HIPAA Notice of Privacy Practices
This notice describes how medical/mental health information about you may be used and disclosed, and how you can access this information. Please review it carefully.
Your Rights
You have the right to:
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Access your records – You can ask to see or receive a copy of your counseling record.
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Request corrections – You can ask us to correct information you believe is inaccurate or incomplete.
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Confidential communications – You can request that we contact you in a specific way (e.g., only by phone, not email).
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Receive a copy of this notice – You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.
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File a complaint – If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services (HHS). Filing a complaint will not affect your services.
Right to Confidentiality
At Quiet Mind Therapy, your privacy is of the utmost importance. What you share in counseling is kept confidential in accordance with professional ethics and federal and state laws.
General Rule
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Information disclosed in counseling sessions is confidential and will not be shared without your written consent.
Exceptions to Confidentiality
There are a few situations where the law and professional ethics require or permit disclosure without your permission:
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Imminent danger to self – If you are at risk of harming yourself.
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Imminent danger to others – If you threaten serious harm to another person.
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Abuse or neglect – If there is suspicion or disclosure of abuse or neglect of a child, elderly person, or vulnerable adult.
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Court order – If required by law or court order.
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Your written request as required to release information to a designated individual or organization.
Our Responsibilities
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We are required by law to maintain the privacy and security of your protected health information (PHI).
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We must follow the duties and privacy practices described in this notice and give you a copy upon request.
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We will not use or share your information other than as described here unless you give us written authorization. If you change your mind, you may revoke your authorization in writing at any time.
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Questions or Complaints
If you have questions about this notice, or if you wish to file a complaint, please contact:
📧 Email: clancy@quietmindtherapy.com
📞 Phone: 615-423-4140
You may also file a complaint with:
U.S. Department of Health and Human Services, Office for Civil Rights
📞 1-877-696-6775
🌐 www.hhs.gov/ocr/privacy/hipaa/complaints