Privacy Policy

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. YOU MAY HAVE ADDITIONAL RIGHTS UNDER STATE AND LOCAL LAW. PLEASE SEEK LEGAL COUNSEL FROM AN ATTORNEY LICENSED IN YOUR STATE IF YOU HAVE QUESTIONS REGARDING YOUR RIGHTS TO HEALTH CARE INFORMATION.

EFFECTIVE DATE: 1/5/2026

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information (PHI).

I. MY PLEDGE REGARDING HEALTH INFORMATION

I understand that health information about you and your health care is personal, and I am committed to protecting it. I create a record of the care and services you receive to:

  • Provide quality care
  • Comply with legal requirements

This notice applies to all records generated by this mental health care practice. It explains:

  • How I may use and disclose your PHI
  • Your rights to your health information
  • My legal obligations regarding PHI

I am required by law to:

  • Keep PHI that identifies you private
  • Provide this notice of my legal duties and privacy practices
  • Follow the terms of this notice currently in effect

I may change the terms of this Notice; new versions will apply to all your information and will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION

Treatment, Payment, or Health Care Operations

I may use or disclose your PHI without written authorization to:

  • Provide treatment (including consulting with other providers)
  • Coordinate care or referrals
  • Carry out health care operations (e.g., billing, appointment reminders)

Note: Disclosures for treatment purposes are not limited to the minimum necessary standard.

Lawsuits and Disputes

PHI may be disclosed in response to:

  • Court or administrative orders
  • Subpoenas, discovery requests, or lawful processes, after efforts to notify you or seek protection of the information

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

  1. Psychotherapy Notes
    I maintain psychotherapy notes as defined in 45 CFR § 164.501. Use or disclosure requires your authorization unless for:
    • My treatment of you
    • Training or supervision of mental health practitioners
    • Legal defense
    • Compliance investigations by HHS
    • Required law or health oversight
    • Coroner duties
    • Averting serious threats to health or safety
  2. Marketing Purposes
    Your PHI will not be used for marketing without written consent. For example, sharing a review that contains PHI requires HIPAA authorization. You may withdraw consent at any time.
  3. Sale of PHI
    I will not sell your PHI.

IV. USES AND DISCLOSURES THAT DO NOT REQUIRE AUTHORIZATION

PHI may be used/disclosed without your authorization for:

  1. Appointment reminders and health-related benefits or services
  2. Legal requirements under state or federal law
  3. Public health activities (e.g., abuse reporting, preventing health threats)
  4. Health oversight activities (audits, investigations)
  5. Judicial and administrative proceedings
  6. Law enforcement purposes
  7. Coroners or medical examiners
  8. Research purposes
  9. Specialized government functions (military, intelligence, executive protection)
  10. Workers’ compensation compliance
  11. Organ and tissue donation requests

V. CERTAIN USES AND DISCLOSURES REQUIRE YOUR OPPORTUNITY TO OBJECT

You may direct me not to share PHI with:

  • Family
  • Friends
  • Others involved in your care or payment
  • Disaster relief situations

Note: In emergencies or if unconscious, consent may be obtained retroactively.

VI. YOUR RIGHTS REGARDING PHI

  1. Request Limits on Use/Disclosure – You can request restrictions; I may decline if it affects care.
  2. Request Restrictions for Paid-Out-of-Pocket Services – You can request PHI not be shared with health plans.
  3. Choose How PHI is Sent – Requests for specific communication methods will be honored.
  4. Access PHI – You may request copies or summaries of your record within 30 days; fees may apply.
  5. Accounting of Disclosures – You can request a list of disclosures (past six years); fees may apply for multiple requests.
  6. Correct or Update PHI – You may request corrections; I will respond in writing within 60 days.
  7. Receive Paper/Electronic Copy of Notice – You may request a paper copy even if emailed.
  8. Choose Someone to Act For You – Legal representatives may act on your behalf.
  9. Revoke Authorization
  10. Opt Out of Communications/Fundraising
  11. File a Complaint – You may contact me or the HHS Office for Civil Rights (www.hhs.gov/ocr/privacy/hipaa/complaints) without retaliation.

VII. CHANGES TO THIS NOTICE

I may change the terms of this notice at any time. New versions will apply to all information and will be available:

  • Upon request
  • In my office
  • On my website

Talin Khechoomian, LCSW
info@therapywithtalin.com
747-977-1674

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