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.

This Notice applies to all records of your care created or maintained by this mental health practice.

Federal law (the Health Insurance Portability and Accountability Act of 1996, or “HIPAA”) and Pennsylvania law protect the privacy of your health information. When PA state law is more restrictive, it will govern how your information is used and disclosed.

EFFECTIVE DATE This Notice is effective as of January 1, 2026

PRACTICE INFORMATION

Morgan Rakay, MA, LPC, BC-DMT
DBA A Quiet Space Counseling
Philadelphia, Pennsylvania
Phone: (267) 908-4664

I. MY DUTIES REGARDING YOUR HEALTH INFORMATION

I understand that information about your mental health care is personal and sensitive. I am committed to protecting your privacy.

I create and maintain records of the care and services you receive. These records are necessary to provide you with quality care and to comply with legal and professional requirements.

I am required by law to:

Maintain the privacy and security of your protected health information
Provide you with this Notice describing my legal duties and privacy practices
Follow the terms of the Notice currently in effect
Notify you if a breach occurs that compromises the privacy or security of your unsecured PHI

I reserve the right to change the terms of this Notice. Any changes will apply to all PHI I maintain about you. Updated versions will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

The following categories describe ways I may use or disclose your PHI. Not every possible use or disclosure is listed, but all permitted uses fall within these categories.

A. For Treatment, Payment, and Health Care Operations

I may use or disclose your PHI without your written authorization for purposes related to treatment, payment, and health care operations, as permitted by law.

Examples include:

Providing or managing your mental health care
Consulting with other licensed health care providers involved in your care, only when permitted by law and/or authorized by you
Scheduling appointments and sending appointment reminders
Billing, payment processing, and related administrative functions

When required, disclosures for treatment purposes will comply with Pennsylvania mental health confidentiality laws, including the Pennsylvania Mental Health Procedures Act (MHPA).

B. Disclosures Required or Permitted by Law

I may use or disclose your PHI without your authorization when required or permitted by federal or Pennsylvania law, including but not limited to:

Reporting suspected child abuse, elder abuse, or abuse of a dependent adult
Preventing or reducing a serious and imminent threat to any person’s health and safety
Health oversight activities such as audits, investigations, or licensure reviews as required by law
Workers’ compensation claims, as required by law
Law enforcement purposes, when legally permitted and ordered by a judge
Disclosures to coroners or medical examiners when authorized by law

C. Lawsuits and Legal Proceedings

I may disclose PHI in response to a valid court order. I may respond to subpoenas or other lawful processes; however, Pennsylvania law provides heightened protection for mental health records, and I will assert applicable privileges and confidentiality protections whenever I am able and required. I will seek your written authorization or a court order signed by a judge before disclosing information.

III. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

A. Psychotherapy Notes

I maintain psychotherapy notes as defined by 45 C.F.R. §164.501. These notes are kept separate from the rest of your medical record. I will not use or disclose psychotherapy notes without your written authorization, except as permitted by law, including:

For my own use in treating you
For my use in defending myself in legal proceedings brought by you
For oversight activities by the U.S. Department of Health and Human Services
When required by law
To prevent a serious and imminent threat to health or safety

B. Other Uses Requiring Authorization

Any use or disclosure of your PHI for purposes not described in this Notice will be made only with your written authorization. If a disclosure is requested for a purpose outside those described above, I will discuss it with you and request that you sign an authorization form.

You may revoke an authorization at any time in writing, except to the extent that action has already been taken in reliance on it.

IV. USES AND DISCLOSURES WHERE YOU MAY AGREE OR OBJECT

With your agreement, I may disclose relevant PHI to a family member, friend, or other person you identify as being involved in your care or payment for your care.

In emergency situations, or if you are incapacitated, I may disclose information if I believe it is in your best interest and consistent with applicable law.

V. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights with respect to your PHI:

Right to Request Restrictions: You may request limits on certain uses or disclosures. I am not required to agree to all requests.
Right to Restrict Disclosures for Services Paid Out-of-Pocket: If you pay in full out-of-pocket, you may request that information about that service not be disclosed to your health plan.
Right to Request Confidential Communications: You may request that I contact you in a specific way or at a specific location.
Right to Access and Copies: You may inspect and obtain a copy of your PHI, with limited exceptions. Requests must be in writing. I will respond within 30 days and may charge a reasonable, cost-based fee. The current fee is $50 for any administrative burden over 15 minutes.
Right to Request Amendments: You may request an amendment if you believe your PHI is incorrect or incomplete.
Right to an Accounting of Disclosures: You may request a list of certain disclosures made within the past six years. One accounting per year is provided at no charge.
Right to Choose a Personal Representative: A legally authorized representative may exercise your rights on your behalf.
Right to File a Complaint: You may file a complaint if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

Complaints may be made to me or to:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: (877) 696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints

VI. CHANGES TO THIS NOTICE

I may change the terms of this Notice at any time. Any changes will apply to all PHI I maintain about you. Updated versions will be available upon request, in my office, and on my website.