Notice of Privacy Practices

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.

Effective Date: August 1, 2026

My Commitment to Your Privacy

Still Bloom Counseling & Wellness is committed to protecting the privacy of your health information. Records are created and maintained to support your treatment, comply with legal and ethical requirements, and document the services provided. Reasonable administrative, physical, and technical safeguards are used to protect the privacy and security of your protected health information (PHI).

Still Bloom Counseling & Wellness is required by law to:

Maintain the privacy and security of your PHI.
Provide you with this Notice of Privacy Practices.
Follow the terms of this Notice currently in effect.
Notify you if a breach occurs that may have compromised the privacy or security of your information.
Update this Notice as needed and make revised versions available.

How Your Information May Be Used and Disclosed

Your PHI may be used or disclosed for purposes such as:

Treatment

Providing therapy, coordinating care, consulting with other healthcare providers, or making referrals when appropriate.

Payment

Obtaining payment for services, including billing, payment processing, or providing superbills at your request.

Healthcare Operations

Activities necessary to operate the practice, such as quality assurance, professional consultation, and administrative functions.

As Required or Permitted by Law

Your information may also be disclosed when required or permitted by law, including situations involving:

Suspected abuse or neglect.
Court orders, law enforcement requests, or other lawful legal processes, as permitted or required by law.
Public health activities.
Health oversight activities.
Preventing or reducing a serious threat to the health or safety of you or others.
Workers' compensation claims, as authorized or required by law.

If you pay for a service out-of-pocket in full instead of using insurance, you may ask me not to share information about that service with your health plan. I will honor your request unless disclosure is otherwise required by law.

Uses and Disclosures Requiring Your Written Authorization

Uses or disclosures not otherwise permitted under HIPAA generally require your written authorization. This includes most uses or disclosures of psychotherapy notes and uses or disclosures of PHI for marketing purposes or the sale of PHI, except as otherwise permitted by law.

Still Bloom Counseling & Wellness does not market or sell your PHI.

You may refuse to authorize these disclosures without affecting your right to receive treatment, except when the requested authorization is necessary to provide a specific service.

You may revoke your authorization at any time in writing, except to the extent that action has already been taken in reliance on your authorization.

Your Choices

When permitted by law, you may choose how your information is shared with family members or others involved in your care. If you are unable to communicate your preferences in certain circumstances, disclosures may be made as permitted by law and professional judgment.

Changes to This Notice

Still Bloom Counseling & Wellness may update this Notice from time to time as permitted by law. Any revised Notice will apply to all PHI maintained by the practice and will be made available upon request, in the office, and on the Still Bloom Counseling & Wellness website.

Your Rights

You may contact Still Bloom Counseling & Wellness to exercise any of the rights described below.

Inspect and obtain an electronic or paper copy of your health records, with limited exceptions.
Designate a personal representative who may exercise your privacy rights as permitted by law.
Request an amendment to your records if you believe information is incomplete or inaccurate.
Request restrictions on certain uses or disclosures of your information. Still Bloom Counseling & Wellness is not generally required to agree to a requested restriction, except when required by law.
Request that Still Bloom Counseling & Wellness contact you in a specific way or at a different address.
Request a list (accounting) of certain disclosures of your health information.
Receive a paper copy of this Notice upon request.
File a complaint if you believe your privacy rights have been violated.

Questions, Concerns, or Complaints

If you have questions about this Notice or believe your privacy rights have been violated, you may contact:

Still Bloom Counseling & Wellness

Jaycie Westphal, LPC, RYT-200

1907 American Drive, Suite A4.5, Neenah, WI 54956

(920) 525-1266

connect@stillbloomtherapy.com

You also have the right to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775 or visiting the Office for Civil Rights complaint website.

You will not be retaliated against for filing a privacy complaint.