Disclaimer for online couples and individual therapy in Florida

HIPAA Notice of Privacy Practices

 

Effective Date: August 1, 2026

At Evolve Psychotherapy, LLC, I understand how personal and sensitive your mental health information is and I am committed to keeping it private and secure. This Notice explains how your health information may be used, how it may be shared, and what rights you have under federal and Florida law.

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ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (hereafter, “HIPAA”), you have certain rights regarding the use and disclosure of your protected health information (hereafter, “PHI”).

 

I am committed to protecting your health information in accordance with:

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• The Health Insurance Portability and Accountability Act (HIPAA)

• The HITECH Act

• 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records)

• Florida Statutes §§ 456.057, 491, 458, 464

• The Florida Mental Health Act (Chapter 394, Baker Act)

• The Florida Information Protection Act (FIPA), Fla. Statute § 501.171

 

By law, I am required to: 

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• Maintain the privacy and security of your Protected Health Information (PHI)

• Provide you with this Notice and follow the terms currently in effect

• Notify you in writing if a breach of unsecured PHI occurs

• Not retaliate against you for filing a privacy complaint 

 

This notice applies to all services provided at Evolve Psychotherapy, LLC including:

 

• Individual therapy

• Couples and family therapy

• Group therapy

• Telehealth services

 

HOW  WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

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1. For Treatment Purposes: We may use and disclose your PHI to provide, coordinate, or manage your care. This includes communication between your treatment providers after obtaining ROI (Release of Information), referrals to outside providers, and coordination during transition of care.

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2. For operations purposes, including sending appointment reminders, billing invoices, and other documentation.

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2. For Payment Purposes
In the case of self-pay, you may request that we not disclose related information to your insurance company. We are required to honor this request when applicable (45 CFR § 164.522).

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3. Uses Required or Permitted by Law
We may disclose your PHI:

• When required by court order or subpoena

• For mandatory abuse reporting (child, elder, vulnerable adult) — Florida Statute §
  39.201

• To prevent serious and imminent threats to health or safety

• For public health reporting

• For law enforcement when legally authorized

• For workers’ compensation claims

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4. Lawsuits and Disputes
If you are involved in a lawsuit or dispute, we may disclose health information in response to a court or administrative order, subpoena, discovery request, or other lawful legal process, only if efforts have been made to notify you about the request or to obtain a protective order.

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5. Disclosures to Family, Friends, or  others involved in Your Care
We may share limited information with family members or others involved in your care unless you object. In emergencies, we may use professional judgment to determine whether disclosure is in your best interest.

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SPECIAL PROTECTIONS

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1. Psychotherapy Notes
Psychotherapy notes are kept separate from your medical record and receive heightened protection under HIPAA (45 CFR § 164.501). We will not disclose psychotherapy notes without your written authorization except:

• For your treatment

• For supervision 

• To defend against legal claims brought by you

• When required by law

• To avert a serious threat

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2. Substance Use Disorder Records (42 CFR Part 2)
If you receive services related to substance use disorder (SUD) evaluation or treatment, your records are protected by federal law under 42 CFR Part 2, which provides stricter confidentiality protections than standard HIPAA rules:

• Written consent is generally required before we may disclose SUD records, even for treatment, payment, or health care operations, unless a Part 2-compliant general consent is already on file.

• SUD records may not be re-disclosed without your authorization unless permitted by law.

• You have the right to revoke your consent for SUD record disclosures in writing at anytime.

IMPORTANT: Your SUD records, and any testimony about what is in those records, may NO T be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you — by any federal, state, or local authority — unless you provide written permission OR a court issues an order after providing you notice and an opportunity to be heard. This protection is stronger than standard HIPAA and cannot be waived without your knowledge (42 CFR §§ 2.63–2.64).

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3. Records of Minors
For clients under the age of 18, Florida law generally grants parents or legal guardians the right to access their child’s records. However, under Fla. Stat. §§ 394.4615 and 491.0147, a minor who seeks mental health services may have certain privacy protections, and we may use clinical judgment to limit parental access when disclosure could harm the therapeutic relationship or the minor’s safety.  Applicable rules and exceptions will be discussed at the start of treatment.

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4. Marketing and Sale of PHI
We do not sell your PHI or use your PHI for marketing without your written authorization.

 

YOUR RIGHTS

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1. Right to Inspect and Obtain Copies
You may request electronic or paper copies of your records (excluding psychotherapy notes).
A reasonable, cost-based fee will be charged for this service. We will respond within 30 days of request.

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2. Right to Amend
You may request corrections to your records if you believe information is inaccurate or incomplete. We will respond in writing within 60 days with a written explanation if the request is denied. ​

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3. Right to Request Restrictions
You may request limits  on disclosures. Given that Evolve Psychotherapy, LLC is private-pay only, we will adhere to your request to not disclose the information to your insurer.

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4. Right to Confidential Communications
You may request that we communicate with you at an alternative address or phone number. We will accommodate reasonable requests.

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5. Right to an Accounting of Disclosures
You may request a list of disclosures made outside of treatment, payment, and operations within the last six years.

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6. Right to Receive This Notice
You may receive a paper or electronic copy of this Notice at any time.

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7. Right to Be Notified of a Breach
You will be notified in writing if your unsecured PHI is compromised, in accordance with HIPAA and the Florida Information Protection Act (Fla. Stat. § 501.171).

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8. Right to File a Complaint
You may file a complaint with us or directly with the U.S. Department of Health and Human Services. You will not face retaliation for filing a complaint.

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TELEHEALTH PRIVACY

 

Given that Evolve Psychotherapy, LLC is fully telehealth:

• We agree to use HIPAA-compliant platforms.

• Electronic communications carry inherent security risks.

• Client is responsible for ensuring privacy at your physical location, as therapist will ensure privacy within their location. 

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BUSINESS ASSOCIATES

We may share PHI with contracted vendors (such as EHR providers and IT
services). These parties are legally required to safeguard your PHI under Business Associate
Agreements.

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HOW TO FILE A PRIVACY COMPLAINT

Privacy  Officer
Evolve Psychotherapy, LLC
Email: evolvepsychotherapyfl@gmail.com

 

or with:
U.S. Department of Health & Human Services
Office for Civil Rights
www.hhs.gov/ocr

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CHANGES TO THIS NOTICE

We reserve the right to revise this Notice. Any revised Notice will be effective for all PHI we
create or maintain, including records created before the revision. Updated versions will be
posted on the Evolve Psychotherapy, LLC  website, in the Simple Practice patient portal, and will be available upon request.