Notice Of Privacy Practices

This notice describes how medical information about you or your dependent may be used and disclosed and how you can access this information. Please review it carefully.

The Therapy Place is committed to keeping your personal health information private and secure. We protect your personal health information by maintaining safeguards that meet or exceed applicable state law and the requirements of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). If you are a parent or guardian of a dependent under the care of our clinic, this notice applies to your dependent's health records and references to "You" in this notice refer to you in your capacity as parent or guardian.

Uses and Disclosures of Personal Health Information

The Therapy Place will not use or disclose your health information without your authorization, except as described in this notice. When you become our patient, you will be asked to sign a consent form allowing us to use your personal information for treatment, payment, and health care operations. For example:

  • Treatment. We will use your information to create a case record, determine the best course of treatment, coordinate your care, consult with other professionals as necessary, or make referrals.
  • Payment. We will use your information to determine eligibility under health plans, manage our billing and claims procedures, and collect payment from you or third-party payers.
  • Health care operations. We will use your information to assess the care and outcomes of treatment and to improve the quality of our services.

The Therapy Place may also use your personal health information where required or permitted by law. These situations include:

  • Emergencies. In an emergency, we may use or disclose health information to notify a family member, personal representative, or person responsible for your care, to determine your location and condition.
  • As required by law. We may notify authorities of alleged abuse or neglect; risk or threat of harm to self or others; information required for public health, law enforcement, or national security purposes; information in response to a subpoena, judicial order, or similar legal process; information required by agencies responsible for oversight or regulation of health care providers; information pertaining to our compliance with HIPAA requirements.
  • Research. We may disclose your protected health information to researchers if an institutional review board or privacy board has approved the research protocols to ensure protection of your privacy.
  • Appointment Reminders and Alternative Treatments. We may use your information to contact you about an upcoming appointment or inform you about treatment alternatives.

In all other situations, we will use or disclose your health information only with your written authorization. If you sign an authorization, you have the right to revoke the authorization to prevent future uses and disclosures.

Your Rights as Patient

You have the following rights with respect to your protected health information:
  • Restrictions. You may request restrictions on how we use or disclose your health information; your request will be considered but we are not legally obligated to agree to your requested restriction.
  • Confidentiality. You may request that your health information be communicated to you in a confidential manner, such as sending mail to an address other than your home.
  • Access. You may inspect and copy your protected health information or request a summary of your health information; if you request copies of your records or a summary, you may be charged reasonable fees for these services.
  • Amendment. If you believe information in our records is incorrect, you may request an amendment to your health information.
  • Accounting of Disclosures. You have the right to receive an accounting of disclosures of your protected health information.

Our Duties

The Therapy Place has the following obligations with respect to your privacy and this notice:
  • We are required by law to maintain the privacy of protected health information and to provide our patients with notice of our privacy practices.
  • We are required to abide by the terms of this notice while it is in effect.
  • We reserve the right to change the terms of this privacy notice and make the revised notice applicable to all health records maintained by our office. If we change our privacy notice, we will post a copy in our lobby, and we will make the changes available to patients on request.


If you believe your privacy rights have been violated in any way, you may file a complaint in writing with the Director of The Therapy Place. We will attempt to resolve your complaint promptly. You also have the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint under any circumstances.

Effective Date

This notice is effective April 14, 2003.


Any questions or concerns relating to your privacy rights should be directed to the Director of The Therapy Place, Lynn Kopfmann, at 952-885-0418.