Notice of Privacy Practices
Effective Date: October 18, 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 Privacy Rights & Our Legal Duties
This Notice describes how Emerald Psychotherapy may use and share your protected health information (PHI), and how you can exercise your rights regarding that information. Please review this document carefully.
Your protected health information includes any information that identifies you and relates to your physical or mental health, the care you receive, or the payment for that care.
We are required by law to:
Maintain the privacy of your protected health information
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of the Notice currently in effect
Notify you in the event of a breach of your unsecured protected health information
How We May Use and Share Your Information
The following describes the ways Emerald Psychotherapy may use or share your protected health information. Any use or sharing not described here will require your written authorization.
Treatment
Your information may be used to provide, coordinate, and manage your mental health care. For example, with your written authorization (Release of Information), your therapist may share relevant information with your prescriber, primary care provider, school, or other treating professionals involved in your care to ensure coordinated, effective treatment. A Release of Information may also be used to coordinate care during a transition between providers, or to communicate with another professional involved in your wellbeing.
Please note that Connor Sullivan does not provide court testimony, courtroom-related documentation, or forensic evaluations as part of this practice.
Payment
Your information may be used to obtain payment for services rendered. This includes submitting claims to your insurance carrier and responding to requests for information related to those claims. Insurance companies may require a clinical diagnosis and other details about your treatment in order to process claims.
Healthcare Operations
Your information may be used for the internal operations of this practice. This includes quality improvement activities, clinical supervision, peer consultation, and training. Your therapist is a provisionally licensed clinician who participates in required clinical supervision with Jennifer Rokeby-Mayeux, LIMHP, CMSW, PMH-C, and in peer consultation with an OCD specialists group. In both contexts, your information is shared only to the extent necessary and all parties are bound by the same confidentiality obligations.
As Required by Law
Your information may be disclosed when required by federal, state, or local law, including but not limited to mandatory reporting of suspected child, elder, or vulnerable adult abuse or neglect, responding to a court order or legal subpoena, or fulfilling duty to warn obligations.
To Avert a Serious Threat to Health or Safety
Your information may be shared with appropriate authorities if we believe it is necessary to prevent a serious and imminent threat to your life or the life of another person.
Other Uses and Disclosures Permitted by Law
In limited situations, and only as permitted or required by law, your information may also be shared:
For public health activities, such as preventing or controlling disease
With health oversight agencies, such as licensing boards, for audits, investigations, and inspections
In response to a court order, subpoena, or other lawful process in a judicial or administrative proceeding
With law enforcement when required by law
With a coroner or medical examiner when required by law
For workers' compensation claims, as allowed by law
For specialized government functions, such as national security, when required by law
Business Associates
Emerald Psychotherapy uses third-party service providers (known as Business Associates) who may have access to your protected health information in order to perform services on our behalf. All Business Associates are required by law to safeguard your information and are bound by a Business Associate Agreement. This includes SimplePractice, our HIPAA-compliant electronic health record and practice management platform, which is used to store your records, process scheduling, and facilitate secure communication.
Uses That Require Your Written Authorization
The following uses and disclosures will only be made with your written authorization:
Most uses and disclosures of psychotherapy notes
Uses and disclosures of your information for marketing purposes
Any sale of your protected health information
Emerald Psychotherapy does not sell your information or use it for marketing.
You may revoke any authorization you have given at any time by submitting a written request. Revoking an authorization stops future uses and disclosures, but it does not undo any sharing that already happened while the authorization was in effect.
Your Rights Regarding Your Health Information
You have the following rights with respect to your protected health information. To exercise any of these rights, please submit a written request to Emerald Psychotherapy at the address or email listed under Contact & Questions below.
Right to Access Your Records
You have the right to inspect and receive a copy of your health records, including an electronic copy. Requests will be fulfilled within 30 days. A reasonable, cost-based fee may be charged for copying and processing.
Right to Request an Amendment
If you believe your health information is inaccurate or incomplete, you have the right to request an amendment. We may deny the request under certain circumstances, but will provide a written explanation if we do.
Right to an Accounting of Disclosures
You have the right to request a list of instances in which your protected health information was disclosed for purposes other than treatment, payment, or healthcare operations. Requests may cover disclosures made up to six years prior to the date of the request.
Right to Request Restrictions
You have the right to request restrictions on how your information is used or shared. We are not required to agree to all requests, but will comply with any restriction we do agree to. Please note that we cannot restrict disclosures required by law.
There is one restriction we must agree to: if you pay for a service in full out of pocket, you may ask that information about that service not be shared with your health plan for payment or healthcare operations, and we will honor that request unless the law requires otherwise.
Right to Request Confidential Communications
You have the right to request that we communicate with you in a specific way or at a specific location (for example, only by portal message rather than phone). We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you have received it electronically. Please contact us to request one.
Right to Receive Breach Notification
You have the right to be notified if your unsecured protected health information is breached. We will notify you in accordance with applicable federal and state law.
Electronic Health Records
Emerald Psychotherapy uses SimplePractice, a HIPAA-compliant electronic health record (EHR) and practice management system, to store and manage your health information. SimplePractice uses industry-standard encryption and security protocols to protect your data. Your records, messages, and documents transmitted through the SimplePractice client portal are encrypted and secure.
Changes to This Notice
Emerald Psychotherapy reserves the right to change the terms of this Notice at any time. Any changes will apply to all health information we maintain. If we make a material change to this Notice, we will provide you with a revised copy. The most current version of this Notice will always be available upon request and on our website.
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with Emerald Psychotherapy or directly with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
To file a complaint with Emerald Psychotherapy:
Connor Sullivan, PLMHP, PCMSW, Privacy Officer
700 R St., Office 317, Lincoln, NE 68501
Phone: 402-235-9224
Email: connor@emerald-psychotherapy.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
Toll-Free: 1-877-696-6775
Website: hhs.gov/ocr
Contact & Questions
If you have any questions about this Notice or your privacy rights, please contact:
Connor Sullivan, PLMHP, PCMSW, Privacy Officer
Emerald Psychotherapy
700 R St., Office 317, Lincoln, NE 68501
Phone: 402-235-9224