HIPAA & Healthcare Privacy
Notice of Privacy Practices
How protected health information (PHI) is used, disclosed, and safeguarded.
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. About This Notice & Protected Health Information
This Notice of Privacy Practices describes the privacy practices of Rootwell Therapy & Consulting LLC ("Rootwell Therapy," "practice," "I," "me," or "my"), a clinical social work practice owned and operated by Regina Tetreault, LICSW.
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable federal and state laws, I am required to maintain the privacy of your Protected Health Information (PHI), to provide you with this Notice of my legal duties and privacy practices with respect to PHI, and to abide by the terms of the Notice currently in effect.
"Protected Health Information" (PHI) refers to individually identifiable information about your past, present, or future physical or mental health condition, the provision of healthcare to you, or payment for healthcare services.
2. Uses and Disclosures for Treatment, Payment, and Health Care Operations
I may use or disclose your PHI without your explicit written authorization for the following purposes:
Treatment
I may use your PHI to provide, coordinate, or manage your clinical care and related services. For example, I may review clinical intake information, progress notes, and treatment plans to tailor your EMDR, DBR, or IFS therapy sessions. If appropriate and with your prior consent or in a clinical consultation context, I may consult with a professional colleague or peer supervisor to ensure optimal care (protecting your identifying details whenever possible).
Payment
I may use and disclose your PHI to bill and collect payment for the treatment and services provided to you. For example, if you request an itemized monthly receipt ("Superbill") to seek out-of-network reimbursement from your health insurance carrier, I will disclose necessary PHI (such as your diagnosis code, CPT service code, session dates, and fee) on that document. Payment processing via credit card platforms integrated into SimplePractice also involves minimal administrative PHI necessary to process your transaction.
Health Care Operations
I may use and disclose your PHI to support the business and administrative operations of this practice. Examples include clinical peer consultation, quality assessment, legal auditing, business planning, and maintaining software systems (such as the HIPAA-compliant Electronic Health Record system, SimplePractice).
3. Uses and Disclosures Requiring Your Written Authorization
Other uses and disclosures of your PHI will be made only with your explicit, signed written Authorization. Specifically:
- Psychotherapy Notes: Notes taken during clinical sessions that are maintained separately from the rest of your medical record require a specific written authorization for release, except in limited legal or educational circumstances.
- Marketing & Commercial Purposes: Rootwell Therapy never uses, sells, or discloses your PHI for marketing, advertising, or commercial purposes.
- Sale of PHI: I will never sell your PHI under any circumstances.
If you provide written authorization to release your records (for example, to a primary care physician, psychiatrist, or former therapist), you may revoke that authorization in writing at any time. Your revocation will stop future releases, but will not affect disclosures already made in reliance on your prior authorization.
4. Uses and Disclosures Permitted or Required by Law Without Authorization
Federal and state laws permit or mandate disclosures of your PHI without your consent or authorization under specific circumstances:
- Suspected Abuse or Neglect: As a Licensed Independent Clinical Social Worker (LICSW), I am a mandated reporter. If I have reasonable cause to suspect child abuse or neglect, or abuse, neglect, or financial exploitation of an elderly or disabled adult, I am legally required to report this to appropriate state protective agencies (such as the MA Department of Children and Families, MA Disabled Persons Protection Commission, or RI Department of Children, Youth & Families).
- Serious and Imminent Threat (Duty to Warn / Protect): If you disclose an intent or threat to cause serious, imminent physical harm to yourself or an identifiable victim, I am ethically and legally obligated to take protective action. This may include notifying the intended victim, contacting law enforcement, or arranging emergency hospitalization.
- Judicial & Administrative Proceedings: If you are involved in a court proceeding and your mental health records are subpoenaed, I will disclose information only in response to a valid court order or court-issued subpoena signed by a judge, or with your written authorization.
- Law Enforcement & Health Oversight: As required by law for health oversight audits, inspections, investigations, or legal proceedings by government regulatory bodies.
- Coroners & Medical Examiners: In the event of death, to identify a deceased person or determine cause of death.
- Workers' Compensation: To comply with laws relating to workers' compensation claims.
- Specialized Government Functions: For national security, military oversight, or protective services if authorized by law.
5. Disclosures Where You Have the Opportunity to Agree or Object
Unless you object in writing, I may disclose relevant PHI to a family member, emergency contact, or close personal friend directly involved in your healthcare or payment for your healthcare if:
- You explicitly designate them on your intake contact form; or
- In an emergency situation where you are incapacitated, I determine in my professional clinical judgment that disclosure is in your best interest.
6. Your Rights Regarding Your Protected Health Information
Under HIPAA and state law, you have the following rights regarding your medical record:
Right to Inspect and Receive Copies
You have the right to inspect and obtain an electronic or paper copy of your clinical record. Requests must be made in writing to regina@rootwelltherapy.com. I will fulfill your request within 30 calendar days (or state statutory timeline). A reasonable, cost-based fee for copying/transmitting may apply as permitted by law.
Right to Request an Amendment
If you feel information in your record is incorrect or incomplete, you may submit a written request for amendment detailing your reasons. If denied, I will provide a written explanation within 60 days, and you may submit a statement of disagreement for inclusion in your file.
Right to an Accounting of Disclosures
You have the right to request a list ("accounting") of certain disclosures of your PHI made for purposes other than treatment, payment, health care operations, or pursuant to your written authorization during the 6 years prior to your request.
Right to Request Restrictions
You have the right to request restrictions on how your PHI is used or disclosed for treatment, payment, or healthcare operations. While I am not required to agree to all restriction requests, I am legally required to agree if you request that I not disclose PHI to a health plan for payment or health care operations purposes, and the PHI pertains solely to a healthcare item or service for which you have paid out-of-pocket in full (such as standard private-pay sessions).
Right to Confidential Communications
You have the right to request that I communicate with you about your healthcare in a specific way or at a specific location (for example, using a personal mobile number, specific email address, or mailing address). I will accommodate all reasonable written requests.
Right to Notification of a Breach
You have the right to be notified promptly in writing if an unauthorized access, acquisition, use, or disclosure of your unsecured PHI occurs.
Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this Notice at any time upon request, even if you previously agreed to receive it electronically.
7. More Protective State Laws (MA & RI)
Regina Tetreault, LICSW is licensed in the Commonwealth of Massachusetts and the State of Rhode Island. Where Massachusetts or Rhode Island state laws governing social work records, psychotherapist-patient privilege, or mental health disclosures offer greater privacy protections than federal HIPAA regulations, the more stringent state law will apply.
8. Complaints & Protection Against Retaliation
If you believe your privacy rights have been violated, you may file a formal complaint with Rootwell Therapy or with the Secretary of the U.S. Department of Health and Human Services.
You will not be penalized, retaliated against, or denied care in any way for filing a privacy complaint.
Practice Privacy Officer
Rootwell Therapy & Consulting LLC
Regina Tetreault, LICSW
Email: regina@rootwelltherapy.com
Phone: 508-250-0566
U.S. Dept. of Health & Human Services
Office for Civil Rights (OCR)
200 Independence Avenue, S.W.
Washington, D.C. 20201
Call: 1-800-368-1019 | TDD: 1-800-537-7697
9. About This Website (Website Data & Security Notice)
This public marketing website (rootwelltherapy.com) collects minimal inquiry data when you click external scheduling links or contact buttons. Please note:
- Public Website Form Disclaimer: Public website contact links and unencrypted email are not secure clinical communication channels. Do not send sensitive clinical information, detailed personal trauma history, or emergency medical details through public web links.
- Client Portal Intake: Formal intake, clinical documentation, and telehealth scheduling take place inside SimplePractice, a secure, HIPAA-compliant platform with encrypted client communications.
- Website Analytics & Cookies: This website uses standard hosting infrastructure and minimal technical cookies required for page loading. No invasive advertising retargeting or commercial advertising pixels are used.
10. Changes to This Notice
I reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that I maintain. Revised notices will be posted on this website and made available in the SimplePractice Client Portal.
Questions About Your Privacy?
Rootwell Therapy & Consulting LLC • Regina Tetreault, LICSW