Notice of Privacy Practices
Simone Silveyra-Babineaux, LPC-Associate, PLLC
Supervised by Gina Rodriguez, LPC-S, LMFT-S
EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on 8/25/2025
This document outlines how your protected health information (PHI) may be used and disclosed by this practice, and details your rights concerning your health information under federal law, including the Health Insurance Portability and Accountability Act (HIPAA), related regulations, and the National Association of Social Workers (NASW) Code of Ethics.
Understanding Your Health Information
As part of receiving services at Simone Silveyra-Babineaux, PLLC, a health record is created that includes personal details about your physical and mental health, services received, and relevant clinical observations. This information—referred to as Protected Health Information (PHI)—includes any data that can be used to identify you and relates to your past, present, or future physical or mental health status and the care provided.
This Notice of Privacy Practices explains how your PHI may be shared, your legal rights regarding that information, and how this practice is required by law to protect your confidentiality.
Practice Responsibilities
As a mental health provider, I am legally obligated to:
Maintain the confidentiality of your PHI;
Provide you with this notice that describes my privacy practices;
Comply with the terms of this notice as currently in effect.
I reserve the right to update this notice at any time. If changes occur, the revised notice will apply to all PHI maintained by the practice and will be made available to you via the website, by mail (upon request), or in person at your next appointment.
How Your PHI May Be Used and Disclosed
The following are ways your PHI may be used or shared without additional written consent:
1. For Treatment
PHI may be used to coordinate your care within the practice, including consultations with clinical supervisors or collaborating professionals involved in your treatment. Disclosure to external consultants will only occur with your written permission.
2. For Payment
With your written consent, PHI may be used to support billing efforts, such as assisting with insurance reimbursement or verifying service necessity through utilization reviews. Please note: payment is due at the time of service. If collection services are required due to unpaid balances, only the minimum necessary information will be disclosed.
3. For Health Care Operations
PHI may be used to support routine business functions within the practice, such as licensing, audits, and service coordination with third-party vendors (e.g., billing services). Such vendors are contractually obligated to protect your PHI. Disclosures for training purposes require your written consent.
4. As Required by Law
Federal regulations require PHI disclosures under certain circumstances, including:
Upon your request
To the U.S. Department of Health and Human Services during audits of HIPAA compliance
Disclosures Without Your Written Authorization
Under specific conditions allowed by HIPAA and the NASW Code of Ethics, your PHI may be disclosed without prior written consent:
Child Abuse or Neglect
Mandated reporting laws require disclosure of suspected abuse or neglect to state-designated child protection agencies.
Abuse of Elderly or Vulnerable Adults
PHI may be released to state or local authorities in cases involving suspected abuse, neglect, or exploitation of elderly or disabled individuals.
Suicide Risk
If there is a clear risk of self-harm and you are unwilling or unable to commit to a safety plan, your counselor may notify emergency services or law enforcement. Hospitalization may be considered, and you will be informed of this decision whenever feasible.
Legal Proceedings
PHI may be disclosed in response to a valid court order, subpoena, or other legal processes, as required by law.
Deceased Individuals
In accordance with state law, limited PHI may be shared with individuals involved in a deceased client’s care or payment for services, as previously authorized. Information may also be released to an executor or next-of-kin. After 50 years from the date of death, PHI is no longer protected under HIPAA.
Medical Emergencies
In situations requiring urgent medical attention, PHI may be shared with healthcare providers to prevent serious harm. A copy of this notice will be made available after the emergency, if possible.
Family Involvement
With your consent—or when necessary to prevent significant harm—information may be shared with close family members or individuals involved in your care.
Law Enforcement
PHI may be released when required by law for purposes such as locating a suspect, responding to a crime on the premises, or investigating threats to safety.
Government & Military Agencies
Disclosures may be made to U.S. military or national security officials, or for medical evaluations by the Department of State, in accordance with applicable laws and your written consent.
Public Safety Concerns
If you pose a serious threat to yourself or others, limited PHI may be disclosed to individuals or authorities able to intervene to prevent harm.
Verbal Permission
If you verbally authorize it, relevant PHI may be disclosed to family or close contacts actively involved in your care.
Disclosures Requiring Written Authorization
Any use or sharing of PHI beyond the scenarios listed above will require your explicit written authorization. This includes:
Most disclosures of psychotherapy notes (which are kept separate from your general health record)
Any uses of PHI for marketing, research, or external purposes not covered by HIPAA
You may revoke your authorization in writing at any time. Revocation will apply moving forward but will not affect actions already taken based on your prior consent.
Your Rights Regarding Your PHI
As a client, you have the following rights concerning your protected health information:
1. Right to Access and Inspect
You may view or request a copy of the records in your designated health file, which includes clinical and billing information. Access may be denied only in rare circumstances where there is a risk of serious harm. Electronic records may be provided upon request, and a reasonable fee may apply for copies or transmissions.
2. Right to Request Amendments
If you believe your PHI is incomplete or inaccurate, you can request a correction. The practice is not required to agree, but your request and any rebuttal will be documented in your record.
3. Right to an Accounting of Disclosures
You may request a summary of certain non-routine disclosures of your PHI made over the previous six years. One free request is allowed annually; a reasonable fee may apply for additional requests.
4. Right to Request Restrictions
You can ask to limit how your PHI is used or disclosed for treatment, payment, or operations. While not all requests must be granted, any restriction related to services you have paid for out-of-pocket must be honored.
5. Right to Request Confidential Communication
You may request communication through specific channels (e.g., phone, mail, email) or at specific locations. Reasonable requests will be honored without requiring you to explain the reason.
6. Notification of a Data Breach
If your unsecured PHI is compromised in a breach, you will be notified in accordance with federal law, including details of the breach and recommendations for protecting yourself.
7. Right to a Copy of This Notice
You may request a paper or electronic version of this notice at any time.
Complaints and Concerns
If you believe your privacy rights have been violated, you have the right to file a complaint without fear of retaliation. Complaints can be submitted to:
U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 Phone: 1-800-368-1019 Online: https://www.hhs.gov/ocr/complaints/
For questions or to exercise any of your privacy rights, please contact:
Simone Silveyra-Babineaux, PLLC simone@therapywithsimone.com | (512) 669-5704