Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Your health record holds information that identifies you and relates to your past, present, or future physical or mental health and the care you receive. This is called protected health information (PHI). This notice explains how we may use and share your PHI under the Health Insurance Portability and Accountability Act (HIPAA), federal rules for substance use disorder records (42 CFR Part 2), Connecticut law, and the ACA Code of Ethics, and how you can access and control it.

Our legal duties

We are required by law to:

  • Keep your PHI private.

  • Give you this notice of our legal duties and privacy practices, and follow the notice currently in effect.

  • Notify you if a breach of your unsecured PHI occurs.

  • Follow whichever law provides you with greater protection when Connecticut law is stricter than HIPAA.

How we use and share your information

Treatment. Clinicians, clinical supervisors, and supervised interns involved in your care at Well Life Therapy may use and share your PHI to provide and coordinate your treatment. We share with providers outside our practice only with your written authorization, except in an emergency.

Payment. If you use insurance, we share the information your plan needs to confirm coverage, process claims, review medical necessity or authorize services. If an account goes to collection, we share only the minimum information needed.

Health care operations. We may use PHI for quality review, supervision, training, licensing, and running our practice. We may share it with vendors who perform services for us, such as billing or our electronic health record, only under a written agreement requiring them to protect it.

Substance use disorder (SUD) records. If we receive SUD treatment records from a program covered by federal law at 42 CFR Part 2, we protect them as that law requires:

  • Unless the law allows otherwise, we use or disclose these records for treatment, payment, or health care operations only with your written consent.

  • We will not use or disclose these records, or testimony about their content, in any civil, criminal, administrative or legislative proceeding against you unless you give written consent, or a court orders it after you or the record holder receives notice and an opportunity to be heard.

  • Once we properly share records with someone, that recipient may not be bound by the same protections.

When we may share without your authorization

The law permits or requires these disclosures in limited situations. We share only what is necessary and, when safe and possible, discuss it with you first.

  • Required by law. We must provide your PHI upon request and share PHI with the U.S. Department of Health and Human Services when it reviews our compliance.

  • Child abuse or neglect. We must report suspected abuse or neglect of anyone under 18 to the Connecticut Department of Children and Families.

  • Elder abuse. We must report suspected abuse, neglect, exploitation, or abandonment of anyone 60 or older to the Department of Social Services, and make any other report Connecticut law requires.

  • Serious threat to health or safety. We may share PHI to prevent or lessen a serious and imminent threat to you or others, including with the person threatened, your emergency contact, police or emergency services, or to arrange hospital care.

  • Court and administrative proceedings. We disclose PHI when a court or administrative order requires it. A subpoena alone is not enough; we also need your written consent.

  • Law enforcement. Only as the law requires, such as a court order, or to report a crime on our premises or in an emergency.

  • Health oversight. To licensing boards and government agencies for audits, investigations, and inspections authorized by law.

  • Public health. To public health authorities as the law requires to prevent or control disease, injury, or disability.

  • Specialized government functions. For military, national security, or State Department purposes, as the law allows.

  • Workers' compensation. As Connecticut law requires for a workers' compensation claim.

  • Deceased clients. To a coroner or medical examiner, or to the executor or next of kin as state law allows. PHI of someone who died more than 50 years ago is no longer protected by HIPAA.

  • Research. Only with your authorization or after a formal privacy approval process.

Family and friends. With your verbal or written permission, we may share information with family members or others directly involved in your care. In an emergency, we may share what is needed to prevent serious harm.

Connecticut protections. Connecticut law protects communications with mental health professionals and HIV-related information more strictly than HIPAA. Where it does, we follow Connecticut law.

Uses that need your written authorization

We will use or share your PHI for any purpose not described in this notice only with your written authorization. That always includes:

  • Most uses and disclosures of psychotherapy notes kept separate from your record.

  • Marketing.

  • Any sale of your PHI.

You may revoke an authorization in writing at any time. Revoking it does not undo anything we already shared while it was in effect.

Fundraising. Well Life Therapy does not send fundraising communications and does not use your information for fundraising.

Your rights

To use any of these rights, send a written request to our Privacy Officer at info@welllifetherapyllc.com or 437 Naubuc Avenue, Suite 107, Glastonbury, CT 06033.

  • See and get a copy of your record. You may inspect or get a paper or electronic copy of your mental health and billing records, or have a copy sent to someone you choose. We may charge a reasonable, cost-based fee. We may deny access only in limited cases, such as when access is reasonably likely to cause serious harm, or for psychotherapy notes kept separately.

  • Ask us to correct your record. If you believe information is wrong or incomplete, you may ask us to amend it. If we decline, you may file a statement of disagreement, which we will add to your record.

  • Get a list of disclosures. You may request an accounting of certain disclosures we made. The first list in any 12-month period is free; we may charge a reasonable fee for more.

  • Ask us to limit what we share. You may request limits on how we use your information for treatment, payment, or operations. We do not have to agree, except that we must honor a request not to share information with your health plan about a service you paid for in full out of pocket.

  • Choose how we contact you. You may ask us to contact you in a certain way or at a certain place, such as a different phone or address. We will accommodate reasonable requests and will not ask why.

  • Get notice of a breach. We will notify you if a breach compromises your unsecured PHI.

  • Choose someone to act for you. A legal guardian or someone with your health care power of attorney may exercise your rights.

  • Get a copy of this notice at any time, on paper or electronically, even if you agreed to receive it electronically.

Complaints

If you believe your privacy rights were violated, you may complain to:

  • Our Privacy Officer: Julie K. Jones, Ph.D., LPC, 437 Naubuc Avenue, Suite 107, Glastonbury, CT 06033 · info@welllifetherapyllc.com · 860-258-6060

  • U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201 · 1-800-368-1019 · www.hhs.gov/ocr/complaints

We will not retaliate against you for filing a complaint.

Changes to this notice

We may change this notice, and changes will apply to all PHI we hold. We post the current notice in our office and on our website, and you may receive it at your next appointment or by mail upon request.

Effective date of this notice: October 12, 2026 (replaces the notice dated May 2017)