except in rare circumstances permitted by statute. Any authorized release must include a statement prohibiting redisclosure.

 

 

Reproductive Health Information

 

We will not disclose reproductive health information to law enforcement without your written authorization or a valid court order. Federal HHS rules prohibit using PHI for investigations related to lawful reproductive healthcare.

 

 

Insurance Billing Consent

 

By choosing to use your insurance benefits, you acknowledge and agree that:

 

• Insurance requires a mental health diagnosis to process claims
• Insurers may request clinical information such as symptoms, diagnoses, and progress summaries
• Only the minimum information necessary will be provided to obtain payment
• Claims, once submitted, cannot be withdrawn or deleted
• You are responsible for deductibles, copayments, coinsurance, and non-covered services
• You may opt for private pay if you prefer increased privacy
• You are financially responsible for services if insurance denies payment
• You must notify the therapist and insurer of insurance changes before your session
• Telehealth coverage varies by insurer and plan

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Business Associate (BA) Disclosure

 

Business Associates may assist with billing, scheduling, telehealth systems, or electronic recordkeeping. All BAs are legally required to safeguard your PHI.

 

 

Complaints

 

If you believe your privacy rights have been violated, you may file a complaint with Graceful Changes Psychotherapy (GracefulChanges757@gmail.com) or with the U.S. Department of Health and Human Services:

 

U.S. Department of Health & Human Services
150 S. Independence Mall West – Suite 372
Philadelphia, PA 19106-3499
(215) 861-4441 | (215) 861-4440 (TDD)
(215) 861-4431 (Fax)

 

If you have questions or concerns about this Notice, please contact me. I am pleased to be of service to you.