Notice of Privacy Practices (HIPAA)

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

Our Duties

We are required by law to maintain the privacy of your protected health information (PHI), provide this Notice, and abide by its terms.

How We May Use and Disclose PHI

### Without your written authorization, for:

**Treatment** — coordination with other providers.

**Payment** — billing and collection for your therapy.

**Healthcare Operations** — quality improvement, staff training, internal audits.

**As Required by Law** — court orders, mandated reporting (abuse/neglect), public health.

**To Prevent Serious Harm** — if necessary to avert a serious threat to you or others.

### With your written authorization:

Any other use or disclosure requires your written authorization, which you may revoke at any time.

Your Rights

You have the right to:

• **Request restrictions** on how your PHI is used. We will consider but are not required to agree.

• **Receive confidential communications** at a particular address or by a particular means.

• **Inspect and copy** your records, with limited exceptions.

• **Amend** your records if you believe information is incorrect.

• **Receive an accounting** of certain disclosures.

• **Receive a paper copy** of this Notice on request.

• **File a complaint** with us or with the U.S. Department of Health and Human Services. We will not retaliate.

How to Exercise Your Rights

Submit requests in writing to office@siblingcarecounseling.com or (305) 505-2381.

Privacy Officer

[Privacy Officer Name], office@siblingcarecounseling.com

Changes to This Notice

We reserve the right to change this Notice. Updates apply to all PHI we maintain. Revised notices will be posted on our website.

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⚠️ STARTER TEMPLATE — replace before accepting real patient data. The U.S. Department of Health and Human Services publishes model notices at https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/model-notices-privacy-practices/index.html