Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES
Effective Date: March 9, 2026 (revised from prior version)
Your privacy is deeply important to this practice. Therapy is built on trust, and protecting the confidentiality of your personal information is a central part of ethical and professional care. This Notice explains how your health information may be used, how it is protected, and the rights you have regarding that 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
Self-Love Counseling, LLC understands that health information about you and your health care is personal. I am committed to protecting your health information. 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 mental health practice. This Notice describes the ways in which I may use and disclose health information about you. It also describes your rights regarding the health information I keep about you and certain obligations I have regarding the use and disclosure of that information.
I am required by law to:
• Maintain the privacy of your protected health information (“PHI”).
• Provide you with this Notice of my legal duties and privacy practices with respect to your PHI.
• Comply with the terms of this Notice currently in effect.
• Notify you if a breach occurs that may have compromised the privacy or security of your health information.
I may change the terms of this Notice at any time. Any changes will apply to all information I maintain about you. A revised Notice will be available in my office and on my website.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that I may use and disclose health information. Not every use or disclosure in a category will be listed; however, all permitted uses and disclosures will fall within one of these categories.
For Treatment, Payment, or Health Care Operations:
Federal privacy rules allow health care providers who have a direct treatment relationship with the patient to use or disclose the patient’s health information without written authorization in order to carry out treatment, payment, or health care operations.
For example, I may disclose your health information to another licensed health care provider for consultation regarding your diagnosis or treatment.
For treatment purposes, health care providers may share relevant information as necessary to provide appropriate care. Treatment includes coordination or management of care with another provider, consultation between providers, and referrals for health care services.
Except in cases of treatment where full information may be necessary to provide appropriate care, I will generally share only the minimum necessary information required for the purpose of the disclosure.
Lawsuits and Disputes:
If you are involved in a lawsuit or legal proceeding, I may disclose health information in response to a court or administrative order. I may also disclose health information in response to a subpoena, discovery request, or other lawful process if certain legal requirements have been met, such as efforts to notify you or to obtain a protective order.
If I provide services to a minor, I may disclose certain health information to a parent or legal guardian as permitted or required by law. In some circumstances, state law allows minors to consent to their own treatment, and in those cases I may be required to limit disclosure of information to parents or guardians. I will follow applicable state and federal laws when determining whether such disclosures are appropriate.
When working with minors, parents or legal guardians may have certain rights to access their child’s treatment information as permitted by law. However, I may limit the sharing of certain information when allowed by law and when I believe it is clinically appropriate in order to support the minor’s privacy and the effectiveness of treatment.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION
Psychotherapy Notes:
I may keep “psychotherapy notes” as defined in 45 CFR §164.501. Psychotherapy notes are notes kept separately from the rest of your medical record that document or analyze the contents of conversation during a counseling session.
Any use or disclosure of psychotherapy notes requires your written authorization except when:
a. Used by me for your treatment
b. Used for training or supervision of mental health practitioners
c. Used in my defense in legal proceedings initiated by you
d. Used by the Secretary of Health and Human Services to investigate compliance with HIPAA
e. Required by law
f. Required for certain health oversight activities
g. Required by a coroner or medical examiner
h. Necessary to prevent a serious threat to health or safety
Marketing Purposes:
I will not use or disclose your PHI for marketing purposes without your written authorization.
Sale of PHI:
I will not sell your protected health information.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE AUTHORIZATION
Subject to certain limitations in the law, I may use or disclose your PHI without your authorization for the following purposes:
• When disclosure is required by federal or state law
• For public health activities, including reporting suspected abuse or neglect
• To prevent or reduce a serious and imminent threat to health or safety
• For health oversight activities such as audits or investigations
• For judicial or administrative proceedings
• For law enforcement purposes as required by law
• To coroners or medical examiners
• For research purposes under strict legal protections
• For specialized government functions
• For workers’ compensation claims
• For appointment reminders and information about treatment alternatives or services
V. USES AND DISCLOSURES WHERE YOU HAVE THE OPPORTUNITY TO OBJECT
Disclosures to Family, Friends, or Others Involved in Your Care:
I may share your PHI with a family member, friend, or another person involved in your care or payment for your care unless you object. In emergency situations where you cannot consent, I will use professional judgment to determine whether the disclosure is in your best interest.
VI. SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS
Federal law provides additional protections for records related to substance use disorder treatment in certain circumstances (42 CFR Part 2). If I create or maintain records specifically related to substance use disorder diagnosis, treatment, or referral, those records may receive additional protections beyond those described in this Notice.
VII. YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding your protected health information:
Right to Request Limits on Uses and Disclosures
Right to Request Restrictions for Out-of-Pocket Expenses Paid in Full
Right to Request Confidential Communications
Right to Access and Obtain Copies of Your Records (excluding psychotherapy notes)
Right to Request Amendments to Your Records
Right to Receive an Accounting of Disclosures
Right to Receive a Paper or Electronic Copy of This Notice
Requests to exercise these rights should be submitted in writing to Self-Love Counseling, LLC.
VIII. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Self-Love Counseling, LLC or with the U.S. Department of Health and Human Services Office for Civil Rights.
You will not be penalized or retaliated against for filing a complaint.
ACKNOWLEDGEMENT
By accessing or using this website, you acknowledge that you have been provided access to this Notice of Privacy Practices.
If you would like a copy of this Notice or have questions about privacy practices, please contact Self-Love Counseling, LLC via email at amber@selflovecounselingllc.com.