Notice of Privacy Practices

Effective Date: March 12, 2026

Chantelle Ingram | Therapy & Consultation

Atlanta, Georgia

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

I. Our Commitment to Your Privacy

  • Your privacy is extremely important. As a mental health provider, I understand that information about your health and personal experiences is sensitive. This Notice describes how your protected health information (PHI) may be used and disclosed and explains your rights regarding that information.

  • Protected health information includes information created or received during the course of therapy that relates to your physical or mental health condition, treatment, or payment for services.

  • This Notice applies only to psychotherapy services provided through this practice and does not apply to consultation or coaching services, which are non-clinical and not governed by HIPAA.

II. Our Legal Duties

Under federal law, I am required to:

  • Maintain the privacy and security of your protected health information

  • Provide you with this Notice of my legal duties and privacy practices

  • Follow the terms of the Notice currently in effect

  • Notify you if a breach occurs that may compromise the privacy or security of your information

III. How Your Information May Be Used and Disclosed

Under HIPAA, your protected health information may be used or disclosed without your written authorization for the following purposes:

1.) Treatment - Your information may be used to provide, coordinate, or manage your mental health care. When appropriate, information may be shared with other healthcare providers involved in your care, typically with your written permission unless there is an emergency.

2.) Payment - Information may be used to bill and collect payment for services.

3.) Health Care Operations- Information may be used for administrative purposes such as recordkeeping, quality improvement, licensing requirements, and professional supervision or consultation.

4.) Business Associates- I may share information with service providers who help operate the practice, such as electronic health record platforms. These providers are required to protect your information and sign Business Associate Agreements in accordance with HIPAA.

5.) Required by Law- Information may be disclosed when required by federal or state law, court order, or lawful subpoena.

  • Abuse or Neglect Reporting

  • Information may be disclosed when required to report suspected abuse, neglect, or exploitation.

  • Serious Threat to Health or Safety

  • Information may be disclosed when necessary to prevent or lessen a serious and imminent threat to your health or safety or the safety of another person.

  • Health Oversight Activities

  • Information may be disclosed to regulatory or licensing agencies for audits, investigations, or compliance reviews.

When information is used or disclosed, reasonable efforts are made to limit it to the minimum necessary information required.

IV. Psychotherapy Notes

Psychotherapy notes receive special protection under HIPAA. These notes are kept separate from the general medical record and are not disclosed without your written authorization except in limited circumstances permitted by law.

V. Other Uses and Disclosures

Any use or disclosure not described in this Notice requires your written authorization. You may revoke an authorization at any time in writing, except to the extent that action has already been taken based on the authorization.

Your information will never be sold and will not be used for marketing purposes.

VI. Your Rights

You have the right to:

1.) Inspect and Obtain Copies - You may request access to your protected health information in paper or electronic form.

2.) Request Corrections- You may request an amendment to your record if you believe information is incorrect or incomplete.

3.) Request Restrictions- You may request restrictions on certain uses or disclosures of your information.

4.) Request Confidential Communications- You may request that communications be sent in a specific way or to a specific location.

5.) Receive an Accounting of Disclosures- You may request a list of certain disclosures made of your information.

6.) Obtain This Notice -You may request a paper or electronic copy of this Notice at any time.

VII. Complaints

If you believe your privacy rights have been violated, you may file a complaint with this practice.

You may also file a complaint with:

U.S. Department of Health and Human Services

Office for Civil Rights

Filing a complaint will not affect your care, and you will not be retaliated against for doing so.

VIII. Changes to This Notice

This practice reserves the right to change the terms of this Notice. Any changes will apply to all information maintained by the practice. The revised Notice will be available upon request and posted as required.

VIII. Coaching services are non-clinical and are not governed by HIPAA.