HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: June 2026
Your Privacy Matters At Mind Body Relational Therapy, LLC, protecting your health information is something we take seriously. This notice describes how your protected health information may be used and disclosed and how you can access your own information. Please read it carefully.
What Is Protected Health Information? Protected health information, or PHI, is any information about your health, treatment, or payment for services that can be linked to you as an individual. This includes things like your name, the dates of your appointments, what we discuss in sessions, diagnoses, and billing records.
How We May Use and Disclose Your Information
For Treatment We may use your health information to provide you with mental health services. This includes coordinating care with other providers involved in your treatment, such as your primary care physician or psychiatrist, if applicable and with your consent.
For Payment We may use your information to bill your insurance company or process payment for services. This includes submitting claims and responding to inquiries from your insurance plan about the services you received.
For Healthcare Operations We may use your information for internal purposes such as quality improvement, training, or administrative functions. These uses are limited to what is necessary to run the practice ethically and effectively.
Uses and Disclosures That Require Your Written Authorization Most uses of your health information beyond treatment, payment, and operations require your written authorization. This includes sharing information with family members or other providers not directly involved in your care, marketing purposes, and the sale of your health information. You have the right to revoke any authorization you have given at any time, in writing.
Special Situations Where Disclosure May Occur Without Authorization There are limited circumstances in which we may be required or permitted to disclose your information without your consent.
Mandatory Reporting: If there is reasonable cause to believe that a child, elder, or dependent adult is being abused or neglected, we are required by law to report this to the appropriate authorities.
Duty to Warn: If you disclose an intent to harm yourself or another identifiable person, we may be required to take steps to protect you or that person, including contacting emergency services or notifying the potential victim.
Court Orders: We may be required to disclose information in response to a valid court order or subpoena.
Public Health: In limited circumstances, disclosure may be required by public health authorities.
Your Rights Regarding Your Health Information
Right to Access: You have the right to request a copy of your health records. Requests should be made in writing and will be fulfilled within 30 days.
Right to Request Corrections: If you believe your records contain an error, you may request that it be corrected.
Right to an Accounting of Disclosures: You may request a list of instances in which your health information was disclosed outside of treatment, payment, and operations purposes.
Right to Request Restrictions: You may ask us to limit how your information is used or shared. We will consider your request but are not always required to agree to it.
Right to Confidential Communications: You may request that we communicate with you in a specific way or at a specific location, for example by email only.
Right to a Paper Copy of This Notice: You may request a printed copy of this notice at any time, even if you have already received it electronically.
Electronic Communication and Security All clinical communication and records are maintained using HIPAA compliant platforms. Standard email is not fully secure and is used only for general inquiries through the contact form on this website, not for clinical information.
Our Responsibilities We are required by law to maintain the privacy of your health information, to provide you with this notice, to follow the terms described in this notice, and to notify you if there is a breach that may have compromised your information.
Changes to This Notice We reserve the right to update this notice at any time. Any changes will apply to information we already hold as well as information we receive in the future. The current version will always be posted on this page with the effective date listed at the top.
Complaints If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.
To contact the Office for Civil Rights: U.S. Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201 1-877-696-6775 www.hhs.gov/ocr
Contact Us For questions about this notice or to exercise any of your rights, please reach out through the contact page or email us directly.
Mind Body Relational Therapy, LLC Diana Violante, LMFT, ACS, C-DBT New Jersey