HIPAA NOTICE OF PRIVACY PRACTICES

Effective October 1, 2026

 

Your Information. Your Rights. My Responsibilities.

This notice describes how health information about you may be used and disclosed, how you can get access to this information, and your rights concerning your protected health information. Please review it carefully.

If you have questions about this notice or your privacy rights, please contact:

Jermaine L. Shorter, LPC-MHSP Inside Out Counseling & Consulting ioccmemphis@gmail.com (901) 830-9147

 

Your Rights

You have certain rights concerning your health information.

Get a Copy of Your Health Information

You may ask to see or receive an electronic or paper copy of your health information and other information I maintain about you, except for information that you do not have a legal right to access, such as psychotherapy notes as defined by HIPAA.

I will provide access to or a copy of your health information within the timeframe required by applicable law, including within 10 working days when required by applicable state law.

I may charge a reasonable, cost-based fee when permitted by law.

Ask Me to Correct Your Health Information

You may ask me to correct health information about you that you believe is incorrect or incomplete.

I may deny your request in circumstances permitted by law. If I deny the request, I will explain the reason to you in writing within the timeframe required by law.

Request Confidential Communications

You may ask me to contact you in a particular way or at a particular location. For example, you may request that I communicate with you through a particular telephone number or email address.

I will accommodate reasonable requests.

Ask Me to Limit What I Use or Share

You may ask me not to use or disclose certain health information for treatment, payment, or health care operations. I am not always required to agree to your request.

If you pay for a health care service out of pocket in full, you may ask me not to disclose information about that service to your health plan for payment or health care operations. I will honor that request unless the law requires me to disclose the information.

Get a List of Certain Disclosures

You may ask for an accounting of certain disclosures of your health information I have made during the six years before the date of your request.

The accounting generally will not include disclosures made for treatment, payment, or health care operations and certain other disclosures that are excluded from the accounting requirement by law.

I will provide one accounting during any 12-month period at no charge. I may charge a reasonable, cost-based fee for additional requests during the same 12-month period.

Get a Copy of This Notice

You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically. I will provide you with a paper copy promptly.

Choose Someone to Act for You

If you have given someone legal authority to act on your behalf, such as through a valid health care power of attorney or guardianship, that person may exercise your privacy rights and make choices concerning your health information as permitted by law.

I will verify the person’s authority before allowing them to act on your behalf.

File a Complaint

If you believe your privacy rights have been violated, you may file a complaint directly with me using the contact information listed above.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

I will not retaliate against you for filing a complaint.

 

Your Choices

For certain health information, you may tell me your preferences about what I share.

Family, Friends, and Others Involved in Your Care

You may tell me whether I may share relevant health information with family members, friends, or others involved in your care or payment for your care.

If you are unable to communicate your preference, such as during an emergency, I may disclose relevant information when permitted by law and when I determine that doing so is in your best interest.

Marketing and Sale of Your Information

I do not sell your protected health information.

I will not use or disclose your protected health information for marketing purposes when your written authorization is required by law unless you provide that authorization.

 

How I May Use and Disclose Your Health Information

HIPAA and other applicable laws permit me to use or disclose health information in certain circumstances without obtaining a separate written authorization from you.

Treatment

I may use your health information and share it with other health care professionals as permitted by law for purposes related to your treatment and coordination of care.

Payment

I may use and disclose health information as necessary to bill for services and obtain payment.

Health Care Operations

I may use and disclose health information as necessary to operate the practice, manage services, maintain records, conduct quality and compliance activities, and perform other health care operations permitted by law.

When Required or Permitted by Law

I may use or disclose health information when required or permitted by federal or state law. Depending on the circumstances, this may include disclosures:

• To report suspected abuse or neglect as required by law.
• To prevent or reduce a serious and imminent threat to health or safety when disclosure is permitted by law.
• For certain public health activities.
• For health oversight activities authorized by law.
• In response to certain court or administrative orders, subpoenas, or other lawful processes when the requirements for disclosure have been satisfied.
• For certain law-enforcement purposes permitted by law.
• To coroners, medical examiners, or others performing duties authorized by law.
• For workers’ compensation or similar programs as authorized by law.
• For certain specialized government functions authorized by law.
• For research when the requirements of applicable privacy law have been satisfied.

When a state or other applicable law provides greater privacy protection than HIPAA, I will follow the more protective law.

 

Mental Health Information and Psychotherapy Notes

Mental health records may receive additional protection under federal or state law.

HIPAA also provides special protection for psychotherapy notes, which are notes recorded by a mental health professional documenting or analyzing the contents of a counseling conversation and kept separate from the rest of the medical record.

If I create and maintain psychotherapy notes as defined by HIPAA, I generally will obtain your written authorization before using or disclosing those notes unless HIPAA or another applicable law permits or requires the use or disclosure without authorization.

Your general clinical record is not automatically considered psychotherapy notes merely because it contains information about psychotherapy.

 

Other Uses and Disclosures

Uses and disclosures of your protected health information that are not described in this notice and are not otherwise permitted or required by law generally will be made only with your written authorization.

If you authorize me to use or disclose your information, you may revoke that authorization in writing at any time, except to the extent that I have already acted in reliance on it.

 

My Responsibilities

I am required by law to maintain the privacy and security of your protected health information.

I must follow the duties and privacy practices described in the Notice of Privacy Practices currently in effect.

I will notify you promptly if a breach occurs that may have compromised the privacy or security of your protected health information.

I will not use or disclose your information other than as described in this notice unless you authorize me to do so in writing or another use or disclosure is permitted or required by law.

 

Changes to This Notice

I may change the terms of this Notice of Privacy Practices. Any revised notice may apply to health information I already maintain as well as information created or received in the future.

The current Notice of Privacy Practices will be available upon request and on the Inside Out Counseling & Consulting website.