Macedone Counseling

NOTICE OF PRIVACY PRACTICES
This notice describes how your health information may be used and disclosed and how you can get access to this information. Please review it carefully. You may have additional rights under state and local law. Please seek legal counsel from an attorney licensed in your state if you have questions regarding your rights to health care information.

Effective Date of This Notice: November 3, 2025

Acknowledgement of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (hereafter “HIPAA”), you have certain rights regarding the use and disclosure of your protected health information (“PHI”).

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 to provide you with quality care and comply with legal requirements. This notice applies to all records of your care generated by this practice. It explains how I may use and disclose health information about you, describes your rights to that information, and outlines my legal obligations.

I am required by law to make sure that PHI identifying you is kept private, give you this notice of my legal duties and privacy practices, and follow the terms of the notice currently in effect. I can change the terms of this notice, and changes will apply to all information I have about you. The new notice will be available upon request, in my office, and on my website.

II. How I May Use and Disclose Health Information About You

The following categories describe ways that I use and disclose health information. Not every use or disclosure in a category will be listed, but all will fall within these categories.

For Treatment, Payment, or Health Care Operations: Federal privacy rules allow health care providers with a direct treatment relationship to use or disclose your PHI without your written authorization to carry out their own treatment, payment, or operations. I may also disclose your PHI for the treatment activities of another provider. For example, if I consult with another licensed provider about your condition, we may use and disclose your PHI to assist with diagnosis and treatment. I may also use your PHI for operations purposes, such as appointment reminders, billing, or other administrative activities.

Disclosures for treatment purposes are not limited to the “minimum necessary” standard because full access to information may be required for quality care. “Treatment” includes coordination and management of care, consultations between providers, and referrals.

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 minor child(ren) in response to a subpoena or lawful process, but only if efforts have been made to inform you or obtain a protective order.

III. Certain Uses and Disclosures Require Your Authorization

1. Psychotherapy Notes: I keep psychotherapy notes as defined in 45 CFR §164.501. Any use or disclosure of such notes requires your authorization unless it is for my use in treating you, for my use in training or supervising other professionals, for defending myself in legal proceedings, for compliance investigations by the U.S. Department of Health and Human Services, or when otherwise required by law (e.g., oversight activities, coroner’s duties, or averting a serious threat to health and safety).

2. Marketing Purposes: I will not use or disclose your PHI for marketing without your written consent. For example, if you provide a review that includes PHI (such as your name, date of service, or treatment details), I will provide a HIPAA authorization for your signature before using it publicly. You may withdraw this consent at any time in writing, though I cannot guarantee removal from third-party sites that may have copied your review.

3. Sale of PHI: I will not sell your PHI.

IV. Uses and Disclosures That Do Not Require Your Authorization

Subject to certain legal conditions, I may use and disclose your PHI without your authorization for the following:

• Appointment reminders and health-related benefits or services.

• When required by law.

• For public health activities, including reporting suspected abuse or preventing serious threats.

• For health oversight activities such as audits and investigations.

• For judicial or administrative proceedings, such as responding to court orders or subpoenas.

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

• To coroners or medical examiners performing lawful duties.

• For research purposes consistent with privacy protections.

• For specialized government functions, such as national security or correctional safety.

• For workers’ compensation purposes, as required by law.

• For organ or tissue donation requests.

V. Uses and Disclosures Requiring the Opportunity to Object

You may choose whether I share your PHI with family, friends, or others involved in your care or payment, or in disaster relief situations. Consent may be obtained retroactively in emergencies or if you are unconscious.

VI. Your Rights Regarding Your PHI

1. Right to Request Limits: You may ask me not to use or disclose certain PHI for treatment, payment, or operations. I may deny the request if it would affect your care.

2. Right to Restrict Disclosures for Out-of-Pocket Payments: You may request restrictions on disclosures to health plans if you have paid for a service in full out-of-pocket.

3. Right to Choose How I Contact You: You may request contact by specific methods or addresses, and I will honor reasonable requests.

4. Right to Access and Copy Records: You may request to see or get a copy of your records (electronic or paper) within 30 days. A reasonable fee may apply.

5. Right to an Accounting of Disclosures: You may request a list of disclosures made in the last six years (excluding those for treatment, payment, or operations).

6. Right to Amend Your PHI: You may request corrections or additions to your record. If denied, I will explain why in writing within 60 days.

7. Right to a Copy of This Notice: You may request a paper or electronic copy at any time.

8. Right to Designate a Representative: If you have a medical power of attorney or legal guardian, that person can act for you.

9. Right to Revoke Authorization: You may revoke previously given authorizations in writing.

10. Right to Opt Out of Communications: You may opt out of communications or fundraising activities.

11. Right to File a Complaint: You may file a complaint if you believe your rights have been violated. Contact me directly, or the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, call (877) 696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints. I will not retaliate against you for filing a complaint.

VII. Changes to This Notice

Changing the terms of this notice may occur at any time. The revised notice will be available upon request, in the office, and on this website.