HIPPA Privacy Policy
I. Introduction
This Notice of Privacy Practices describes how Space for Me Therapy may use and disclose your Protected Health Information (PHI) to provide you with therapy services. It
also describes your rights regarding your PHI. We are committed to protecting the privacy of your health information and to following all applicable laws and regulations,
including the Health Insurance Portability and Accountability Act (HIPAA).
II. What is Protected Health Information (PHI)?
PHI is any information that could be used to identify you, such as your name, address, date of birth, Social Security number, or other unique identifying information, and that
relates to your past, present, or future physical or mental health condition, or the provision of care.
III. How We May Use and Disclose Your PHI
• For Treatment:
We may use and disclose your PHI to provide you with therapy services, which includes diagnosis, counseling, and treatment planning.
• For Payment:
We may use and disclose your PHI to obtain payment for services from you or your insurance company.
• For Healthcare Operations:
We may use and disclose your PHI for administrative, business, and other healthcare operations, such as quality assurance, credentialing, and auditing.
• With Your Authorization:
We will not use or disclose your PHI for any purpose other than treatment, payment, or healthcare operations without your written authorization.
Exceptions:
We may disclose your PHI without your authorization in certain circumstances, such as:
◦ Legal Requirements: When required by law, such as a court order or subpoena.
◦ Public Health: To prevent or control disease, injury, or disability, or to report child abuse or neglect.
◦ To Avert a Serious Threat: If we reasonably believe that you pose a serious threat to yourself or others.
◦ To Family Members or Others Involved in Your Care: With your consent or when it is in your best interest, we may discuss your care with family members or others
involved in your care.
◦ Psychotherapy Notes: We will not use or disclose your psychotherapy notes without your written authorization, except as permitted by law.
IV. Your Rights Regarding Your PHI
• Right to Request Restrictions: You may request that we limit the use and disclosure of your PHI. We will consider your request and attempt to accommodate it to the extent possible.
• Right to Access Your PHI: You have the right to request access to your PHI, with certain exceptions.
• Right to Request Amendment: You may request that we amend your PHI if you believe it is inaccurate or incomplete.
• Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your PHI.
• Right to Receive a Copy of this Notice: You have the right to receive a copy of this Notice of Privacy Practices.
• Right to Revoke Authorization: You may revoke your authorization to use or disclose your PHI, except to the extent that we have already relied on the authorization.
V. Contact Information
If you have any questions or concerns about your privacy rights or this Notice of Privacy Practices, please contact Space for Me Therapy at (480)841-5827 or megancox@spaceformetherapy.com.
VI. Changes to this Notice
We reserve the right to change this Notice of Privacy Practices. We will post any changes to this Notice on our website and will provide you with a revised copy upon
request.
VII. Compliance
We are committed to complying with all applicable HIPAA regulations. We will take reasonable steps to ensure that your PHI is protected and that your privacy rights are
respected.
VIII. Psychotherapy Notes
• Definition:Psychotherapy notes are notes that are separate from the rest of your medical record and contain a more detailed record of our therapy sessions.
• Use and Disclosure:
We will not use or disclose your psychotherapy notes without your written authorization, except as permitted by law.
