HIPAA NOTICE OF PRIVACY PRACTICES

Effective Date: 04/06/2025; Updated 7/21/2026

I understand that information about you and your health care is personal. I am committed to protecting your privacy. I create and maintain records of the care and services you receive, and these records are necessary for providing quality treatment and complying with legal requirements.

This Notice describes how I may use and disclose your protected health information (“PHI”), your rights regarding your PHI, and my legal obligations.

I am required by law to:

  • Ensure that PHI identifying you is kept private

  • Provide you with this Notice of Privacy Practices

  • Follow the terms of the Notice currently in effect

  • Inform you that I may change this Notice at any time, and that changes will apply to all information I maintain

  • Updated Notices will be available upon request and in my office.

I. How I May Use and Disclose Your PHI

Treatment, Payment, and Health Care Operations

I may use or disclose your PHI without written authorization for treatment, payment, and health care operations. This includes consultations with other licensed providers, coordination of care, referrals, billing, and administrative functions. Disclosures for treatment purposes are not subject to the “minimum necessary” standard.

Legal Proceedings

If you are involved in a legal matter, I may disclose PHI in response to a court or administrative order. I may also respond to subpoenas or discovery requests after reasonable efforts to notify you or obtain protective measures.

II. Uses and Disclosures Requiring Your Authorization

Psychotherapy Notes

I maintain psychotherapy notes as defined by 45 CFR §164.501. These notes require your written authorization for use or disclosure except when:

  • Used by me (the originator of the notes) for your treatment

  • Used for training or supervision

  • Needed for my legal defense

  • Required by the Secretary of Health and Human Services

  • Required by law (such as mandatory reporting or court orders)

  • Needed for health oversight activities (such as licensing board reviews or audits)

  • Required by a coroner or medical examiner

  • Necessary to prevent a serious and imminent threat to health or safety, consistent with applicable law and ethical standards

Marketing

I will not use or disclose your PHI for marketing purposes.

Sale of PHI

I will not sell your PHI.

III. Uses and Disclosures Not Requiring Authorization

I may use or disclose your PHI without authorization when permitted or required by law, including:

  • Reporting suspected abuse or neglect

  • Public health activities (such as disease reporting, preventing or controlling illness, or organ donation activities)

  • Health oversight activities (such as audits, investigations, or licensing reviews)

  • Judicial or administrative proceedings

  • Law enforcement purposes

  • Coroner or medical examiner duties

  • Approved research

  • Specialized government functions (including military, national security, and protective services)

  • Workers’ compensation compliance

  • Disaster relief efforts

  • Appointment reminders or information about treatment alternatives

  • Averting a serious threat to health or safety

IV. Uses and Disclosures Requiring an Opportunity to Object

I may disclose PHI to family members, friends, or others involved in your care or payment unless you object. In emergencies, I may disclose relevant information and obtain your consent afterward.

V. Your Rights Regarding Your PHI

1. Requesting Restrictions

You may request limits on how your PHI is used or disclosed for treatment, payment, or operations. I may decline if the restriction would affect your care.

2. Restricting Disclosures to Health Plans

If you pay for a service in full and out of pocket, you may request that PHI related to that service not be disclosed to your health plan.

3. Confidential Communications

You may request that I contact you in a specific way (e.g., a particular phone number or mailing address). I will accommodate reasonable requests.

4. Inspecting and Obtaining Copies

You may request an electronic or paper copy of your record (excluding psychotherapy notes). I will provide it within 30 days and may charge a reasonable, cost‑based fee.

5. Accounting of Disclosures

You may request a list of disclosures made in the past six years, excluding those for treatment, payment, operations, or those you authorized. I will respond within 60 days.

6. Amending Your PHI

If you believe your PHI is incorrect or incomplete, you may request an amendment. I may deny the request but will explain why in writing within 60 days.

7. Copy of This Notice

You may request a paper or electronic copy of this Notice at any time.

VI. Filing Complaints About Privacy Practices

You may file a complaint if you believe your privacy rights have been violated. You can:

Contact me directly using the information below

File a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights

You will not be penalized for filing a complaint.

VII. Contact Information

If you have questions about this Notice or wish to exercise your privacy rights, you may contact:

Katie Stiteley at 8GK Consulting, LLC

Phone: (920) 445-9723

Email: info@8GKConsulting.com

Address: 677 Baeten Rd, Ste 201, Green Bay, WI 54304

VIII. State‑Specific Requirements

Florida (Applies to Clients Seen in Florida)

Record Retention

I am required to maintain your records for at least 7 years after your last date of service.

Confidentiality – Florida Statute 456.057

Your records are confidential and may not be released without your written authorization, except as permitted by law.

Practice Closure, Relocation, or Death

If I close or relocate my practice and am no longer available to clients, or in the event of my death: A notice will be published in the newspaper of greatest general circulation in the county once a week for 4 consecutive weeks

The notice will include the date of closure/relocation and the location where records will be availableRecords will be maintained for 2 years after closure or death

Michigan (Applies to Clients Seen in Michigan)

Record Retention Michigan health care standards require records to be retained for at least 7 years.

Michigan Mental Health Code – MCL 330.1748

Your mental health records are protected under the Michigan Mental Health Code, which may be more restrictive than HIPAA.

Disclosures generally require your written consent except in specific statutory circumstances.

When Michigan law is more protective, I will follow the more restrictive rule.

Acknowledgment of Receipt

By agreeing to this Notice, you acknowledge that you have received and reviewed my HIPAA Notice of Privacy Practices.

For more information, visit: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html