Notice of Privacy Practices
Last Updated: October 2026
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Your health record contains personal and protected health information (“PHI”) about you and the mental health services you receive. PHI includes information that may identify you and relates to your past, present, or future physical or mental health, condition, or treatment. This Notice explains how your PHI may be used and disclosed in accordance with applicable law, HIPAA regulations, and professional ethical standards. It also explains your rights regarding access to and control of your PHI.
I am required by law to maintain the privacy and security of your PHI, to provide you with notice of my legal duties and privacy practices, to follow the terms of this notice currently in effect, and to notify you if a breach of your unsecured PHI occurs. I reserve the right to revise this notice at any time. Revisions apply to all PHI maintained by this practice. Updated copies are available on our website, through the client portal, or upon request.
Uses and Disclosures of Protected Health Information
For Treatment. Your PHI may be used or disclosed for purposes of providing, coordinating, or managing your treatment and related services, including consultation with clinical supervisors or other healthcare providers involved in your care. Information will only be shared with outside providers or consultants with your written authorization unless otherwise permitted or required by law.
For Payment. Your PHI may be used or disclosed to obtain payment for services, including insurance verification, claims submission, utilization review, or determining eligibility for benefits. If collection efforts become necessary, only the minimum information necessary will be disclosed.
For Healthcare Operations. Your PHI may be used for administrative, operational, or quality assurance purposes necessary to operate the practice, such as licensing, audits, training, credentialing, billing services, or business support services. Third-party service providers with access to PHI are required to protect its confidentiality in accordance with HIPAA.
Uses and Disclosures Required or Permitted by Law. HIPAA and Florida law permit or require disclosure of PHI without authorization in certain situations, including:
When required by federal or state law;
For public health or safety reporting requirements;
To report suspected abuse, neglect, or exploitation of a child, elderly person, or vulnerable adult;
To comply with court orders, subpoenas, or other legal proceedings;
To prevent or lessen a serious threat to your safety or the safety of another person;
To law enforcement when legally required;
During medical emergencies;
or healthcare oversight, audits, investigations, or licensing activities;
To authorized business associates performing services on behalf of the practice; or
As otherwise permitted or required under HIPAA regulations.
Verbal Permission. With your verbal permission, relevant information may be shared with family members or others directly involved in your care.
With Your Written Authorization. Any use or disclosure of your PHI not described in this notice will only occur with your written authorization. In particular, written authorization is required for most uses and disclosures of psychotherapy notes (my private notes, kept separate from your record), for uses and disclosures of PHI for marketing, and for any sale of PHI. You may revoke your authorization at any time in writing, except to the extent action has already been taken in reliance upon it.
Substance Use Disorder Treatment Records. Some records of substance use disorder diagnosis or treatment are protected by additional federal confidentiality rules (42 CFR Part 2). Where those rules apply, such records will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order issued after you have had an opportunity to be heard. Information disclosed under HIPAA may be redisclosed by the recipient and may no longer be protected by the HIPAA Privacy Rule. Where Florida law is more protective of mental health or substance use records, I follow Florida law.
Your Rights Regarding Protected Health Information
Right to Access and Copies. You have the right to inspect and obtain a copy of your PHI, including in electronic form where available, with limited exceptions permitted by law. Reasonable fees may apply.
Right to Request Amendment. You may request correction of information you believe is inaccurate or incomplete. Requests must be in writing. I am not required to agree to all requested amendments.
Right to an Accounting of Disclosures. You may request a list of certain disclosures of your PHI. Reasonable fees may apply for multiple requests within a 12-month period.
Right to Request Confidential Communications. You may request that communications about your treatment or billing occur in a specific manner or at a specific location.
Right to Request Restrictions. You may request restrictions on certain uses or disclosures of your PHI. I am not required to agree except where required by law. If you pay for a service out of pocket in full, you may ask me not to share information about that service with your health plan for payment or operations, and I will agree unless the law requires the disclosure.
Right to a Copy of This Notice. You may receive a copy of this Notice at any time, on paper or electronically.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with this practice or with the U.S. Department of Health and Human Services, without fear of retaliation.
To this practice: Nicholas J. Makris, MS, LMHC · (954) 408-2805 · admin@polaripsychotherapy.com · 805 E Broward Blvd #301, Fort Lauderdale, FL 33301
To HHS: Office for Civil Rights, hhs.gov/hipaa/filing-a-complaint · 1-800-368-1019
Questions
For questions about this notice or your privacy rights, contact Nicholas J. Makris, MS, LMHC at (954) 408-2805 or admin@polaripsychotherapy.com.