Notice of Privacy Practices

Effective: April 28, 2026 · Required by HIPAA

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Our pledge regarding protected health information (PHI)

Therapy Practice is required by the Health Insurance Portability and Accountability Act (HIPAA) to maintain the privacy of your protected health information (PHI), provide you with this notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect.

How we may use and disclose your PHI

Without specific authorization, we may use or disclose your PHI for:

• Treatment — coordinating care with other providers when necessary.
• Payment — billing your insurance carrier for services.
• Healthcare operations — quality assurance, training, and routine practice management.

For most other uses or disclosures, we will obtain your written authorization. You may revoke that authorization at any time, in writing.

Disclosures we are required to make

Federal and state law require certain disclosures, including:

• To public health authorities for required reporting.
• To law enforcement or child / adult protective services when there is a reasonable suspicion of abuse or imminent harm.
• In response to a court order or subpoena (with appropriate notice and protective procedures).
• When you, or someone you have identified, present a serious and imminent threat to self or others.

Your rights under HIPAA

• Inspect & copy your PHI (with limited exceptions for psychotherapy notes).
• Request amendments to your PHI.
• Accounting of disclosures we have made for purposes other than treatment, payment, or operations.
• Request restrictions on certain uses or disclosures.
• Request confidential communications at alternative addresses or by alternative means.
• Receive a paper copy of this notice on request.
• File a complaint with us or with the U.S. Secretary of Health and Human Services without retaliation.

Psychotherapy notes

Process notes I keep separately from your medical record receive special protection under HIPAA. They will not be released without your specific written authorization, except as required by law.

Changes to this notice

We reserve the right to change this notice and to make the new notice apply to PHI we already have. Changes will be posted at this URL and made available in the office.

Contact & complaints

To exercise any right above or to file a complaint, contact:

Therapy Practice · Privacy Officer
hello@yourpractice.com · (555) 555-0100

You may also file a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights, at hhs.gov/ocr. We will not retaliate against you for filing a complaint.