Notice of Privacy Practices

Notice of Privacy Practices

Acuity Counseling, PLLC

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Who We Are & What This Notice Covers

PHI includes any information that identifies you and relates to your past, present, or future physical or mental health, the services you receive, or payment for those services.

We take your privacy seriously. If you ever have questions about this Notice, we are here to help.

2. How We May Use and Disclose Your PHI Without Your Written Authorization

A. Treatment, Payment, and Healthcare Operations (TPO)

We may use or disclose your PHI for:

1. Treatment

Examples:

• Coordination of care with other professionals
• Referral communications
• Clinical supervision
• Consultation for your benefit

2. Payment

• Billing insurance
• Benefit verification
• Prior authorization
• Claims management

3. Healthcare Operations

• Quality improvement
• Auditing and compliance activities
• Workforce training and supervision
• Business operations and management
• Intern education

We may share PHI with business associates who support our operations. All business associates sign a HIPAA-compliant BAA requiring them to protect your information.

B. Other Disclosures Allowed or Required by Law

We may also use or disclose PHI without your authorization when required or permitted by federal or Oklahoma law.

1. Mandatory Reporting (Oklahoma Specific)

We are required to report:

• Suspected child abuse or neglect to the
  Oklahoma Department of Human Services (DHS)
  DHS Hotline: 1-800-522-3511
• Suspected abuse, neglect, or exploitation of vulnerable adults or elders to appropriate authorities.

2. Serious Threats to Health or Safety

We may disclose PHI when necessary to prevent or lessen a serious and credible threat to your safety or someone else’s.

Oklahoma Law:
Oklahoma grants mental health professionals a permissive duty to take protective action when a client communicates a serious and credible threat of harm. We may, at our discretion and using clinical judgment, disclose information to:

• Law enforcement
• A potential victim or their family
• Emergency responders
• Other persons necessary to ensure safety

We will disclose only the minimum necessary information needed to protect life.

3. Legal and Administrative Processes

• Court orders
• Subpoenas (when legally permitted)
• Health oversight audits/investigations
• Law enforcement requests permitted by law

4. Public Health and Other Required Uses

• Certain public health reporting
• Workers’ compensation programs
• Requests by the U.S. Department of Health & Human Services (HHS/OCR)

C. Incidental Disclosures

Minimal, unavoidable disclosures may occur despite reasonable safeguards (e.g., someone seeing you in the waiting area or telehealth audio overlap). HIPAA allows incidental disclosures when safeguards are in place.

D. Prohibited Uses and Disclosures

We will not:

• Sell your PHI
• Use or disclose PHI for marketing without your authorization

E. Substance Use Disorder Patient Records

To the extent that we maintain substance use disorder patient records subject to 42 CFR Part 2, we will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena as required by law.

We will provide clear notice and a choice before using Part 2 information for fundraising communications.

3. Uses and Disclosures Requiring Your Written Authorization

We must obtain your written authorization for uses or disclosures not described in this Notice or not otherwise permitted by law. This includes:

• Psychotherapy notes (defined below)
• Most marketing communications
• Sale of PHI
• Any other non-routine or non-required disclosure

You may revoke authorization in writing at any time.

Psychotherapy Notes – Definition

Psychotherapy notes are the therapist’s personal notes documenting or analyzing the content of your counseling sessions. These notes are:

• Maintained separately from the clinical record
• Intended for the therapist’s use only
• Not part of the “designated record set”

Psychotherapy notes do not include:

• Treatment plans
• Diagnoses
• Medications
• Session dates/times
• Summaries of symptoms or interventions

We will not disclose psychotherapy notes without your written authorization, except as permitted by law for treatment, supervision, or legal defense.

4. Your Rights Regarding Your PHI

A. Right to Request Restrictions

You may request restrictions on:

• TPO-related disclosures
• Disclosures to individuals involved in your care

We are not required to agree, except:
If you pay out of pocket in full, you may require us not to disclose that service to your health plan.

B. Right to Request Confidential Communications

You may request specific methods of contact (e.g., specific phone number, mailing address). We will accommodate reasonable requests.

C. Right to Access and Receive Copies

You may inspect or obtain a copy of PHI we maintain about you.

Timeframes:

• We will generally provide a copy or summary within 30 calendar days of receiving your request.
• If we need additional time, we may take one extension of up to 30 additional calendar days. We will notify you in writing within the initial 30-day period, explain the reason for the delay, and state when we will complete the request.

Fees:
We may charge a reasonable, cost-based fee.*
A detailed fee schedule is available upon request.

D. Right to Request an Amendment

You may request correction of PHI you believe is inaccurate or incomplete. If denied, we will provide a written explanation and instructions on how to submit a statement of disagreement.

E. Right to an Accounting of Disclosures

You may request a list of certain disclosures made without your authorization, excluding TPO and other legally exempt categories.

F. Right to a Paper Copy

You may request a paper copy of this Notice at any time, even if you previously agreed to electronic delivery.

5. Minors & Parental Access (Oklahoma Law)

In Oklahoma, parents and legal guardians generally have the right to access their minor child’s health information. However, state and federal laws include important exceptions.

When Parental Access May Be Limited

We may limit or deny parental access to a minor’s mental health information only when:

• Disclosure is reasonably likely to endanger the life or physical safety of the minor or another person, as permitted under Oklahoma law.

In addition, Oklahoma and federal law allow minors to consent to certain types of care without parental involvement. When a minor legally consents to their own treatment, we may not disclose information about that treatment to a parent or guardian without the minor’s permission, except as otherwise required by law. These situations may include:

• Pregnancy-related care
• Testing or treatment for sexually transmitted infections
• Treatment related to drug or alcohol use
• Other circumstances where federal law provides special confidentiality protections (such as 42 CFR Part 2)

Professional Judgment

When a safety concern is present, our licensed clinicians will use their professional judgment to determine whether limiting parental access is necessary to protect the minor or others.

Psychotherapy Notes

Psychotherapy notes (a therapist’s private notes kept separate from the clinical record) are protected under HIPAA and are not accessible to minors or parents without written authorization, except in very limited circumstances permitted by law.

6. Our Duties

We are legally required to:

• Maintain the privacy and security of your PHI
• Provide this Notice describing our privacy practices
• Notify you of a breach of unsecured PHI without unreasonable delay and no later than 60 days
• Abide by the terms of this Notice

Changes to This Notice

We may modify this Notice at any time. Changes apply to all PHI we maintain, including PHI created before the revision.

Updated Notices will be:

• Posted on our website: https://acuitycounselingok.com
• Displayed in our office
• Available upon request

7. Questions, Concerns, or Complaints

If you have questions or believe your privacy rights were violated, contact:

Acuity Counseling, PLLC — Privacy Officer
1725 Signal Ridge Dr, Suite 150
Edmond, OK 73013
Phone: (405) 563-1109
Email: privacy@acuitycounselingok.com

We will not retaliate against you for filing a complaint.

You may also file a complaint with the U.S. Department of Health & Human Services:

Office for Civil Rights (OCR)
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: (800) 368-1019
TDD: (800) 537-7697
Online Complaint Portal: https://ocrportal.hhs.gov

Effective Date

This Notice is effective on August 24, 2026.