Amy Beth Acker Psychotherapy and Consulting, LLCEffective Date: 8/21/26
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
My Commitment and Legal Responsibilities
I understand that information about you and your health care is personal. I am committed to protecting your protected health information ("PHI"). I create and maintain records of the care and services you receive from this practice. I need these records to provide treatment, operate the practice, obtain payment when applicable, and comply with legal and professional obligations.
This Notice applies to the health records created or maintained by Amy Beth Acker Psychotherapy and Consulting, LLC. It explains how I may use and disclose your PHI, your rights regarding your PHI, and my legal responsibilities.
I am required by law to:
Maintain the privacy and security of your PHI;
Provide you with this Notice describing my legal duties and privacy practices;
Follow the duties and privacy practices described in the Notice currently in effect;
Notify you promptly following a breach that may have compromised the privacy or security of your PHI; and
Refrain from retaliating against you for exercising your privacy rights or filing a complaint.
How I May Use and Disclose Your PHI
Treatment
I may use your PHI and disclose it to other health care professionals for treatment and coordination of care. For example, with appropriate consideration of applicable confidentiality laws and professional standards, I may communicate with another health care provider involved in your care to coordinate treatment or obtain a clinical consultation.
Payment
I may use and disclose your PHI to bill for services and obtain payment from you, a health plan, or another responsible party. For example, if you authorize courtesy submission of an out-of-network claim, I may provide your insurer with information such as your diagnosis, dates of service, procedure codes, and fees. Your separate financial agreement explains the limits of courtesy claim submission and your responsibility for payment.
Health Care Operations
I may use and disclose your PHI to operate this practice and support the quality and administration of your care. For example, I may use information to conduct quality assessment, perform legally required compliance activities, obtain legal or accounting services, or work with a business associate that assists the practice. Business associates are required by written agreement, when applicable, to safeguard PHI.
Appointment Reminders and Treatment-Related Communications
I may use and disclose limited PHI to contact you about appointments, scheduling, treatment alternatives, or other health-related services that may be relevant to you. Communications will be made using the methods and contact information you have provided, subject to any reasonable confidential-communication request you make.
People Involved in Your Care or Payment for Your Care
I may disclose PHI relevant to your care or payment for your care to a family member, close friend, personal representative, or another person you identify as involved, when you agree, do not object after being given an opportunity to do so, or the law otherwise permits the disclosure. If you are unable to state a preference, I may disclose limited information when, in my professional judgment, doing so is in your best interest. I may also disclose information when necessary to lessen a serious and imminent threat to health or safety, as permitted by law.
Uses and Disclosures Required or Permitted by Law
Subject to applicable federal and New Jersey confidentiality protections, I may use or disclose PHI without your written authorization in circumstances including the following:
Required by law: To comply with federal, state, or local law, provided the use or disclosure is limited to what the law requires.
Public health and safety: For legally authorized public health activities, reporting suspected abuse or neglect, reporting certain injuries or conditions, or preventing or reducing a serious threat to health or safety.
Health oversight: To a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure proceedings, or disciplinary matters.
Judicial and administrative proceedings: In response to a court or administrative order or, when applicable legal conditions are satisfied, a subpoena, discovery request, or other lawful process. Additional federal or New Jersey confidentiality and privilege protections may restrict disclosure.
Law enforcement: For limited law-enforcement purposes authorized by law and subject to applicable confidentiality protections.
Coroners, medical examiners, and funeral directors: When authorized by law to permit them to perform their duties.
Organ and tissue donation: To organ-procurement organizations or others involved in organ, eye, or tissue donation and transplantation, when applicable and permitted by law.
Disaster relief: To an authorized disaster-relief organization when needed to coordinate notification of family or others involved in your care, when permitted by law.
Workers' compensation: As authorized by and to the extent necessary to comply with workers' compensation or similar laws.
Specialized government functions: For limited functions authorized by law, such as military and veterans' activities, national security and intelligence activities, protective services, or correctional-institution activities.
Research: For research permitted by law, such as research approved through an authorization, waiver, or other legally sufficient process. This practice does not ordinarily conduct research using client PHI.
Department of Health and Human Services: To the U.S. Department of Health and Human Services when it requests information to determine my compliance with federal privacy law.
Uses and Disclosures Requiring Your Written Authorization
Uses and disclosures of PHI not described in this Notice will be made only with your valid written authorization unless otherwise permitted or required by law. If you authorize a use or disclosure, you may revoke your authorization in writing at any time. Revocation will not affect information already used or disclosed in reliance on your authorization before I received the revocation.
Your written authorization is generally required for:
Most uses and disclosures of psychotherapy notes, as that term is specifically defined by HIPAA;
Uses and disclosures of PHI for marketing purposes, except for limited communications allowed by law; and
Any sale of PHI.
This practice does not sell PHI and does not use PHI for marketing.
Psychotherapy Notes
"Psychotherapy notes" under HIPAA are notes recorded by a mental health professional that document or analyze the contents of a counseling session and are kept separate from the rest of the medical record. They do not include ordinary progress notes or information such as diagnosis, symptoms, treatment plan, medications, session times, or summaries of treatment.
If I maintain psychotherapy notes as defined by HIPAA, most uses or disclosures require your written authorization. Authorization is not required for certain limited uses or disclosures permitted by law, including my use of the notes to treat you; certain supervised mental-health training activities; defending myself in a legal action or proceeding brought by you; oversight of the person who created the notes; uses or disclosures required by law and limited to the relevant legal requirement; activities by the U.S. Department of Health and Human Services to investigate HIPAA compliance; certain disclosures to a coroner or medical examiner; or uses or disclosures necessary to avert a serious and imminent threat to health or safety.
Special Protection for Substance Use Disorder Patient Records
Discussing alcohol or substance use in psychotherapy does not, by itself, make an ordinary psychotherapy record a record governed by 42 C.F.R. Part 2. Part 2 generally applies to records created by a federally assisted program that provides substance use disorder diagnosis, treatment, or referral for treatment, and may continue to protect qualifying records received from such a program.
To the extent that I receive or maintain substance use disorder patient records that are subject to 42 C.F.R. Part 2, I will comply with the additional protections applicable to those records. I will not use or disclose information from those records in a civil, criminal, administrative, or legislative investigation or proceeding against you without your written consent or a court order and subpoena that satisfy applicable legal requirements.
If this practice were to use Part 2 information for a fundraising communication, I would provide clear and conspicuous advance notice and an opportunity for you to elect not to receive such communications. This practice does not conduct fundraising using client PHI or Part 2 records.
Your Rights Regarding Your PHI
Right to Inspect and Obtain a Copy
You may ask to inspect or obtain an electronic or paper copy of PHI maintained about you in the designated record set. Psychotherapy notes and certain other information identified by law are not subject to the ordinary right of access. I will generally provide access, a copy, or an agreed-upon summary within 30 days after receiving your request. I may charge a reasonable, cost-based fee as permitted by law. In limited circumstances, I may deny access; when required, I will explain the denial in writing and describe any available review rights.
Right to Request an Amendment
If you believe PHI in your record is incorrect or incomplete, you may request an amendment in writing and explain why the information should be amended. I may deny the request in circumstances allowed by law, but I will provide a written explanation, generally within 60 days, and explain your related rights.
Right to Request Confidential Communications
You may ask me to contact you in a particular way or at a particular location. For example, you may ask me to use a particular telephone number or email address. I will accommodate reasonable requests. You are responsible for providing accurate contact information and informing me when it changes.
Right to Request Restrictions
You may ask me not to use or disclose certain PHI for treatment, payment, or health care operations. I am generally not required to agree, and I may decline a request when, for example, it could affect your care or my ability to comply with law or professional obligations. If I agree, I will follow the restriction except when disclosure is needed for emergency treatment or otherwise permitted or required by law.
If you pay in full out of pocket for a specific service and request that I not disclose information about that service to your health plan for payment or health care operations, I must agree unless the disclosure is required by law. If you request this restriction, you must notify me before information about the service is submitted to the health plan and satisfy applicable payment arrangements.
Right to an Accounting of Disclosures
You may request a list of certain disclosures of your PHI made during the six years preceding your request. The accounting generally does not include disclosures for treatment, payment, or health care operations; disclosures made to you; disclosures you authorized; and certain other disclosures excluded by law. I will provide one accounting in any 12-month period without charge. I may charge a reasonable, cost-based fee for additional accountings during the same period after informing you of the cost and giving you an opportunity to withdraw or modify the request.
To the extent that this practice maintains records subject to 42 C.F.R. Part 2, you may also have accounting rights applicable to disclosures made with consent, as provided by federal law.
Right to Receive 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. An electronic copy may also be requested. The current Notice is available on the practice website and through the practice's electronic client system.
Right to Choose a Personal Representative
If a person has legal authority to act on your behalf, such as through a valid health care power of attorney, guardianship, or other authority recognized by law, that person may exercise applicable privacy rights for you. I will verify the person's authority before treating the person as your personal representative.
Right to Complain Without Retaliation
You may complain directly to me if you believe your privacy rights have been violated. I will not retaliate against you for making a complaint or exercising a privacy right.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by:
Mailing: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201
Calling: 1-877-696-6775
Additional New Jersey Protections
New Jersey law and professional rules may provide additional confidentiality and privilege protections for mental health and social work records. I will comply with applicable federal and New Jersey requirements. When a state law provides greater privacy protection or more restrictive disclosure requirements than HIPAA, I will follow the more protective applicable requirement.
Nothing in this Notice is intended to waive any psychotherapist-client, social-worker-client, or other privilege available under applicable law.
Changes to This Notice
I may change the terms of this Notice and the corresponding privacy practices. Changes may apply to all PHI I maintain, including information created or received before the revision, to the extent permitted by law. A revised Notice will state its effective date and will be available upon request, through the practice's electronic client system, and on the practice website.
Contact the Privacy Officer to exercise a privacy right, request a copy of this Notice, ask a privacy question, or submit a complaint.
ACKNOWLEDGMENT OF RECEIPT
By electronically acknowledging below, I confirm that I received or was given access to the Notice of Privacy Practices of Amy Beth Acker Psychotherapy and Consulting, LLC. My acknowledgment confirms receipt of the Notice; it does not constitute a waiver of any privacy right and does not mean that I agree to any use or disclosure beyond what is permitted by law.
