Notice of Privacy Practices

Practice Information

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 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 of the records of your care generated by this practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

Make sure that protected health information ("PHI") that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.

I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. How We Typically Use or Share Your Information

The following categories describe the most common ways we use and disclose health information for your care. For each category of uses or disclosures we explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed, described in detail, or illustrated in an example. Additional situations that either require or do not require your authorization are described in the sections below.

Treatment: We may use or disclose your PHI to provide, coordinate, or manage your mental health treatment and related services. For example, your psychotherapist may discuss details of your case within peer consultation to improve the quality of your care or to gain specialized clinical insight.

Payment: We may use and disclose your PHI so that we can bill and receive payment for the treatment and services provided to you. For example, if you choose to pay for services using a credit card, we may share a limited amount of your PHI (such as your name and the cost of the service) with our third-party payment processor. As another example, we may provide you with a superbill containing your PHI (including an applicable diagnosis) so that you can submit it to your insurance company in order to seek potential partial reimbursement for some of our services.

For Healthcare Operations: We may use and disclose your PHI to support our healthcare operations, including but not limited to the business and administrative activities of the practice. For example, we may enter your PHI into our electronic health record database for healthcare operations.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. If you sue a third party and claim mental health damages (such as "emotional distress" or "mental anguish"), your PHI may be subject to disclosure as your mental health has been placed "at issue" in the case. If we are required to disclose your PHI in a dispute involving you and a third party (such as a subpoena in a divorce or custody case), we will make efforts to notify you before any records are released. We may also use or disclose your health information to defend ourselves or to pursue legal remedies in any lawsuit or administrative proceeding arising from our professional relationship.

III. Certain Uses and Disclosures Require Your Authorization.

Psychotherapy Notes: I may keep "psychotherapy notes" separate from your clinical record and any use or disclosure of such notes requires your authorization unless the use or disclosure is:

a. For my use in treating you.
b. For my use in training or supervising associates to help them improve their clinical skills.
c. For my use in defending myself in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the session notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.

Marketing Purposes: As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

Sale of PHI: As a psychotherapist, I will not sell your PHI in the regular course of my business.

IV. Certain Uses and Disclosures Do Not Require Your Authorization:

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child abuse and neglect and abuse, neglect, or exploitation of an elder (60+) or incapacitated adult, or preventing or reducing a serious threat to anyone's health or safety.
To avert a serious threat to health or safety, I may disclose your PHI without your authorization if you communicate a specific and immediate threat of serious bodily injury or death against an identified or identifiable person. In accordance with Virginia law, I am required to take precautions to protect that third party, which may include notifying the potential victim, notifying law enforcement, or seeking your involuntary hospitalization.
To avert a serious threat to your own health or safety, I may disclose your PHI without your authorization to any person reasonably able to prevent or lessen the threat (including family members, emergency contacts, or law enforcement) if I have a good faith belief that you present a serious and imminent threat to your own health or safety.
If I asses that you are involved in a life-threatening emergency (including but not limited to a physical medical crisis, a suicidal crisis, or an overdose) and I cannot ask your permission, I may disclose the minimum necessary PHI to emergency personnel, law enforcement, or your designated emergency contact.
If you are a licensed healthcare professional, I am required by Virginia law to report to the Department of Health Professions if I believe your condition makes you unable to practice safely or if you pose a danger to yourself, your patients, or the public.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
For law enforcement purposes, including reporting crimes occurring on my premises.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the patients who received one form of care versus those who received another form of care for the same condition.
Specialized government functions, including but not limited to ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers' compensation laws.
Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

V. Certain Uses and Disclosures Require You to Have the Opportunity to Object:

Disclosures to family, friends, or others: I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

I may use or disclose health information to notify or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use of disclosures of your health information, I will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, I will disclose health information based on a determination using my professional judgment disclosing only health information that is directly relevant to the person's involvement in your healthcare. I will also use my professional judgment and my experience with common practice to make reasonable inferences in your best interest in allowing another person to pick up health information.

VI. You Have the Following Rights With Respect to Your PHI:

The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your health care.

The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

The Right to Choose How I Send PHI to You: You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.

The Right to See and Get Copies of Your PHI: You have the right to get an electronic or paper copy of your medical record and other health information I have about you, with the exception of psychotherapy notes. In accordance with Virginia law, I will provide you with a copy of your record, or a summary of it if you agree to receive a summary, within fifteen (15) days of receiving your written request. I may charge a reasonable, cost-based fee for the labor, supplies, and postage needed to fulfill your request, as permitted under Virginia and federal law. If I am unable to provide the records within this 15-day timeframe, I will notify you in writing of the reason for the delay.

The Right to Get a List of the Disclosures I Have Made: You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.

The Right to Correct or Update Your PHI: If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving your request.

The Right to Get a Paper or Electronic Copy of this Notice: You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

Right to Notification of a Breach: I am required by law to maintain the privacy of your PHI. In the event of any "breach" (the unauthorized acquisition, access, use, or disclosure) of your unsecured PHI, I will notify you as soon as possible, but no later than 60 days after the discovery of the breach, in accordance with federal and state law.

Enhanced Protections for Substance Use Disorder (SUD) Records: To the extent that we create, receive, or maintain substance use disorder patient records about you that are subject to 42 CFR Part 2, we will not use or share those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your specific written consent or a court order and a subpoena, as required by law.

V. Questions and Complaints

Questions: If you have any questions about our privacy practices or want more information, please contact our Privacy Officer, Melayna Schiff, directly at [email protected].

Complaints: If you believe your privacy rights have been violated, you may file a complaint with me or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

To ask a question or file a complaint with me: You may send an email to [email protected].

To file a complaint with the federal government: You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

Effective Date of This Notice

This notice is effective May 2, 2026.