HIPAA Notice of Privacy Practices

Troy Bennett Counseling
Effective Date: 12/01/2025

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.

1. Your Rights

You have the right to:

• Get a copy of your mental health/medical record

You can ask to see or get an electronic or paper copy of your clinical record.
We will provide a copy or summary, usually within 30 days, and may charge a reasonable, cost-based fee.

• Request correction of your record

If you believe your record is incomplete or incorrect, you can request a correction.
We may deny your request, but we will tell you why in writing within 60 days.

• Request confidential communication

You may request that we contact you in a specific way (e.g., phone vs. email) or at a specific location.

• Ask us to limit what we use or share

You may request limits on how we use or share your protected health information (PHI).
We will consider your request but are not required to agree unless the request involves restricting information to your health plan when you pay for services in full out of pocket.

• Receive a list of disclosures

You can ask for a list of times we have shared your PHI for six years prior to your request, with exceptions such as disclosures for treatment, payment, and healthcare operations.

• Receive a copy of this Notice

You may request a paper or electronic copy of this Notice at any time.

• Choose someone to act for you

If you have a legal guardian or medical power of attorney, that person may exercise your rights.

• File a complaint

If you believe your privacy rights have been violated, you may file a complaint:

  1. Directly with Troy Bennett Counseling

  2. With the U.S. Department of Health and Human Services (HHS)

You will not be penalized for filing a complaint.

2. Your Choices

You have choices in how we use and share your information in situations such as:

  • Sharing information with family members or others involved in your care

  • Sharing information in disaster relief situations

  • Including your information in a provider directory

We will obtain your written permission before sharing:

  • Psychotherapy notes

  • Marketing communications

  • Sale of health information

You may revoke your authorization at any time in writing.

3. Our Uses and Disclosures

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

• For Treatment

We use your PHI to provide, coordinate, or manage your mental health care.

• For Payment

We share information required to bill and receive payment from you, your insurance plan, or another payer.

• For Healthcare Operations

We use PHI to run our practice, improve services, conduct clinical supervision, and maintain licensing and accreditation requirements.

4. Other Permitted or Required Disclosures

We may disclose your PHI without your authorization in certain situations:

• When required by law

Including court orders, subpoenas, and mandatory reporting laws.

• For public health and safety

Including reporting:

  • Abuse or neglect of minors or vulnerable adults

  • Serious threats to health or safety

  • Specific communicable diseases (as required by law)

• For oversight activities

Such as audits, licensing, or quality reviews.

• For law enforcement purposes

In limited situations as permitted by law.

• To coroners, medical examiners, or funeral directors

When necessary.

• For specialized government functions

Such as national security or military activities, where applicable.

• To comply with HIPAA reporting requirements

5. Our Responsibilities

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

  • We will notify you 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.

  • We will not use or share your information in ways not covered by this Notice without written authorization.

6. Changes to This Notice

We may update this Notice as laws or practice changes occur.

The updated version will be posted on our website and available upon request.

7. Contact Information

If you have questions or wish to exercise your privacy rights, contact:

Troy Bennett Counseling
7077 Northland Circle N., Suite 330
Brooklyn Park, MN
Email: troy@troybennettcounseling.com
Phone: +1-612-208-2847