NOTICE OF PRIVACY PRACTICES
Divine Mind Therapy
Effective Date: February 16, 2026
YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
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 RIGHTS
You have the right to:
Get a copy of your health and claims records
Correct your health and claims records
Request confidential communication
Ask us to limit the information we share
Get a list of those with whom we've shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated
YOUR CHOICES
You have some choices in the way that we use and share information as we:
Tell family and friends about your condition
Provide disaster relief
Include you in a hospital directory
Provide mental health care
Market our services and sell your information
Raise funds
OUR USES AND DISCLOSURES
We may use and share your information as we:
Treat you
Run our organization
Bill for your services
Help with public health and safety issues
Do research
Comply with the law
Respond to organ and tissue donation requests
Work with a medical examiner or funeral director
Address workers' compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions
DETAILED INFORMATION ABOUT YOUR RIGHTS
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your care. This includes medical and billing records, but does not include psychotherapy notes. To inspect and copy your health information, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable, cost-based fee for copying, mailing, or other costs incurred in providing the copy.
We may deny your request to inspect and copy in certain limited circumstances. If you are denied access, you may request that the denial be reviewed. A licensed healthcare professional chosen by Divine Mind Therapy will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend
If you feel that the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Divine Mind Therapy. To request an amendment, you must submit your request in writing and provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available
Is not part of the health information kept by or for Divine Mind Therapy
Is not part of the information which you would be permitted to inspect and copy
Is accurate and complete
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of your health information. To request this list or accounting of disclosures, you must submit your request in writing. Your request must state a time period which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list.
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
We are not required to agree to your request except in one situation: if you pay for a service or healthcare item out-of-pocket in full and you request that we not share information about that service or item with your health insurer for purposes of payment or our operations, we will honor that request.
To request restrictions, you must make your request in writing. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice even if you have received the notice electronically. You may request a copy of this notice at any time by contacting our office, and we will provide one to you promptly.
Right to be Notified of a Breach
You have the right to be notified in the event that we (or a Business Associate) discover a breach of your unsecured health information.
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. We will make sure the person has this authority and can act for you before we take any action.
Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with Divine Mind Therapy or with the U.S. Department of Health and Human Services Office for Civil Rights.
To file a complaint with Divine Mind Therapy, contact:
Jewell Jones, LCSW/LICSW
Divine Mind Therapy
Jewell@divinemindtherapy.com
To file a complaint with the U.S. Department of Health and Human Services: Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 1-877-696-6775 www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be penalized or retaliated against for filing a complaint.
DETAILED INFORMATION ABOUT YOUR CHOICES
We have certain choices in the way we use and share information as we treat you, run our organization, and bill for our services. For these choices, we may use and share your information as needed and as allowed by law.
Choices That Require Your Written Permission
In the following cases, we will never share your information unless you give us written permission:
Marketing purposes
Sale of your information
Most sharing of psychotherapy notes
Choices Where You Can Tell Us Your Preference
For these disclosures, you may tell us your preference. We will follow your instructions as much as possible before we share information in these ways:
Tell family, close friends, or others involved in payment for your care about your condition
Share information in a disaster relief situation
If you are not able to tell us your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
DETAILED INFORMATION ABOUT OUR USES AND DISCLOSURES
How We Typically Use or Share Your Health Information
We typically use or share your health information in the following ways:
Treatment
We can use your health information and share it with other professionals who are treating you. Example: We may share your treatment plan with other providers involved in your care, such as your primary care physician or psychiatrist.
Payment
We can use and share your health information to bill and receive payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
Healthcare Operations
We can use and share your health information to run our practice and improve your care. Example: We use health information about you to manage your treatment and services and to evaluate the quality of care you receive.
Business Associates
We may share your information with third parties who perform services on our behalf (Business Associates). All Business Associates must agree in writing to protect the privacy of your information. Example: We may use a billing service to assist with claims processing.
How Else Can We Use or Share Your Health Information?
We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
Public Health and Safety
We can share health information about you for certain situations such as:
Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone's health or safety
Research
We can use or share your information for health research under certain conditions.
Compliance with the Law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
Workers' Compensation, Law Enforcement, and Other Government Requests
We can use or share health information about you:
For workers' compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services
Lawsuits and Disputes
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Medical Examiner, Coroner, or Funeral Director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Organ and Tissue Donation
We can share health information about you with organ procurement organizations.
SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER (SUD) RECORDS
Additional Protections Under Federal Law (42 CFR Part 2)
Records relating to your diagnosis or treatment for substance use disorder (including alcohol and drug use disorders) maintained by Divine Mind Therapy are protected by Federal confidentiality rules (42 CFR Part 2). These rules provide additional protections beyond the standard HIPAA Privacy Rule protections described in this Notice.
What Information is Protected Under Part 2
Information about your substance use disorder diagnosis, treatment, or referral for treatment is protected under Part 2 if the information was created or obtained by a federally assisted substance use disorder program, or was created or received by Divine Mind Therapy in connection with your substance use disorder treatment. This includes information about:
Alcohol use disorder treatment
Drug use disorder treatment
Medication-assisted treatment (MAT)
Detoxification services
Counseling and therapy related to substance use
Any other substance use disorder services
How Your SUD Records May Be Used and Disclosed
With Your Consent:
You may sign a general consent that allows Divine Mind Therapy to use and disclose your SUD records for treatment, payment, and healthcare operations purposes. This consent may authorize all future uses and disclosures for these purposes unless you revoke it.
You may revoke this consent at any time by submitting a written revocation to our office. Revocation will not affect any information already disclosed based on your prior consent.
Without Your Consent: Federal law permits use or disclosure of your SUD records without your consent only in the following limited circumstances:
Medical emergencies
Research (with specific protections in place)
Audit and evaluation activities by authorized federal, state, or local authorities
Court orders (in very limited circumstances after special procedures)
Reporting of suspected child abuse or neglect
Reporting crimes on program premises or against program personnel
Qualified Service Organization Agreements for services such as billing, legal counsel, or data processing
Restriction on Redisclosure: Anyone who receives your SUD records from us is generally prohibited from disclosing that information to anyone else without your specific written consent, unless the disclosure is allowed by law. This restriction on redisclosure applies to all recipients of your SUD records.
Notice to Recipients: When we disclose your SUD records with your consent, we will include the following statement:
"This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient."
Restrictions on Use in Legal Proceedings
Your SUD records are protected against use in any civil, criminal, administrative, or legislative proceedings conducted by any federal, state, or local authority unless:
You provide written consent
A court order is obtained following special procedures specified in federal regulations
The disclosure is specifically permitted under federal regulations
A subpoena, warrant, or similar legal document is not sufficient to authorize disclosure of SUD records without your consent or a proper court order.
Your Rights Regarding SUD Records
In addition to the rights described earlier in this Notice, you have the following specific rights regarding your SUD records:
Right to Consent or Refuse Consent:
You have the right to consent to or refuse to consent to any use or disclosure of your SUD records
If you refuse to consent to a disclosure, we may be unable to provide certain services to you
Right to Revoke Consent:
You have the right to revoke any consent you have provided at any time
Revocation must be made in writing and submitted to our office
Revocation will not affect any actions taken based on your consent before it was revoked
Right to an Accounting:
You have the right to receive an accounting of disclosures of your SUD records
This accounting will include all disclosures made with or without your consent, as applicable
Right to Request Restrictions:
You have the right to request restrictions on certain uses and disclosures of your SUD records
We are not required to agree to all requested restrictions, but we will consider each request
Right to File Complaints:
If you believe your rights under Part 2 have been violated, you may file a complaint with:
Divine Mind Therapy at the contact information listed above
The U.S. Department of Health and Human Services Office for Civil Rights at the contact information listed above
You will not be retaliated against for filing a complaint.
Our Responsibilities Regarding SUD Records
Divine Mind Therapy is required to:
Protect the confidentiality of your SUD records as required by federal law (42 CFR Part 2)
Provide you with this Notice of our privacy practices and Part 2 protections
Follow the terms of the Notice currently in effect
Obtain your consent before using or disclosing your SUD records except as specifically permitted by law
Maintain a complaints process and respond to complaints
Ensure that our Business Associates protect your SUD records in accordance with federal regulations
Provide notice to recipients of your SUD records about the restrictions on redisclosure
Not use or disclose your SUD records in any manner that is not permitted by federal regulations
OUR RESPONSIBILITIES
Divine Mind Therapy is required to:
Maintain the privacy and security of your protected health information
Notify you promptly if a breach occurs that may have compromised the privacy or security of your information
Follow the duties and privacy practices described in this notice and give you a copy of it
Not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. If we make a significant change to our privacy practices, we will change this notice and provide the new notice to you at your next appointment or upon request.
CHANGES TO THE TERMS OF THIS NOTICE
We can change the terms of this Notice, and the changes will apply to all information we have about you. The new notice will be available upon request, through our EHR patient portal, on our website (if applicable), and we will provide notice to you electronically or by mail if there are material changes.
EFFECTIVE DATE
This Notice is effective as of February 16, 2026.
CONTACT INFORMATION
If you have questions about this Notice or need more information, please contact:
Divine Mind Therapy
Jewell Jones, LCSW/LICSW
516 Vauxhall St STE 101 New London CT 06320
(860) 949-1156
Jewell@divinemindtherapy.com