notice of privacy practices.
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Dr. Kelsey A. Varzeas, PhD, LMHC, CMPC
Phone: (508) 556-4278
Website: https://www.endure-well.com/
Effective Date: May 22, 2025
I. SUMMARY:
This is a summary of how we may use and disclose your protected health information and your rights and choices when it comes to your information. We will explain these in more detail on the following pages.
*Please keep in mind that this information contains both protection under the Health Insurance Portability and Accountability Act (HIPPA) and Massachusetts State law (including but not limited to 262 CMR 8.00, G.L. c. 112 §§ 163-172 and c. 13, § 88-90) which may give individuals greater protection.
Your Rights
You have the right to:
Get a copy of your paper or electronic protected health information.
Correct your protected health information.
Ask us to limit the information we share, in some cases.
Get a list of those with whom we've shared your information.
Request confidential communication.
Get a copy of this privacy notice.
Choose someone to act for you.
File a complaint if you believe we have violated your privacy rights.
Your Choices:
You have some choices about how we use and share information as we:
Communicate with you.
Tell family and friends about your condition.
Provide disaster relief
Provide mental health care
Market our services
Our uses and Disclosures:
We may use and disclose your information as we:
Treat you.
Bill for services.
Run our organization.
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.
II. PURPOSE:
I respect your privacy. I am also legally required to maintain the privacy of your protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA) and other federal and state laws. I follow state privacy laws, including when they are stricter or more protective of your PHI than federal law.
As part of my commitment and legal compliance, I am providing you with this Notice of Privacy Practices (Notice). This Notice describes:
My legal duties and privacy practices regarding your PHI, including my duty to notify you following a data breach of your unsecured PHI.
My permitted uses and disclosures of your PHI.
Your rights regarding your PHI.
Contact:
If you have any questions about this Notice, please contact Dr. Kelsey A. Varzeas via phone ((508) 556-4278) or email (kelsey@endure-well.com).
PHI Defined:
Your PHI is health information about you:
Which someone may use to identify you; and
Which we keep or transmit in electronic, oral, or written form.
It includes information such as your:
Name;
Contact information;
Past, present, or future physical or mental health or medical conditions;
Payment for health care products or services; or
Prescriptions.
Scope:
I create a record of the care and health services you receive, to provide your care, and to comply with certain legal requirements. This Notice applies to all the PHI that I generate and that I receive or maintain. I follow the duties and privacy practices that this Notice describes and any changes once they take effect.
Changes to this Notice:
I can change the terms of this Notice, and the changes will apply to all information I have about you. The new notice will be available on request, in our office, and on our website.
Data Breach Notification
I will promptly notify you if a data breach occurs that may have compromised the privacy or security of your PHI. I will notify you within the legally required time frame, no later than 60 days after a breach is discovered. Most of the time, I will notify you in writing, by first-class mail, or I may email you if you have provided me with your current email address and you have previously agreed to receive notices electronically. In limited circumstances when I have insufficient or out-of date contact information, I may provide notice in a legally acceptable alternative form.
III. YOUR RIGHTS:
When it comes to your health information, you have certain rights. This section explains your rights and some of my responsibilities to help you. You have the right to:
Get a copy of your PHI. You can ask to see or obtain an electronic or paper copy of the PHI that I maintain about you (right to request access).
Clarifications about your access rights under Massachusetts law (262 CMR 8.02):
During your course of treatment, treatment records will be maintained for a minimum period of seven (7) years from the date of our last professional contact. The following provisions inform you of the manner in which you or your authorized representative may inspect treatment records in accordance with Massachusetts State law. In the event that the client is a minor, I will maintain treatment records for at least one year after the client has reached the age of majority as defined by statute (18 years old), but in no event shall the record be retained for less than seven years.
Upon written request and within a reasonable period of time, I will provide you or your authorized representative a copy of your requested treatment records.
I may only decline to permit you or your authorized representative to inspect or obtain a copy of your treatment records if I, in the reasonable exercise of my professional judgement, believe that allowing you or your authorized representative to inspect or copy your records would adversely affect your physical or mental well-being. In this case, I will provide you with a treatment summary in lieu of the full treatment record. If after receiving the treatment summary you still wish to request a copy of your full treatment record, I will provide a full copy to an attorney designated by you.
I am prohibited from requesting payment of any balance due for prior therapy services rendered to you as a precondition for making the treatment records available.
I may, however, charge a reasonable fee for the copying of treatment records and postage, where applicable.
I will comply with all applicable regulations and laws in the creation, maintenance, storage, transfer and disposal of client records and in the event of withdrawal from practice or my death.
Ask me to correct your medical record. You may ask me to correct or amend PHI that I maintain about you that you think is incorrect or inaccurate. For these requests:
you must submit requests in writing or electronically, specify the inaccurate or incorrect PHI, and provide a reason that supports your request
I will generally decide to grant or deny your request within 60 days. If I cannot act within 60 days, I will give you a reason for the delay in writing and include when you can expect me to complete my decision, which will be no longer than an additional 30 days. I will only ask for an extension once in response to a request.
I may deny your request for an amendment if you ask us to amend PHI that is not part of our record, that I did not create, that is not part of a designated record set, or that is accurate and complete.
Ask us to limit what we use or share. You have the right to ask us to limit what I use or share about your PHI (right to request restrictions). You can contact me and request that I not use or share certain PHI for treatment, payment, or operations or with certain persons involved in your care. I may require that you submit this request in writing. For these requests:
I am not required to agree;
I may say “no” if it would affect your care; but
I will agree not to disclose information to a health plan for purposes of payment or health care operations if the requested restriction concerns a health care item or service for which you or another person, other than the health plan, paid in full out-of-pocket, unless it is otherwise required by law.
Get a list of those with whom we've shared your PHI. You have the right to request an accounting of certain PHI disclosures that I have made. For these requests:
I will respond no later than 60 days after receiving the request. I may ask for an additional 30 days during this 60-day period, but if I do, I will only do it once, provide a written statement of why, and indicate the date by which I intend to send the response.
I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures, such as any you asked me to make; and
I will provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months. I will notify you about the costs in advance and you may choose to withdraw or modify your request at that time.
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 PHI. I will confirm the person has this authority and can act for you before I take any action.
Request confidential communications. You have the right to request that I communicate with you about health matters in a certain way or at a certain location. For example, you can ask that I only contact you at work or at a specific address. For these requests:
I will not ask for the reason;
you must specify how or where you wish to be contacted; and
I will accommodate reasonable requests.
Make a Complaint: You have the right to complain if you feel I have violated your rights. I will not retaliate against you for filing a complaint. You may either file a complaint:
directly with us by contacting phone (508) 556-4278) or email (kelsey@endure-well.com). All complaints must be submitted in writing; or
with the Office for Civil Rights at the US Department of Health and Human Services. Send a letter to U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F HHH Bldg. Washington, D.C. 20201; or visit www.hhs.gov/ocr/privacy/hipaa/complaints/.
IV. YOUR CHOICES:
For certain health information, you can tell me your choices about what I share. If you have a clear preference for how I share your information in the situations described below, please contact me and I will make reasonable efforts to follow your instructions.
In these cases, you have both the right and choice to tell me whether to:
Share information, such as your PHI, general condition, or location, with your family, close friends, or others involved in your care.
Share information in a disaster relief situation, such as to a relief organization to assist with locating or notifying your family, close friends, or others involved in your care.
V. USES AND DISCLOSURES:
The law permits or requires me to use or disclose your PHI for various reasons, which I explain in this Notice. I have included some examples, but have not listed every permissible use or disclosure. When using or disclosing PHI or requesting your PHI from another source, I will make reasonable efforts to limit my use, disclosure, or request about your PHI to the minimum we need to accomplish our intended purpose. PHI that the law permits or requires us to disclose may be further shared by recipients and is no longer protected by law or the safeguards and restrictions in place when it is in our possession.
In non-emergency situations, no PHI will be disclosed without direct prior permission being given by you except in limited circumstances, as outlined in section VI. If permission is given, this will be documented and included in your file. Permission can later be revoked at any time. If I receive a release asking for your PHI from another party I will first verify this with you and ask for your permission to release your PHI. If you do not give permission, I will not release your PHI.
Additionally, in the following cases, I will not share your information unless you give me your written permission:
Most sharing of “psychotherapy notes” as defined by 45 CFR § 164.501;
For marketing purposes;
Selling or otherwise receiving compensation for disclosing your PHI;
Certain research activities; and
Other uses and disclosures not described in this Notice.
Uses and Disclosures for Treatment, Payment, or Health Care Operations
Treatment: I may use or disclose your PHI and share it with other professionals who are treating you, including doctors, nurses, technicians, medical students, or hospital personnel involved in your care. For example, I might disclose information about your overall health condition to physicians who are treating you for a specific injury or condition.
Billing and payment: I may use and disclose your PHI to bill and get payment from health plans or others. For example, I share your PHI with your health insurance plan so it will pay for the services you receive.
Running our organization. I may use and disclose your PHI to run my practice, improve your care, and contact you when necessary. For example, I may use your PHI to manage the services and treatment you receive or to monitor the quality of my health care services.
VI. OTHER USES AND DISCLOSURES:
Under HIPAA and Massachusetts state law, the following are circumstances in which I may legally waive confidentiality, without your consent.
If I become a defendant in a civil, criminal, or disciplinary case related to my services to you, confidentiality may be waived — but only to the extent necessary for that specific legal proceeding.
Where you are a defendant in a criminal proceeding and the use of the privilege would violate your rights to present testimony and witnesses on your behalf.
Cases of potential harm to yourself or significant or deadly harm to others.
Responding to certain legal actions including but not limited to: determining that you need hospitalization for mental illness or pose an imminent danger to yourself or others; in the initiation of kinship placement searches under G.L. c. 119 § 23(7)(c); or to give testimony under G.L. c. 119 § 24 regarding emergency orders transferring custody and investigation of "abandoned children”.
The following are circumstances in which I am required to waive confidentiality, without your consent, as mandated by Massachusetts state law:
Mandated Reporting: As a Licensed Mental Health Counselor (Allied Mental Health and Licensed Human Services Professional) I am a mandated reporter. Massachusetts law requires mandated reporters to immediately make an oral report to the Department of Children and Families (DCF) when, in their professional capacity, they have reasonable cause to believe that a child under the age of 18 years is suffering from abuse and/or neglect.
Duty to Warn: I am required to take reasonable precautions to warn or in any other way protect potential victims if you communicate to me, or I am aware of an explicit threat to kill or inflict serious bodily injury upon a reasonably identified victim or victims and you have the apparent intent and ability to carry out the threat.