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

What Is “Medical Information”?: For the purposes of this Notice, the term “medical information” is synonymous with the terms“ personal health information” and “protected health information” and pertains to any individually identifiable health information(either directly or indirectly identifiable), whether oral, written, or recorded in any other medium, that is created or received by a health care provider (The Cabin), health plan, or others relating to your past, present, or future physical or mental health or condition, the provision of health care (e.g., mental health services) to you, and/or the past, present, or future payment for the provision of health care.

As mental health care providers licensed by the State of Indiana, or under supervision of a licensed mental health care provider, our therapists create and maintain treatment records containing individually identifiable health information about you. These records are generally referred to as “medical records” or “mental health records.” This notice, among other things, concerns the privacy and confidentiality of those records and the information contained therein.

Uses and Disclosures Without Your Authorization – For Treatment, Payment, or Health Care Operations: Federal privacy regulations allow us, as health care providers who have a direct treatment relationship with you, to use or disclose your personal health information—without your written authorization—in order to carry out our treatment, payment, and/or health care operations.

We may disclose your protected health information to another health care provider for treatment purposes without your written authorization. For example, if your therapist decides to consult with another licensed health care provider about your condition, he/she would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist in the diagnosis or treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard because physicians and other health care providers need access to a patient’s full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care among health care providers or by a health care provider with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another. An example of a use or disclosure for payment purposes would be our disclosure of your personal health information to your health insurance plan if your insurance plan requests a copy of your health records, or a portion thereof, in order to determine whether or not payment is warranted under the terms of your policy or contract.

An example of a use or disclosure for health care operations purposes would be our use or disclosure of your personal health information to your health insurance plan should your plan decide to audit our practice in order to review our competence and performance, or to detect possible fraud or abuse.

PLEASE NOTE: Your therapist, or someone in this practice acting with the authority to do so, may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Your prior written authorization is not required for such contact.

Other Uses and Disclosures without Your Authorization: Your therapist may be required or permitted to disclose your personal health information (e.g. your mental health records) without your written authorization. The following circumstances are examples of when such disclosures may or will be made:

1. If disclosure is compelled by a court order

2. If disclosure is compelled by a board, commission, or administrative agency for purposes of adjudication pursuant to its lawful authority.

3. If a party to a proceeding compels disclosure before a court or administrative agency pursuant to a subpoena, subpoenaduces tecum (e.g., a subpoena for mental health records), notice to appear, or any provision authorizing discovery in a proceeding before a court or administrative agency.

4. If a board, commission, or administrative agency pursuant to an investigative subpoena compels disclosure issued pursuant to its lawful authority.

5. If disclosure is compelled by an arbitrator or arbitration panel, when lawfully requested by either party, pursuant to a subpoena duces tecum (e.g., a subpoena for mental health records), or any other provision authorizing discovery in a proceeding before an arbitrator or arbitration panel.

6. If disclosure is compelled by a search warrant lawfully issued by a governmental law enforcement agency.

7. If disclosure is compelled by the Indiana Child Abuse and Neglect Reporting Act (for example, if your therapist has reasonable suspicion of child abuse or neglect).

8. If disclosure is compelled by the California Elder/Dependent Adult Abuse Reporting Law (for example, if your therapist has a reasonable suspicion of elder abuse or dependent adult abuse).

9. If disclosure is compelled or permitted by the fact that you are in such mental or emotional condition as to be dangerous to yourself or to the person or property of others, and if your therapist determines that disclosure is necessary to prevent the threatened danger.

10. If disclosure is compelled or permitted by the fact that you tell your therapist of a serious threat (imminent) of physical violence to be committed by you against a reasonable identifiable victim or victims.

11. If disclosure is compelled or permitted, in the event of your death, to the coroner in order to determine the cause of death.

12. As indicated above, your therapist is permitted to contact you without your prior authorization to provide appointment reminders or information about alternatives or other health-related benefits and services that may be of interest to you. Be sure to let us know where and by what means (e.g. telephone, letter, email, fax) you prefer to be contacted.

13. If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law, including but not limited to audits, criminal or civil investigations, or licensure or disciplinary actions. The Indiana Health Professions Bureau, who license mental and family therapists and mental health counselors, is an example of such a health oversight agency.

14. If disclosure is compelled by the U.S. Secretary of Health and Human Services to investigate or determine our compliance with privacy requirements under the federal regulations (the “Privacy Rule”).

15. If disclosure is otherwise specifically required by law.

PLEASE NOTE: The above list is not exhaustive, but informs you of most circumstances in which disclosure can be made without your written authorization. Other uses and disclosures would generally, but not always, be made only with your written authorization, even though federal privacy regulations or state law may allow such use/disclosure without your authorization. Uses or disclosures made with your written authorization will be limited to the information specified in the authorization form, which must be identified “in a specific and meaningful fashion.” You may revoke your written authorization at any time, in writing, unless we have already taken action in reliance on your written authorization or unless the authorization was obtained as a condition of obtaining insurance coverage for you. If Indiana law protects your confidentiality or privacy more than the federal “Privacy Rule” does, or if Indiana law provides you greater rights than the federal rule with respect to access to your records, we will abide by Indiana law. In general, uses or disclosures by us of your personal health information (without your authorization)will be limited to the minimum necessary to accomplish the intended purpose of the use or disclosure. Similarly, when your therapist requests your personal health information from another health care provider, health plan or health care clearinghouse, they will make an effort to limit the information requested to the minimum necessary to accomplish the intended purpose of the request. As mentioned above in the section dealing with uses or disclosures for treatment purposes, the “minimum necessary” standard does not apply to disclosures to or requests by a health care provider for treatment purposes, as health care providers need complete access to information in order to provide quality care.

Your Rights Regarding Protected Health Information: You have the right to request restrictions on certain uses and disclosures of protected health information about you (such as those necessary to carry out treatment, payment, or health care operations);however, we are not required to agree to your requested restriction. Should we agree, we will maintain a written record of the agreed upon restriction.

1. You have the right to receive confidential communications of protected health information from us by alternative means or at alternative locations.

2. You have the right to inspect and copy your protected health information by making a specific request to do so in writing. This right to inspect and copy is not absolute. We are permitted to deny access for specified reasons. For instance, you do not have this right of access with respect to your therapist’s “psychotherapy notes.” The term “psychotherapy notes” means notes (recorded in any medium) by a mental health professional documenting or analyzing the contents of conversation during a private, joint, family, or group counseling session that are separate from the rest of the individual’s medical (includes mental health) record. The term excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following: diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date.

3. You have the right to amend protected health information in your therapist’s records by making a written request that provides a reason supporting the requested amendment. This right to amend is not absolute. Your therapist is permitted to deny the requested amendment for specified reasons. You also have the right, subject to limitations, to provide your therapist with a written addendum to any item or statement in your records that you believe to be incorrect or incomplete and to have the addendum become a part of your record.

4. You have the right to receive an accounting of the disclosures of protected health information made by us in the six years prior to the date on which the accounting is requested. As with other rights, this right is not absolute. Your therapist is permitted to deny the request for specified reasons. For instance, we do not have to account for disclosures made in order to carry out your treatment, payment or health care operations. We also do not have to account for disclosures of protected health information that are made with your written authorization, since you have a right to receive a copy of any such authorization you might sign.

5. You have the right to obtain a paper copy of this notice upon request.

PLEASE NOTE: In order to avoid confusion or misunderstanding, we ask that if you wish to exercise any of the rights enumerated above, you put your request in writing and deliver or send the request to us. If you wish to learn more detailed information about any of the above rights, or their limitations, please let us know. Our Privacy Officer (as more fully described below) is willing to discuss any of these matters with you.

Your Therapist’s Duties: Your therapist is required by law to maintain the privacy and confidentiality of your personal health information. This notice is intended to inform you of your rights and our legal duties and privacy practices with respect to such information. We are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of this notice and/or our privacy practices and to make the changes effective for all protected health information that we maintain, even if it was created or received prior to the effective date of the notice revision. If we make a revision to this notice, we will make the notice available at our office upon request on or after the effective date of the revision and we will post the revised notice on our website.

Our Privacy Officer and Contact Person, Jennie Smith, is responsible for managing the development, implementation, and adoption of clear privacy policies and procedures for The Cabin. The Privacy Officer must assure that these privacy policies and procedures are followed by all individuals employed by or under contract with The Cabin. The Privacy Officer must ensure training occurs for all individuals employed by or under contract with The Cabin so that they understand the privacy policies and procedures. In general, all patient records and information are treated as confidential in this practice and are released to no one without the written authorization of the patient, except as indicated in this notice or except as may be otherwise permitted by law. Patient records are kept secured and are not readily available to those who do not need them.

If you believe your privacy right may have been violated by an employee or contracted individual of The Cabin, you may report this violation to Jennie Smith and/or to the Secretary of the U.S. Department of Health and Human Services (“Secretary”). You may file a complaint with Jennie Smith by telephone at 317-296-8019, or in writing, by providing her with the manner in which you believe the violation occurred, the approximate date of the occurrence, and any pertinent details regarding the violation. We will not retaliate against you in any way for filing a complaint with Jennie Smith or with the Secretary. Complaints to the Secretary must be filed in writing and can be mailed to: U.S. Department of Health and Human Services, Region V, Office for Civil Rights, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601.

Should you have questions regarding this Notice, or desire further information regarding its contents, please contact Jennie Smith. As the Contact Person and Privacy Officer for this practice, she will do her best to answer your questions and provide you with additional information. This notice first became effective on 9/13/2006 and updated on 12/5/2025.