Notice of Privacy Practices
Notice of Privacy Practices
This notice describes how your health information may be used and disclosed, and how you can access it. Please review it carefully.
Effective as of July 27, 2026.
My pledge regarding health information
Health information about you and your care is personal. I create a record of the services you receive from me and use HIPAA-compliant technology to create and maintain that record. I am required by law to keep information that identifies you private, to give you this notice of my legal duties and privacy practices, and to follow the terms of the notice currently in effect. I may change the terms of this notice, and the updated version will be available upon request.
How I may use and disclose health information
For treatment, payment, and health care operations. I may use or disclose your protected health information (PHI) to provide, coordinate, or manage your care, including consulting with another licensed provider about your treatment, without your written authorization.
For lawsuits and disputes. I may disclose health information in response to a valid court or administrative order, or in response to a subpoena or other lawful process, but only where required and, where possible, after an effort has been made to notify you or to obtain an order protecting the information.
Uses and disclosures that require your authorization
Psychotherapy notes. I keep psychotherapy notes as defined under 45 CFR § 164.501. Any use or disclosure of these notes requires your authorization, except where I use them in your treatment, in my own clinical supervision, to defend myself in a legal proceeding you have brought, where required by law, or where necessary to avert a serious threat to health or safety.
Marketing and sale of PHI. I will not use or disclose your PHI for marketing purposes, and I will not sell your PHI in the ordinary course of business.
Uses and disclosures that do not require your authorization
Subject to the limits of the law, I can use and disclose your PHI without your authorization for the following reasons:
When required by state or federal law
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or to prevent a serious threat to health or safety
For health oversight activities, including audits and investigations
For judicial and administrative proceedings, though my preference is to seek your authorization first when possible
For law enforcement purposes, including reporting a crime occurring on my premises
To a coroner or medical examiner performing duties authorized by law
For research purposes, with identifying information never disclosed without your separate permission
For specialized government functions as required by law
For workers' compensation purposes, though my preference is to seek your authorization first when possible
To send appointment reminders or share information about treatment alternatives or other services I offer
Disclosures you may object to
I may share your PHI with a family member, friend, or other person involved in your care or payment for care, unless you object. In an emergency, your opportunity to object may occur after the fact.
Your rights regarding your PHI
The right to request limits on how I use or disclose your PHI for treatment, payment, or operations. I am not required to agree, and may decline if I believe it would affect your care.
The right to request a restriction on disclosure to a health plan for services you have paid for out-of-pocket in full.
The right to choose how I contact you, with all reasonable requests honored.
The right to see and get a copy of your PHI, other than psychotherapy notes, within 30 days of a written request. A reasonable, cost-based fee may apply.
The right to request a list of disclosures I have made for purposes other than treatment, payment, or operations, covering up to six years. I will respond within 60 days. The first request in a year is free; a fee may apply to additional requests.
The right to request that I correct or add to your PHI if you believe it is incomplete or inaccurate. I will respond in writing within 60 days, including if I decline.
The right to a paper or electronic copy of this notice at any time, even if you have previously agreed to receive it electronically.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with me directly, or with the U.S. Department of Health and Human Services, Office for Civil Rights. Filing a complaint will not affect your care or any future services.
Contact
Shima Baronian, LMSW, CFSW
Shima Baronian Services, LLC
831 Auburn Rd, Ste 210 #1110
Dacula, GA 30019-2549