HIPAA Notice
Notice of Privacy Practices
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.
1. My commitment to your privacy
As a licensed clinical social worker in New Jersey, I am required by law to protect the privacy of your health information, known as Protected Health Information (PHI), in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and New Jersey law. This notice explains how I use, share, and safeguard that information, and what your rights are.
2. How your information may be used and disclosed
I may use and disclose your health information in the following ways:
- For treatment. To provide and coordinate your care, including with other providers involved in your treatment when you have authorized it.
- For payment. To process payment for services, including providing a superbill if you request one.
- For healthcare operations. For administrative purposes such as maintaining records, quality improvement, and compliance.
- As required by law. When federal, state, or local law requires disclosure.
- To prevent serious harm. If there is a serious and imminent threat to your health or safety, or to the health or safety of others, as permitted or required by New Jersey law.
- To report abuse or neglect. When I am required by law to report suspected abuse or neglect of a child, an elderly person, or a person with a disability.
- For legal proceedings. In response to a court order, and in some cases a subpoena, as permitted by law.
Any other use or disclosure of your information requires your written authorization. You may revoke an authorization in writing at any time, except to the extent I have already acted on it.
3. Psychotherapy notes
Psychotherapy notes, meaning notes I may keep about the contents of our sessions that are separate from your clinical record, receive additional protection under HIPAA. In most cases they cannot be disclosed without your specific written authorization.
4. Your rights
You have the following rights regarding your health information:
- Right to access. You may request to see or receive a copy of your health records. I may charge a reasonable, cost-based fee.
- Right to amend. You may request corrections if you believe information in your record is incorrect or incomplete.
- Right to an accounting of disclosures. You may request a list of certain disclosures I have made of your information.
- Right to request restrictions. You may ask me to limit how I use or disclose your information. I am not always required to agree, but I will consider every request.
- Right to confidential communications. You may ask me to contact you in a particular way or at a particular address, such as only by email.
- Right to a paper copy of this notice. You may request a paper copy at any time.
- Right to be notified of a breach. You will be notified if a breach occurs that compromises the privacy of your information.
5. My responsibilities
I am required by law to maintain the privacy and security of your health information, to provide you with this notice of my legal duties and privacy practices, and to follow the terms of the notice currently in effect.
6. How I protect your information
I use appropriate administrative, technical, and physical safeguards to protect the confidentiality and security of your information, including a secure, HIPAA-compliant electronic health record system.
7. Changes to this notice
I reserve the right to change this notice, and to make the revised notice effective for all information I maintain. Any changes will be posted on this website, and you may request a copy at any time.
8. Questions and complaints
If you believe your privacy rights have been violated, you may file a complaint with me directly, or with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr/complaints. You will not be retaliated against for filing a complaint.
Sarah Levant, LCSW, SEP
Somatic Healing NJ
sarah@mysomatichealing.com
By receiving services from Somatic Healing NJ, you acknowledge receipt of this Notice of Privacy Practices.