HIPAA Notice of Privacy Practices

HIPAA NOTICE OF PRIVACY PRACTICES

Last updated: April 22, 2026

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

OUR LEGAL DUTY

Capital Private Psychological Services is required by law to:

Maintain the privacy and security of your Protected Health Information (“PHI”)
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of this Notice currently in effect
Notify you if a breach occurs that may compromise your information

HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

We may use and disclose your PHI for the following purposes:

Treatment

We may use your information to provide, coordinate, or manage your care.

Example: Sharing information with another healthcare provider involved in your treatment.

Payment

We may use your information to bill and receive payment for services.

Example: Providing necessary information to your insurance company.

Healthcare Operations

We may use your information to operate our practice and improve the quality of care.

Example: Quality improvement activities, staff training, and compliance monitoring.

OTHER PERMITTED USES AND DISCLOSURES

We may also use or disclose your PHI when permitted or required by law, including:

Public health and safety activities
Preventing or reducing a serious threat to health or safety
Health oversight activities
Judicial and administrative proceedings
Law enforcement purposes
Workers’ compensation claims

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

We will obtain your written authorization before:

Using or disclosing psychotherapy notes (except where permitted by law)
Using your information for marketing purposes
Selling your information

You may revoke your authorization at any time in writing, except where we have already relied on it.

YOUR RIGHTS

You have the following rights regarding your PHI:

Access Your Records

You may request copies of your medical or billing records.

Request Corrections

You may request corrections to inaccurate or incomplete information.

Request Confidential Communications

You may request that we contact you in a specific way (for example, only by phone or email).

Request Restrictions

You may request limits on how we use or share your information. We will comply with a request to restrict disclosure of your information to a health plan if the information relates solely to a service for which you have paid out of pocket in full, unless otherwise required by law.

Receive an Accounting of Disclosures

You may request a list of certain disclosures we have made.

Receive a Copy of This Notice

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

To exercise any of these rights, please contact us using the information provided at the end of this Notice. We may require written requests for certain actions. You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

OUR RESPONSIBILITIES

We will:

Keep your PHI private and secure
Use and disclose your information only as described in this Notice
Notify you of any breach of your unsecured PHI
Honor your rights as described above

MINORS

When permitted by law, parents or legal guardians may have access to a minor’s PHI. In certain situations, minors may have privacy rights under applicable state and federal law.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice at any time. Any updated Notice will apply to all PHI we maintain and will be made available on our website and upon request.

QUESTIONS OR COMPLAINTS

If you have questions about this Notice or believe your privacy rights have been violated, you may contact us:

Capital Private Psychological Services
722 Buckles Ct N, Suite 210
Gahanna, OH 43230

Phone: +1 (614) 656-7025
Email: vm@cppstherapy.com

You may file a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.