Notice of Privacy Practices

← Privacy

Irvin Family Therapy dba Marriage Center of Indiana
Missy Irvin, LMFT
10 S 9th Street, Suite 10, Noblesville, IN 46060
(317) 674-3240 | missy.irvin@marriagecenter.us

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

Effective date: October 10, 2026

I. My Pledge Regarding Your Health Information

I understand that health information about you and your care is personal, and I am committed to protecting it. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with legal requirements. This Notice applies to all records of your care created or kept by my practice. It describes how I may use and disclose your health information, your rights regarding that information, and my obligations.

I am required by law to:

Keep your protected health information (“PHI”) private and secure.
Give you this Notice of my legal duties and privacy practices with respect to your PHI.
Notify you promptly if a breach occurs that may have compromised the privacy or security of your PHI.
Follow the terms of the Notice that is currently in effect.

I may change the terms of this Notice, and the changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. How I May Use and Disclose Your Health Information

The following categories describe ways I use and disclose health information. Not every use or disclosure in a category is listed, but all of the ways I am permitted to use and disclose information fall within one of these categories.

For Treatment. I may use and disclose your PHI to provide, coordinate, or manage your care. For example, I may consult with another licensed health care provider about your treatment, or share information with another provider you are referred to.

For Payment. I may use and disclose your PHI to bill and receive payment for services, for example to your Employee Assistance Program, or on a superbill or statement you request so you can seek reimbursement from your insurance.

For Health Care Operations. I may use and disclose your PHI to run my practice, for example for quality improvement, consultation, training, licensing, and legal or accounting services.

Business Associates. I work with outside companies that help me run my practice, such as my secure electronic health record, scheduling, billing, and telehealth platform (SimplePractice). These business associates are required by law and by written agreement to protect your information and to use it only as I direct.

Appointment Reminders and Services. I may use and disclose your PHI to remind you of appointments, including by email or text if you have agreed to receive them, and to tell you about treatment options or other health-related services I offer.

III. Uses and Disclosures That Require Your Authorization

Psychotherapy Notes. I keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501. These notes are kept separate from the rest of your record, and any use or disclosure of them requires your written Authorization, except:

For my use in treating you.
For my use in training or supervising mental health practitioners to help them improve their skills.
For my use in defending myself in legal proceedings brought by you.
For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
When required by law, limited to the requirements of that law.
For certain health oversight activities related to the originator of the notes.
When required by a coroner or medical examiner performing duties authorized by law.
When needed to help prevent a serious threat to the health or safety of others.

Marketing and Sale of PHI. I will not use or disclose your PHI for marketing purposes, and I will not sell your PHI.

Fundraising. I do not use your PHI for fundraising.

Other Uses and Disclosures. Any use or disclosure not described in this Notice will be made only with your written Authorization. You may revoke an Authorization at any time by giving me written notice, except to the extent I have already acted on it.

IV. Uses and Disclosures That Do Not Require Your Authorization

Subject to certain limits in the law, I may use and disclose your PHI without your Authorization:

When required by state or federal law, limited to the requirements of that law.
For public health activities, including reporting suspected abuse or neglect of a child, an elder, or an endangered adult, as Indiana law requires.
To prevent or lessen a serious and imminent threat to the health or safety of you, another person, or the public.
For health oversight activities, such as audits, investigations, and licensing actions.
For judicial and administrative proceedings, such as responding to a court or administrative order. If I receive a subpoena or similar request, I will disclose information only if efforts have been made to notify you or to obtain a court order protecting the information. Whenever possible, I will seek your Authorization first.
For limited law enforcement purposes, such as reporting a crime that occurs on my premises.
To coroners or medical examiners performing duties authorized by law.
For research approved through a process that protects your privacy.
For specialized government functions, such as military, national security, or protective services, or for the safety of people in correctional institutions.
For workers’ compensation, as permitted by workers’ compensation laws. My preference is to obtain your Authorization first.

V. Uses and Disclosures Where You Have the Opportunity to Object

Family, Friends, and Others Involved in Your Care. I may share your PHI with a family member, friend, or other person you identify as involved in your care or in paying for it, unless you object in whole or in part. In an emergency, or if you are unable to agree or object, I may share information if I believe it is in your best interest, and I will give you the opportunity to object as soon as possible.

Couples Therapy “No Secrets” Policy. In couples therapy, the relationship is my client, and information shared in joint sessions is part of the shared record. I follow a “no secrets” policy: I will not keep secrets between partners that could interfere with the couples work. If one partner shares information with me outside of a joint session, whether in an individual session, a phone call, an email, or a text, I may use my professional judgment to share it with the other partner when it is relevant to the therapy. If you tell me something you are not ready to share, such as an ongoing affair, I will help you find a way to share it yourself within a reasonable time. If you choose not to, I may need to end couples therapy and offer referrals.

VI. Your Rights Regarding Your PHI

Right to Request Limits on Uses and Disclosures. You may ask me not to use or disclose certain PHI for treatment, payment, or health care operations. I am not required to agree, and I may say no if I believe it would affect your care.

Right to Restrict Disclosures When You Pay in Full. If you pay for a service in full out of pocket, you may ask me not to share information about that service with your health plan for payment or operations purposes. I will agree unless a law requires me to share it.

Right to Choose How I Contact You. You may ask me to contact you in a specific way (for example, by cell phone rather than home phone) or at a different address. I will agree to all reasonable requests.

Right to See and Get Copies of Your PHI. Except for psychotherapy notes, you may request an electronic or paper copy of your record and other information I have about you. I will provide a copy or, if you agree, a summary, within 30 days of your written request. I may charge a reasonable, cost-based fee.

Right to Get a List of Disclosures. You may request a list of the times I have disclosed your PHI for purposes other than treatment, payment, health care operations, or as you authorized, for up to six years before your request. I will respond within 60 days. The first list in a 12-month period is free; I may charge a reasonable, cost-based fee for additional requests.

Right to Correct or Update Your PHI. If you believe there is a mistake in your PHI or that important information is missing, you may ask me to correct or add to it. I may say no, but I will tell you why in writing within 60 days.

Right to Be Notified of a Breach. You have the right to be notified if a breach of your unsecured PHI occurs.

Right to a Copy of This Notice. You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically. It is also posted on my website.

Right to 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.

VII. Indiana Law

Indiana law provides additional protections for mental health records. When Indiana law is more protective of your privacy than federal law, I follow Indiana law.

VIII. Questions and Complaints

If you have questions about this Notice, want to exercise any of your rights, or believe your privacy rights have been violated, contact my Privacy Officer:

Missy Irvin, LMFT, Privacy Officer
Irvin Family Therapy dba Marriage Center of Indiana
10 S 9th Street, Suite 10, Noblesville, IN 46060
(317) 674-3240 | missy.irvin@marriagecenter.us

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201; by calling 1-877-696-6775; or online at www.hhs.gov/ocr/privacy/hipaa/complaints.

I will not retaliate against you in any way for filing a complaint.

IX. Effective Date

This Notice is effective October 10, 2026 and replaces the Notice dated April 7, 2017.