notice of privacy practices

Monday Counseling and Consulting PLLC | Lindsey Smith, LCSWA | lindsey@mondaycounseling.org

Effective date: April 28, 2026

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 records of your care generated by this mental health care practice. It describes the ways I may use and disclose health information about you, your rights to the health information I keep about you, and my obligations regarding the use and disclosure of your health information.

I am required by law to:

• Keep protected health information ("PHI") that identifies you private.
• Provide you with this notice of my legal duties and privacy practices.
• Follow the terms of the notice 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 and on my website.

II. how I may use and disclose health information about you

The following categories describe different ways I use and disclose health information. Not every use or disclosure in a category will be listed, but all permitted uses and disclosures will fall within one of the categories below.

For treatment, payment, or health care operations. Federal privacy rules allow health care providers who have a direct treatment relationship with a patient/client to use or disclose personal health information without written authorization to carry out treatment, payment, or health care operations. For example, if I consult with another licensed health care provider about your condition, I may use and disclose your personal health information to assist in diagnosis and treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard because therapists and other health care providers need access to the full record to provide quality care. "Treatment" includes coordination and management of health care, consultations between providers, and referrals.

Lawsuits and disputes. If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order, subpoena, discovery request, or other lawful process — but only if efforts have been made to notify you about the request or to obtain a protective order.

III. certain uses and disclosures require your authorization

Psychotherapy notes. I do keep psychotherapy notes as defined in 45 CFR § 164.501. Any use or disclosure of such notes requires your written authorization unless the use or disclosure is:

• For my use in treating you.
• For my use in training or supervising mental health practitioners.
• For my use in defending myself in legal proceedings instituted by you.
• For use by the Secretary of Health and Human Services to investigate HIPAA compliance.
• Required by law.
• Required for certain health oversight activities.
• Required by a coroner performing duties authorized by law.
• Required to help avert a serious threat to the health and safety of others.

Marketing and sale of PHI. As a psychotherapist, I will not use or disclose your PHI for marketing purposes or sell your PHI in the regular course of business.

IV. certain uses and disclosures do not require your authorization

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

• When disclosure is required by state or federal law.
• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing a serious threat to health or safety.
• For health oversight activities, including audits and investigations.
• For judicial and administrative proceedings, including responding to a court or administrative order.
• For law enforcement purposes, including reporting crimes occurring on my premises.
• To coroners or medical examiners performing duties authorized by law.
• For research purposes.
• For specialized government functions, including military missions, intelligence operations, or safety of those in correctional institutions.
• For workers' compensation purposes.
• For appointment reminders and health-related benefits or services.

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 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.

VI. your rights with respect to your PHI

Right to request limits on uses and disclosures. 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 if I believe it would affect your health care.

Right to request restrictions for out-of-pocket expenses. You have the right to request restrictions on disclosures of your PHI to health plans for payment or operations purposes if the PHI pertains solely to a service you paid for out-of-pocket in full.

Right to choose how I send PHI to you. You have the right to ask me to contact you in a specific way or to send mail to a different address. I will agree to all reasonable requests.

Right to see and get copies of your PHI. Other than psychotherapy notes, you have the right to get an electronic or paper copy of your medical record and other information I have about you. I will provide a copy or summary within 30 days of your written request and may charge a reasonable, cost-based fee.

Right to get a list of disclosures. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or operations. I will respond within 60 days. The list covers disclosures made in the last six years. The first request each year is free; additional requests may incur a reasonable fee.

Right to correct or update your PHI. If you believe there is a mistake in your PHI or that important information is missing, you have the right to request a correction or addition. I may say no, but will explain why in writing within 60 days.

Right to a paper or electronic copy of this notice. You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it by email.

questions

If you have questions about this Notice or how your health information is handled, reach out at lindsey@mondaycounseling.org. You can also read about your right to a Good Faith Estimate of therapy costs, or see current session fees on the therapy cost page.