Notice of Privacy Practices

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Effective Date: June 2026

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THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.

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My Commitment to Your Privacy

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As a Licensed Clinical Social Worker, I am legally required to protect the privacy of your protected health information (PHI) and provide you with this Notice of Privacy Practices.

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Uses and Disclosures of Information

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Your protected health information may be used for:

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Treatment

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Providing, coordinating, and managing your mental health care.

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Payment

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Obtaining reimbursement from insurance companies or other payers.

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Health Care Operations

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Administrative, quality assurance, and practice management activities necessary to operate the practice.

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Uses Requiring Your Authorization

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Written authorization is generally required before releasing information to:

• Family members

• Schools

• Employers

• Attorneys

• Other third parties

 

You may revoke an authorization at any time unless action has already been taken.

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Disclosures Required by Law

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Information may be disclosed without authorization when required by law, including:

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• Suspected child abuse or neglect

• Elder or dependent adult abuse

• Court orders

• Serious threat to health or safety

• Certain public health activities

 

Your Rights

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You have the right to:

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• Access your health records

• Request amendments to records

• Request restrictions on disclosures

• Request confidential communications

• Receive a copy of this notice

• File a complaint regarding privacy concerns

 

Complaints

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If you believe your privacy rights have been violated, you may contact:

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Jacqueline Machado, LCSW
Privacy Officer
info@jacquelinemachado.com

 

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

 

No retaliation will occur for filing a complaint.

 

This Notice may be updated periodically. The most current version will always be available upon request.