Effective Date: July 15, 2026
Notice of Privacy Practices
We are required by law to maintain the privacy of your Protected Health Information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice that is currently in effect.
This Notice explains how your PHI may be used and disclosed, and how you may access that information. Please review it carefully.
Uses and Disclosures for Treatment, Payment, and Health Care Operations
Your PHI may be used or disclosed for treatment, payment, and health care operations, including:
- Treatment: To provide, coordinate, or manage your health care and related services. We may consult with other health care providers regarding your treatment and coordinate referrals, prescriptions, laboratory services, and follow-up care.
- Payment: To obtain payment for services provided to you. This may include billing, claims management, collection activities, eligibility determinations, and disclosure of information to your health plan or other payer.
- Health Care Operations: For practice management, quality assessment, credentialing, auditing, and improvement activities that help us operate our practice and support the quality and efficiency of care we provide.
Other Permitted or Required Disclosures
Your PHI may also be disclosed without your written authorization as required or permitted by law, including but not limited to the following purposes:
- Public health and safety purposes, including reporting certain diseases, injuries, vital events, or abuse and neglect as required by law.
- Health oversight activities, such as audits, investigations, inspections, licensure actions, or disciplinary proceedings by agencies authorized by law.
- Judicial and administrative proceedings, when disclosure is authorized by a court order, subpoena, discovery request, or other lawful process.
- Law enforcement purposes, including reporting as required by law, responding to lawful requests, or preventing a serious threat to health or safety.
- Workers' compensation claims and related proceedings, as authorized by and limited to the requirements of applicable workers' compensation laws.
- Other disclosures required by law, including disclosures to avert a serious threat to health or safety or to comply with federal, state, or local law.
Disclosures Requiring Written Authorization
Written authorization is required before using or disclosing PHI for purposes not described in this Notice, including:
- Psychotherapy notes, except as permitted by law.
- Marketing purposes, unless the communication is otherwise permitted without authorization.
- Selling PHI.
- Any other use or disclosure not described in this Notice or otherwise required or permitted by law.
You may revoke an authorization in writing at any time, except to the extent action has already been taken in reliance on it.
Psychotherapy Notes
Psychotherapy notes are specially protected and will not be disclosed without your written authorization except as permitted by law. These notes receive heightened privacy protection and are not routinely included in records used for treatment, payment, or operations.
Telehealth Privacy Considerations
Telehealth services are provided using secure, HIPAA-compliant platforms. No platform can guarantee absolute security, and there are inherent privacy risks. By using telehealth services, you acknowledge and accept these risks.
Client Rights Regarding Protected Health Information
- Right to Inspect and Obtain a Copy
You may request to inspect or obtain a copy of PHI maintained in your designated record set, subject to limited exceptions permitted by law.
- Right to Request an Amendment
You may request that we amend PHI if you believe it is incorrect or incomplete. We may deny the request in certain circumstances permitted by law.
- Right to an Accounting of Disclosures
You may request a list of certain disclosures of your PHI made by us, as required by law.
- Right to Request Restrictions
You may request limits on how we use or disclose your PHI. We are not required to agree to every request, but we will consider it carefully.
- Right to Request Confidential Communications
You may request that we communicate with you about medical matters in a particular way or at a particular location.
- Right to a Paper Copy
You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
- Right to Electronic Access / Patient Portal
You may have the right to access your records electronically through a patient portal or other approved electronic method, subject to legal and technical limitations.
Changes to This Notice
We reserve the right to change this Notice at any time, and the revised Notice will apply to all PHI that we maintain. We will post the current Notice in our office and on our website, if applicable, and we will make copies available upon request. The effective date of the revised Notice will be clearly indicated so that you can identify the current version in effect.
State Law Protections
We comply with applicable privacy laws in Illinois, Wisconsin, and Oregon. Where state law provides greater privacy protections than HIPAA, we will follow the more protective law. This may include additional protections for mental health records and other sensitive information.
Breach Notification
If a breach of unsecured PHI occurs, we will notify you as required by HIPAA and applicable state law.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Privacy Officer: David J. Goodman, PhD
Goodman Mental Health, LLC
825 S. Waukegan Rd., Ste. A8 #1009
Lake Forest, IL 60045
Email: admin@goodmanmentalhealth.com
Text: 414-324-6348
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
We will not retaliate against you for filing a complaint.
Acknowledgment of Receipt
By signing below, you acknowledge that you have received a copy of this Notice of Privacy Practices. Your signature confirms that you have been given the opportunity to review this Notice and ask questions about its contents.
If you decline to sign, we may still provide services as permitted by law, and we will document that a copy of the Notice was made available to you.
Client Information and Signature