NOTICE OF PRIVACY PRACTICES

Last Updated 03/14/26.

This notice describes how medical information about you may be used and disclosed by Amanda Lynne, PhD, LLC and how you can get access to this information. Please review this notice carefully.

Understanding Your Protected Health Information (PHI)

When you visit, a record is made of your symptoms, assessments, diagnoses, treatment plan, and other mental health or medical information. Your record is the physical property of Amanda Lynne, PhD, LLC, whereas the information within belongs to you. Being aware of what is in your record will help you to make informed decisions when authorizing disclosure to others. In using and disclosing your protected health information (PHI), it is our objective to follow the Privacy Standards of the federal Health Insurance Portability and Accountability Act (HIPAA) and requirements of Indiana law.

Your Mental Health and/or Medical Record Serves As A:

  • Basis for planning your care and treatment

  • Means of communication among the health professionals who may contribute to your care

  • Legal document describing the care you received

  • Means by which you or a third-party payer can verify that services billed were actually provided

  • Source of information for public health officials charged with improving the health of the nation

  • Source of data for business and facility planning

  • Tool with which we can assess and continually work to improve the care we provide.

Responsibilities of Amanda Lynne, PhD, LLC

We are required to:

  • Maintain the privacy of your PHI as required by law and provide you with notice of our legal duties and privacy practices with respect to the PHI that we collect and maintain about you.

  • Abide by the terms of this notice currently in effect. We have the right to change our notice of privacy practices and to make the new provisions effective for all PHI that we maintain, including that obtained prior to the change. Should our information practices change, we will post new changes in the reception room and provide you with a copy, upon request.

  • Notify you if we are unable to agree to a requested restriction. 

  • Accommodate reasonable requests to communicate with you about PHI by alternative means or at alternative locations. 

  • Use or disclose your PHI only with your authorization except as described in this notice.

Your Protected Health Information (PHI) Rights

You have the right to:

  • Review and obtain a paper copy of the notice of privacy practices upon request and of your health information, except that you are not entitled to access, or to obtain a copy of, psychotherapy notes. We may deny your request to review and obtain your health information under certain circumstances. Copy charges may apply. 

  • Request and provide written authorization and permission to release information for purposes of outside treatment and health care operations. This authorization excludes psychotherapy notes and any audio/video tapes that may have been made with your permission by your therapist.

  • Revoke your authorization in writing to use, disclose, or restrict health information except to the extent that action has already been taken.

  • Request a restriction on certain uses/disclosures of PHI, but we are not required to agree to the restriction request. We will notify you within 10 days if we cannot agree to the restriction.

  • Request that we amend your health information by submitting a written request with the reasons supporting the request. We are not required to agree to the requested amendment.

  • Obtain an accounting of disclosures of your health information for purposes other than treatment, payment, health care operations and certain other activities for the last six years.

  • Request confidential communications of your health information by alternative means or at alternative locations. 

Disclosures for Treatment, Payment, and Health Operations

I. Amanda Lynne, PhD, LLC will use your PHI, with your consent, in the following circumstances:

  • Treatment: Information obtained by your therapist or from other members of your health care team will be documented in your record and used to determine the management and coordination of treatment that will be provided for you.  

  • For payment, if applicable: If you choose to bill insurance for treatment, Amanda Quinby, PhD, LLC may disclose your health information in order to obtain reimbursement for your health care or to determine eligibility or coverage.  In these cases, the minimum amount of information necessary to obtain payment or determine coverage will be disclosed.  Amanda Lynne, PhD, LLC also reserves the right to provide collection agencies with the minimum amount of information necessary for them to collect payment in situations where staff members’ attempts of collecting payment from the client have been unsuccessful.

  • For health care operations: Amanda Lynne, PhD, LLC may use information in your health record to assess the performance and operations of  services. This information will then be used in an effort to continually improve the quality and effectiveness of the mental health services we provide.

  • Disclosure to others outside of Amanda Lynne, PhD, LLC: If you give us a written authorization, you may revoke it in writing at any time, but that revocation will not affect any use or disclosures permitted by your authorization while it was in effect. We will not use or disclose your health information without your authorization, except as described below to report a serious threat to health or safety or child and adult abuse or neglect.

II. Amanda Lynne, PhD, LLC will use your PHI, without your consent or authorization, in the following circumstances:

  • Child Abuse: If we have reasonable cause to suspect that a child known to us in the course of professional duties has been abused or neglected, or have reason to believe that a child known to us in the course of our professional duties has been threatened with abuse or neglect, and that abuse or neglect of the child will occur, we must report this to the relevant county department, child welfare agency, police, or sheriff’s department.

  • Adult and Domestic Abuse: If we believe that a vulnerable adult is the victim of abuse, neglect or domestic violence, or the possible victim of other crimes, we may report such information to the relevant county department or state official.

  • Serious Threat to Health or Safety: If we have reason to believe, exercising best judgment and our professional care and skill, that you may cause serious harm to yourself or another person, we may take steps, without your consent, to notify or assist in notifying a family member, personal representative, person responsible for your care, police department, hospital, or person at risk of being harmed by you, in order to protect you or another person from harm. This may include instituting commitment proceedings.

  • Judicial or administrative proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law and we will not release the information without written authorization from you or your personal or legally-appointed representative, or a subpoena/court order. The privilege does not apply when you are being evaluated by a third party or where the evaluation is court ordered. 

  • As required by law for national security and law enforcement: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence and other national security activities. We may disclose health information for law enforcement purposes as required by law or in response to a valid court order.

  • Law/Health Oversight: As required by law, we may disclose your health information. 

  • Research: We may disclose health information to researchers when an institutional review board has reviewed and approved the research proposal and established protocols to ensure the privacy of your health information.  This data is generally de-identified.

  • Worker’s Compensation: We may disclose health information to the extent authorized by you and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law; we may be required to testify. 

  • As required by law for purposes of public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

  • Business Associates: There are some services provided to Amanda Lynne, PhD, LLC through contracts with business associates. An example includes computer support for our scheduling system. When these services are contracted, we may disclose your health information to our business associate so they can perform the job we’ve asked them to do. Business associates are required to safeguard your information.

Substance Use Disorder Records

Federal law provides special protections for records relating to substance use disorder (SUD) treatment under 42 CFR Part 2. These protections are stricter than the general HIPAA privacy rules described in this notice. Where Part 2 applies to your records, those stricter rules govern, and the uses and disclosures described in this notice are limited accordingly.

SUD records received from programs subject to 42 CFR Part 2, or testimony relaying the content of such records, may not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you unless based on: (1) your written consent, or (2) a court order issued after you have been given notice and an opportunity to be heard. Any court order authorizing such use or disclosure must also be accompanied by a subpoena or other legal requirement compelling disclosure before the records may be used or disclosed.

Please be aware that once your health information has been disclosed to another party in accordance with HIPAA, that information may be further disclosed by the recipient and may no longer be protected under the HIPAA Privacy Rule.

For More Information or to Report a Problem

If you have questions or would like additional information, please ask your therapist, who will provide you with additional information.

If you are concerned that your privacy rights have been violated or if you disagree with a decision we have made about access to your health information, or if you would like to make a request to amend or restrict the use or disclosure of your health information, you may contact:

Amanda Lynne, PhD, LLC:  Amanda Lynne Quinby 

205 North College Avenue, Suite 314, Bloomington, IN 47404

Phone: 812-606-2919

If you believe that your privacy rights have been violated, you can also file a complaint with the Secretary of the U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health & Human Services
150 S. Independence Mall West - Suite 372, Philadelphia, PA 19106-3499
(215) 861-4441; (215) 861-4440 (TDD)   Fax: (215) 861-4431 

You may also visit this web site for forms: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

Amanda Lynne, PhD, LLC respects your right to the privacy of your health information. There will be no retaliation in any way for filing a complaint with us or the U.S. Department of Health and Human Services.