Understanding How Your Private Health Information is Kept Safe in My Practice
HIPAA—how your privacy is handled in my practice
Effective Date: July 2025 — supersedes all prior versions
Quick view:
• I follow HIPAA & California confidentiality laws.
• I store all records in SimplePractice (a HIPAA‑secure EHR).
• You may download this notice at any time or request a paper copy.
• Video sessions are covered by a separate Telehealth Consent you sign before tele‑sessions begin.
Silas Kohler-unsplash
HIPAA Notice of Privacy Practices (NPP)
I. My pledge regarding your health information
I understand that information about you and your health care is personal. I create and maintain records of the care and services you receive in order to provide quality care and meet legal requirements. I am required by law to:
Keep your protected health information (PHI) private.
Give you this notice of my legal duties and privacy practices.
Follow the terms of this notice until it is replaced.
Post the current notice on my website and supply copies on request.
I may change the terms of this notice at any time. Changes apply to all information I maintain. The latest version is always available at /hipaa-notice.
II. How I may use & disclose your PHI
1 Treatment, payment & health‑care operations (TPO)
Federal law allows me to use or disclose PHI without your written authorization for:
Treatment (e.g., consultation with another licensed provider).
Payment (e.g., preparing a superbill you submit to insurance).
Operations (e.g., clinical supervision, quality assurance).
Note: Disclosures for treatment are not limited to the “minimum necessary” because complete information may be required for quality care.
2 Other uses allowed or required by law
I may use or disclose PHI without authorization for the purposes below. When feasible, I will seek your consent first.
Reporting suspected child, elder, or dependent‑adult abuse.
Serious threat to health or safety.
Health‑oversight audits or investigations.
Court orders & subpoenas (after notice to you when possible).
Workers‑compensation claims.
Coroners, law enforcement, specialized government functions, and certain research activities.
3 Uses that require your written authorization
Psychotherapy notes (except for limited treatment, training, or legal‑defense purposes).
Marketing or sales of PHI.
Any other use not described in this notice.
You may revoke an authorization at any time in writing.
Inspect and copy: Receive electronic or paper copies of your records (except psychotherapy notes) within 30 days. Reasonable copy fees may apply.
Correct/amend: Request corrections to incomplete or inaccurate information.
Accounting of disclosures: Get a list (up to six years back) of certain disclosures I made without your authorization.
Request restrictions: Ask me to limit disclosures; I’m not required to agree, except when you fully pay out‑of‑pocket for a service and request that info not be shared with your health plan.
Confidential communication: Ask me to contact you at a specific address, phone, or email.
Paper copy of this notice: Available even if you accepted it electronically.
III. Your rights regarding PHI
IV. Tele‑Mental‑Health & SimplePractice
I offer video sessions statewide through SimplePractice Telehealth, a HIPAA‑secure platform. Technology risks and your additional rights are described in the Telehealth Consent you sign before any video session.
(Download PDF from this page or request a paper copy.)
If you believe your privacy rights have been violated, you may file a complaint with me or the U.S. Department of Health & Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.
V. Questions or complaints
Need this in plain‑language audio, large print, or another format?
Contact me and I’ll provide it in an accessible form within 10 days.
Telehealth Consent (Via Simple Practice)
Revised July 2025
NOTE — Privacy: All in‑office privacy practices apply equally to telehealth. Review the HIPAA Notice of Privacy Practices above for full details.
Consent for Telehealth Sessions and to Use the Telehealth by SimplePractice Service
1. Purpose & technology
I provide real‑time video psychotherapy through SimplePractice Telehealth. You’ll receive a secure, one‑click link—no password is required in a desktop browser.
Mobile users: download the free Telehealth by SimplePractice app (iOS or Android) before your first session.
Telehealth visits may not feel the same as in‑person meetings because we are not in the same room, and some non‑verbal cues are harder to perceive.
You can find more information about SimplePractice’s telehealth services here.
2. Benefits & risks
Benefits • Access to care anywhere in California • No travel time • Continuity when sick or traveling.
Risks • Internet or platform outages • Potential privacy breaches if you use public Wi‑Fi or live smart‑speakers • Tele‑sessions may not fit every clinical need; I may recommend referral to an in‑person provider when clinically indicated.
3. Client responsibilities
Join from a private, quiet, well‑lit space. Disable smart assistants (Siri, Alexa, Google Home) during sessions.
Use headphones or AirPods if others are nearby.
Arrive 3–5 minutes early to handle software updates or gear checks.
You may meet from a parked car; sessions are not permitted while a vehicle is moving.
You must be physically located in California during sessions.
Do not share your personal telehealth link.
Confirm your street address at the start of each session so emergency responders can locate you if needed.
4. Emergencies
Telehealth by SimplePractice is NOT an emergency service. If you are in crisis, call 911 or go to the nearest ER. You may also call or text the 988 Suicide & Crisis Lifeline.
Though you and I may be in direct, virtual contact through the Telehealth Service, neither SimplePractice nor the SimplePractice Telehealth Service provides any medical or healthcare services or advice including, but not limited to, emergency or urgent medical services.
5. Technology & third‑party disclaimer
The Telehealth by SimplePractice service facilitates video connections only; it does not provide medical or mental‑health advice. SimplePractice is not responsible for your clinical care, and I may not have real‑time access to its technical logs or data outside our sessions.
6. Fees, billing & records
Telehealth sessions are billed at the same rate as in‑person services. All records—including session metadata—are stored in SimplePractice’s HIPAA‑compliant EHR.
7. Right to withdraw consent
You may end or pause telehealth at any time without affecting future care. I may recommend referral to an in‑person therapist or local emergency services if clinically necessary.
8. Acknowledgement & signature
Telehealth by SimplePractice is the technology service we will use to conduct telehealth videoconferencing appointments. By signing electronically in SimplePractice, you certify that you:
• have read and understood this Telehealth Consent,
• have received the HIPAA Notice of Privacy Practices,
• agree to engage in telehealth under the terms above.
Electronic Signature & Date fields are completed in the SimplePractice portal.
Download HIPAA + Telehealth PDF
"MAY YOU BE WELL.
MAY YOU BE HAPPY.
MAY YOU BE FREE OF SUFFERING."
~TIBETAN HEART MEDITATION