Notice of Privacy Practices
This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully.
My Legal and Ethical Duty
I am committed to protecting your privacy. I am required by law to maintain the privacy of your protected health information (PHI) and to provide you with this notice of my legal duties and privacy practices. I will abide by the terms of this notice and comply with applicable federal (HIPAA) and state (Kansas and Missouri) privacy laws.
How I May Use and Disclose Your Health Information
I may use and disclose your PHI for the following purposes:
Treatment
I may use your PHI to provide, coordinate, or manage your mental health care and related services. For example, I may consult with other healthcare providers involved in your care.
Payment
I may use and disclose your PHI to obtain payment for services provided to you, including billing insurance companies or third-party payers.
Healthcare Operations
I may use and disclose your PHI for administrative, quality assurance, and operational purposes, such as reviewing the quality of my services or maintaining records.
As Required by Law
I will disclose your PHI when required to do so by federal, state, or local law, including Kansas and Missouri laws governing mental health and reporting requirements.
Other Permitted Uses and Disclosures
To Prevent Harm: If there is a serious threat to your health or safety or the health or safety of others.
Abuse/Neglect Reporting: If there is suspected child, elder, or dependent adult abuse or neglect.
Judicial and Administrative Proceedings: In response to a court order or subpoena, as required by law.
Law Enforcement: For law enforcement purposes as permitted by law.
Public Health Activities: For public health reporting as required by law.
Health Oversight Activities: To government agencies for oversight activities authorized by law.
Workers’ Compensation: As required to comply with workers’ compensation laws.
With Your Authorization
Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke your authorization at any time, except to the extent that action has already been taken.
Your Rights Regarding Your Health Information
You have the following rights under HIPAA and applicable KS and MO law:
Right to Inspect and Copy: You may request to inspect and obtain a copy of your PHI, subject to certain exceptions.
Right to Amend: You may request that I amend your PHI if you believe it is incorrect or incomplete.
Right to an Accounting of Disclosures: You may request a list of certain disclosures of your PHI made in the past six years.
Right to Request Restrictions: You may request restrictions on how I use or disclose your PHI. While I will consider your request, I am not required to agree to all restrictions.
Right to Request Confidential Communications: You may request that I communicate with you in a certain way or at a certain location.
Right to a Paper Copy of This Notice: You may request a paper copy of this notice at any time.
State-Specific Rights (Kansas and Missouri)
Both Kansas and Missouri law provide additional protections for mental health records. In most cases, your psychotherapy notes are afforded greater privacy and will not be disclosed without your written authorization, except as required by law (such as mandatory abuse reporting or imminent risk of harm).
Changes to This Notice
I reserve the right to change the terms of this notice and make the new notice effective for all PHI I maintain. If I make changes, I will post the revised notice on my website and provide a copy upon request.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with me or with the Secretary of the U.S. Department of Health and Human Services. I will not retaliate against you for filing a complaint.
To file a complaint with me, contact:
Johanna Kelley, LSCSW, LCSW
Safe & Loud LLC
Email: johanna@safeandloudtherapy.com
Phone: 816-388-0370
To file a complaint with the Secretary of the U.S. Department of Health and Human Services:
HHS Office for Civil Rights (OCR)
Online: Use the OCR Complaint Portal to file a complaint electronically.
Mail: Download, print, and mail the complaint and consent forms from hhs.gov to the centralized case management operations:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 509F HHH Bldg.
Washington, D.C. 20201
Email: Email completed complaint and consent forms to OCRComplaint@hhs.gov.
Regional Office (for Kansas and Missouri): You can also contact the regional office located in Kansas City, MO, at:
Address: 601 East 12th St., Room 248, Kansas City, MO 64106
Contact Information
If you have any questions about this notice or your privacy rights, please contact:
Johanna Kelley, LSCSW, LCSW
Safe & Loud LLC
Email: johanna@safeandloudtherapy.com
Phone: 816-388-0370
This notice is available in paper form upon request.