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.

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Nicole Helverson, PsyD is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.

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The following categories describe different ways that we use and disclose your PHI. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information fall within the categories below.
 

Your Rights

You have the right to:

• Get a copy of your paper or electronic medical record

• Correct your paper or electronic medical record

• Request confidential communication

• Ask us to limit the information we share

• Get a list of those with whom we’ve shared your information

• Get a copy of this privacy notice

• Choose someone to act for you

• File a complaint if you believe your privacy rights have been violated

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Our Uses and Disclosures

We may use and share your information as we:

• Treat you

• Run our organization

• Bill for your services

• Help with public health and safety issues

• Comply with the law

• Address workers’ compensation, law enforcement, and other government requests

• Respond to lawsuits and legal actions

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Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

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Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

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Ask us to amend your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. To do so, send a written request with the reason(s) for the desired changes.

• We may say “no” to your request, but we’ll tell you why in writing within 60 days. A written statement of disagreement may be submitted.

 

Request confidential communications

• You can ask us to contact you in a specific way.

• We will say “yes” to all reasonable requests.

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Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. 

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

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Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

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Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

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Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

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File a complaint if you feel your rights are violated

• You can file a complaint if you feel we have violated your rights by contacting us – you’ll find the contact information at the bottom of this document.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a complaint.​​

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Our Uses and Disclosures

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How do we typically use or share your health information?

We typically use or share your health information in the following ways:

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Treat you

We can use your health information and share it with other professionals who are treating

you.

 

Example: You request that treatment information is shared with your primary care provider (PCP) or psychiatrist.

 

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

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Example: We use health information about you to manage your treatment and services, or to send you appointment reminders.

 

Bill for your services

Your PHI will be used, as needed, to bill and collect payment for your health care services, to verify benefits, seek coverage information, attain preauthorization for recommended services, to demonstrate medical necessity for services, or as required for utilization review. Your PHI may be released to an outside agency for collection purposes.

 

Example: We give information about you to your health insurance plan so it will pay for your services.

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How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

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Help with public health and safety issues

We can share health information about you for certain situations such as:

• Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing a serious threat to anyone’s health or safety

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Do research

We can use or share your information for health research.

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Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

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Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

• For workers’ compensation claims

• For law enforcement purposes or with a law enforcement official

• With health oversight agencies for activities authorized by law

• For special government functions such as military, national security, and presidential protective services

• If you are an inmate of a correctional institution or under the custody of a law enforcement official, your PHI may be released to the correctional institution or law enforcement official for purpose of ensuring proper health care, to protect your health and safety or the health and safety of others; or for the safety and security of the correctional institution.

 

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

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Use and Disclosure of Substance Use Disorder Records Subject to 42 CFR Part 2:
(A) If applicable, your substance use disorder (“SUD”) records are protected by federal law under 42 C.F.R. Part 2 (“Part 2”). This law provides extra confidentiality protections and requires a separate patient consent for the use and disclosure of SUD counseling notes. Each disclosure made with patient consent must include a copy of the consent or a clear explanation of the scope of the consent. It must also be accompanied by a written notice containing the language in 42 CFR Part 2.32(a). Disclosure of these records requires your explicit written consent, except in limited circumstances such as:

• Medical Emergencies: to the extent necessary to treat you,

• Reporting Crimes on Program Premises,

• Child Abuse Reporting: In connection with incidents of suspected child abuse or neglect to appropriate state or local authorities, and
• Fundraising: We will provide you with an opportunity to decline to receive any fundraising communications prior to making such communications.

You may revoke this consent at any time.

 

(B) Prohibitions on Use and Disclosure of Part 2 Records:
SUD records received from programs subject to Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested SUD record is used or disclosed. If SUD records are disclosed to us or our business associates pursuant to your written consent for treatment, payment, and healthcare operations, we or our business associates may further use and disclose such health information without your written consent to the extent that the HIPAA regulations permit such uses and disclosures, consistent with the other provisions in this Notice regarding PHI.

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Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

• We will never market or sell personal information.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, and on our web site.

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Effective Date of Notice: This notice went into effect on July 1, 2020; Last Updated February 5, 2026

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This notice applies to the practice of Nicole Helverson, PsyD. If you have any questions about this notice, if you wish to contact us about your privacy rights or obtain a copy of your records, or you wish to file a complaint, you can contact the Privacy Officer/HIPAA Liaison:

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Nicole Helverson, PsyD

199 New Rd Ste 61

#183

Linwood, NJ 08221

484-804-9972
 

In the event that state law provides greater protection than the HIPAA protections listed in this Notice, we will follow the requirements of state law.

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