Notice of Privacy Practices

Amayo Counseling
Carolyn Amayo, LPC
carolyn@amayocounseling.com
901-652-4641

EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on November 1, 2026.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU 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, and I am committed to protecting it. 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 of the records of your care generated by this mental health care practice. It tells you about the ways I may use and disclose health information about you, your rights to the health information I keep about you, and certain obligations I have regarding its use and disclosure. I am required by law to:

  • Make sure that protected health information ("PHI") that identifies you is kept private.

  • Give you this notice of my legal duties and privacy practices with respect to health information.

  • Follow the terms of the notice that is currently in effect.

  • Notify you if a breach occurs that may have compromised the privacy or security of your information.

  • Provide you with adequate notice of your rights and my legal duties if I create or maintain records protected by 42 C.F.R. Part 2.

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 that I use and disclose health information. For each category I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For treatment, payment, or health care operations. Federal privacy regulations allow health care providers who have a direct treatment relationship with a client to use or disclose the client's personal health information, without the client's written authorization, to carry out the provider's own treatment, payment, or health care operations. I may also disclose your PHI for the treatment activities of any health care provider without your written authorization. For example, if I consult with another licensed health care provider about your condition, I would be permitted to use and disclose your PHI to assist in the diagnosis and treatment of your mental health condition.

If your records are protected under 42 C.F.R. Part 2, certain uses and disclosures permitted by HIPAA for treatment, payment, and health care operations are materially limited by the stricter standards of those regulations. Information disclosed under these rules may be redisclosed by the recipient and may no longer be protected by federal privacy standards.

Disclosures for treatment purposes are not limited to the minimum necessary standard, because therapists and other health care providers need access to full and complete information in order to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care with a third party, consultations between health care providers, and referrals of a client from one health care provider to another.

Lawsuits and disputes. If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about you or your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. However, records protected by 42 C.F.R. Part 2, or testimony relaying their content, will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide specific written consent or a court order is issued in accordance with 42 C.F.R. Part 2.

III. Certain uses and disclosures require your authorization

  1. Psychotherapy notes. I may keep "psychotherapy notes" as that term is defined in 45 C.F.R. § 164.501. Any use or disclosure of such notes requires your authorization unless the use or disclosure is:

    • For my use in treating you.

    • For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

    • For my use in defending myself in legal proceedings instituted by you.

    • For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

    • Required by law, and the use or disclosure is limited to the requirements of that law.

    • Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

    • Required by a coroner who is performing duties authorized by law.

    • Required to help avert a serious threat to the health and safety of others.

  2. Substance use disorder (SUD) counseling notes. I may also maintain "SUD counseling notes," which are notes recorded by a substance use disorder provider documenting the contents of a counseling session. Any use or disclosure of these notes requires your separate written authorization, which cannot be combined with a consent for other types of records. You can revoke your consent at any time, except to the extent that I have already acted on it.

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

  4. Sale of PHI. I will not sell your PHI.

IV. Certain uses and disclosures do not require your authorization

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

  1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of that law.

  2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone's health or safety.

  3. For health oversight activities, including audits and investigations.

  4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain your authorization before doing so.

  5. For law enforcement purposes, including reporting crimes occurring on my premises.

  6. To coroners or medical examiners, when they are performing duties authorized by law.

  7. For research purposes, including studying and comparing the mental health of clients who received one form of therapy with those who received another form of therapy for the same condition.

  8. For specialized government functions, including ensuring the proper execution of military missions, protecting the President of the United States, conducting intelligence or counterintelligence operations, or helping to ensure the safety of those working within or housed in correctional institutions.

  9. For workers' compensation purposes. Although my preference is to obtain your authorization, I may provide your PHI in order to comply with workers' compensation laws.

  10. For appointment reminders and health related benefits or services. I may use and disclose your PHI to remind you of an appointment with me, or to tell you about treatment alternatives or other health care services or benefits that I offer.

V. Certain uses and disclosures require you to have the opportunity to object

  1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. In emergency situations, the opportunity to consent may be obtained afterward.

  2. Fundraising. If I intend to use or disclose your records protected by 42 C.F.R. Part 2 for fundraising for my benefit, I will provide you with a clear and conspicuous opportunity to opt out before any such use or disclosure occurs.

VI. Your rights with respect to your PHI

  1. The right to request limits on uses and disclosures of your PHI. 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 to your request, and I may say "no" if I believe it would affect your health care.

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

  3. The right to choose how I send PHI to you. You have the right to ask me to contact you in a specific way (for example, home or work phone) or to send mail to a different address, and I will agree to all reasonable requests.

  4. The right to see and get copies of your PHI. Other than psychotherapy notes and SUD counseling notes, you have the right to get an electronic or paper copy of your record and other information that I have about you. I will provide you with a copy of your record, or a summary of it if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.

  5. The right to get a list of the disclosures I have made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an authorization. I will respond within 60 days of receiving your request. The list will include disclosures made in the last six years unless you request a shorter time. I will provide the list at no charge, but if you make more than one request in the same year, I will charge a reasonable, cost-based fee for each additional request. You also have the right to request an accounting of disclosures specifically for your substance use disorder records protected under 42 C.F.R. Part 2.

  6. The right to correct or update your PHI. If you believe that there is a mistake in your PHI, or that important information is missing, you have the right to request that I correct or add to it. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving it.

  7. The right to get a paper or electronic copy of this notice. You have the right to get a paper copy of this notice and the right to get a copy by email. Even if you have agreed to receive this notice by email, you also have the right to request a paper copy.

  8. The right to be notified of a breach. You have the right to be notified if a breach occurs that may have compromised the privacy or security of your PHI.

VII. Questions and complaints

If you have questions about this notice, or if you believe your privacy rights have been violated, please contact me first:

Carolyn Amayo, LPC, Privacy Officer
carolyn@amayocounseling.com
901-652-4641

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-800-368-1019, or online at www.hhs.gov/ocr/complaints.

I will not retaliate against you in any way for filing a complaint.