Effective Date: July 2, 2026 Notice Version: 1.0
Your-Self Holistic Center 285 Washington Street, Suite 4 North Easton, Massachusetts 02356
Designated Privacy Contact: Sarah Hanlon Business Telephone: 508-556-1135 Email: sarah.iha.practitoner@gmail.com
This Notice describes how medical, health, treatment, billing, and other protected information about you may be used and disclosed by Your-Self Holistic Center.
It also explains how you may access this information, request corrections, make privacy-related requests, and exercise your privacy rights.
Your-Self Holistic Center is committed to protecting the privacy and security of your health information.
This Notice applies to Your-Self Holistic Center and its authorized providers, practitioners, instructors, administrators, staff members, contractors, and other workforce members who create, receive, access, maintain, or transmit protected health information through our services and systems.
You have the right to:
These rights are explained in more detail below.
In certain situations, you may tell us how you want your information used or shared.
These situations may include:
We may use or disclose your protected health information for purposes permitted or required by law, including:
You may ask to inspect or receive an electronic or paper copy of health information that we maintain about you in a designated record set.
Depending on the services you receive, this information may include:
We will generally provide access, a copy, or an agreed-upon summary within the time required by applicable law.
We may charge a reasonable, cost-based fee when permitted.
In limited circumstances, we may deny access to certain information. When required, we will explain the reason in writing and tell you whether you may request a review of the decision.
To request access, contact Sarah Hanlon using the contact information listed in this Notice.
You may ask us to correct health information that you believe is inaccurate or incomplete.
Your request should:
We may deny the request in circumstances permitted by law, including when:
If we deny the request, we will explain the reason in writing within the legally required period.
You may be permitted to submit a written statement of disagreement for inclusion in your record.
We will not erase or silently replace a signed SOAP note, assessment, consent, or other finalized record. Approved corrections will be documented through an amendment process that preserves the original record and its history.
You may ask us to communicate with you in a particular way or at a particular location.
For example, you may ask us to:
We will accommodate reasonable requests.
You generally do not need to explain why you are making the request unless additional information is needed to carry it out.
You may ask us not to use or disclose certain health information for:
We are not required to agree to every request.
If we agree to a restriction, we will follow it except when information is needed to provide emergency treatment or when another use or disclosure is required by law.
When you pay for a service or healthcare item completely out of pocket, you may ask us not to disclose information about that service or item to your health plan for payment or healthcare-operation purposes.
We will honor a qualifying request unless the disclosure is required by law.
This restriction may not apply to other services that were not paid for completely out of pocket.
You must inform us of the requested restriction before information is submitted to the health plan.
You may ask for a list of certain disclosures we made of your health information during the six years before the date of your request.
The accounting may identify:
The accounting generally does not include certain disclosures, such as disclosures:
We will generally provide one accounting during a 12-month period without charge.
We may charge a reasonable, cost-based fee for additional requests during the same period after informing you of the expected cost.
You may request a paper copy of this Notice at any time, even when you previously agreed to receive it electronically.
The current Notice will be available:
If another person has legal authority to act as your personal representative, that person may exercise your privacy rights and make choices about your health information.
A personal representative may include:
Before acting on a representative's request, we may require documentation verifying the person's identity and legal authority.
We may decline to recognize someone as a personal representative when permitted by law, including certain situations involving suspected abuse, neglect, endangerment, or another legal restriction.
You may file a complaint if you believe Your-Self Holistic Center has violated your privacy rights.
You may contact:
Sarah Hanlon, Designated Privacy Contact Your-Self Holistic Center 285 Washington Street, Suite 4 North Easton, Massachusetts 02356
Telephone: 508-556-1135 Email: sarah.iha.practitoner@gmail.com
You may also file a complaint with the:
U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201
Telephone: 1-877-696-6775
Complaints may also be submitted through the HHS Office for Civil Rights online complaint portal.
Your-Self Holistic Center will not retaliate against you, refuse services, or treat you differently because you filed a complaint or exercised a privacy right.
You may tell us whether we may share relevant information with:
When you are present and able to make decisions, we will generally ask for your agreement or provide an opportunity to object.
When you are not present or cannot make decisions, we may use professional judgment to determine whether a limited disclosure is in your best interest when permitted by law.
We will share only information directly relevant to the person's involvement in your care or payment.
We may share limited information with an organization assisting with disaster-relief or emergency-response activities so family members or others responsible for your care may be informed of your location, condition, or status.
We will follow your instructions when reasonably possible.
We will not use or disclose your protected health information for marketing purposes when written authorization is required unless you sign a valid authorization.
Certain communications about:
may not be considered marketing under applicable law.
You may revoke a marketing authorization in writing.
We will not sell your protected health information without your written authorization when authorization is required by law.
Your-Self Holistic Center does not currently use protected health information to send fundraising communications.
If that practice changes, we will update our policies and provide any notice and opt-out rights required by law.
General public fundraising or sponsorship information that is not based on your protected health information is not governed by this section.
If we maintain substance use disorder patient records protected by 42 CFR Part 2, we will provide clear notice and an opportunity to choose whether to receive fundraising communications that use information from those records.
Most uses or disclosures of separately maintained psychotherapy notes require written authorization, subject to limited legal exceptions.
Your-Self Holistic Center will apply this protection only when it maintains records that legally qualify as psychotherapy notes.
Ordinary intake forms, massage-therapy records, coaching records, session notes, and SOAP notes do not automatically qualify as psychotherapy notes.
Uses and disclosures not described in this Notice will be made only with your written authorization unless another use or disclosure is permitted or required by law.
You may revoke an authorization in writing at any time.
A revocation will not affect actions already taken in reliance on the authorization.
We may use and disclose your health information to provide, coordinate, or manage your services.
Examples may include:
For example, a massage therapist may review your health history, pain information, functional limitations, reported allergies, and prior SOAP notes before providing a session.
We may use and disclose your information for healthcare operations and legitimate organizational activities.
These activities may include:
Access will be limited according to the person's role and legitimate need for the information.
We may use and disclose your health information to bill and receive payment for services.
This may include disclosures to:
Information used for payment may include:
Payment-card information will be processed through an approved payment processor and should not be placed in clinical notes.
We may contact you regarding:
We will use reasonable privacy safeguards and honor reasonable confidential-communication requests.
Communications will contain only the information reasonably necessary for their purpose.
We may disclose health information for public-health or safety activities permitted or required by law.
These activities may include:
We will follow applicable legal requirements and limit the disclosure to information reasonably necessary for the purpose.
We may disclose information to an authorized government agency when we reasonably believe a person may be a victim of abuse, neglect, or domestic violence and the disclosure is permitted or required by law.
When legally required or appropriate, we will inform you of the disclosure unless doing so could place you or another person at risk.
We may disclose information to a health-oversight agency for activities authorized by law, including:
We will disclose information when federal or state law requires it.
This may include providing information to the U.S. Department of Health and Human Services when it is reviewing our compliance with federal privacy requirements.
When Massachusetts law or another applicable law provides greater privacy protection than federal law, we will follow the more protective requirement.
We may disclose information in response to:
We will disclose only information authorized by the order or otherwise permitted by law.
When a request is not accompanied by a court or administrative order, additional privacy protections may apply before information is disclosed.
We may disclose information for certain law-enforcement purposes when permitted or required by law.
Examples may include:
We will not disclose information merely because a person identifying themselves as a law-enforcement official requests it. The request must have a valid legal basis.
We may disclose health information as authorized by and necessary to comply with workers' compensation laws or similar programs that provide benefits for work-related injuries or illnesses.
We may use or disclose health information for research when:
Your decision not to participate in research will not affect your ordinary services unless the service is itself part of the research and the law permits participation to be required.
We may disclose health information to:
The disclosure must be permitted by law and reasonably necessary for the recipient to perform authorized duties.
We may disclose health information to organizations involved in organ, eye, or tissue donation and transplantation when applicable and permitted by law.
We may disclose health information for certain special government functions permitted by law, including:
We may use or disclose health information when necessary to prevent or reduce a serious and imminent threat to the health or safety of a person or the public.
Any disclosure will be made only to a person reasonably able to prevent or lessen the threat and in accordance with applicable law and professional standards.
To the extent that Your-Self Holistic Center receives or maintains substance use disorder patient records protected by 42 CFR Part 2, those records may have protections in addition to ordinary HIPAA requirements.
We will not use or disclose Part 2 records in a civil, criminal, administrative, or legislative investigation or proceeding against you unless:
A general consent for treatment, payment, or healthcare operations does not by itself authorize the use of protected Part 2 records against you in a legal proceeding.
When applicable, Part 2 information will be handled according to its separate consent, disclosure, redisclosure, and record-management requirements.
Your-Self Holistic Center is not representing that it operates a federally assisted substance use disorder treatment program unless it separately qualifies as such a program.
This section applies when we lawfully receive, maintain, or hold records protected by 42 CFR Part 2.
Your-Self Holistic Center may create, receive, store, and transmit protected health information electronically through:
We use reasonable administrative, physical, and technical safeguards intended to protect this information.
Clients are responsible for:
Email, text messages, and voicemail may carry privacy risks.
We may use email, text message, telephone, voicemail, or secure portal messages for appointment and administrative communications.
Unless you request otherwise, routine messages may include limited information such as:
We will avoid including unnecessary medical or health details in routine messages.
You may request an alternate communication method by contacting Sarah Hanlon.
Information you submit through an intake form, assessment, health update, or other client form may be made available to the provider responsible for your services.
Relevant client-reported information may be transferred into a reviewable draft of the Subjective section of a SOAP note.
Transferred information must:
Allergies, sensitivities, precautions, and possible contraindications may also appear as separate safety alerts for provider review.
Automated alerts are intended to prompt provider review. They do not independently diagnose a condition or determine whether a service is medically appropriate.
Your-Self Holistic Center may use approved automated tools to assist authorized providers or staff with permitted administrative and documentation functions.
These functions may include:
Automated tools will not independently:
Information will be shared with an automated or artificial-intelligence service only when the service has been reviewed and approved for the intended use and any legally required privacy protections or agreements are in place.
We may share protected health information with contractors or service providers that perform authorized functions on our behalf.
These services may include:
When required, these organizations must enter into written agreements requiring them to safeguard protected health information and use it only for authorized purposes.
We may remove information that could reasonably identify you and use or disclose the resulting de-identified information for lawful purposes.
Information that has been properly de-identified is not treated as protected health information under HIPAA.
We may also use a limited data set when permitted by law and protected by an appropriate data-use agreement.
Certain incidental disclosures may occur despite reasonable safeguards.
For example, another person might hear a client's name called in a reception area.
An incidental disclosure is permitted only when it results from an otherwise permitted activity and reasonable safeguards are in place.
Your-Self Holistic Center is required to:
We will not use or disclose your information in a manner inconsistent with this Notice unless:
You may revoke a written authorization at any time by submitting a written request.
The revocation will not affect actions already taken in reliance on your authorization.
We may change the terms of this Notice.
A revised Notice may apply to all protected health information we maintain, including information created or received before the revision.
When we make a material change:
You may request the current version at any time.
Certain information may receive additional protection under federal or Massachusetts law.
This may include information related to:
When another applicable law provides greater privacy protection than HIPAA, Your-Self Holistic Center will follow the more protective requirement.
A separate authorization or consent may be required before certain categories of information are disclosed.
For questions concerning this Notice, privacy rights, record requests, corrections, restrictions, confidential communications, accounting requests, or privacy complaints, contact:
Sarah Hanlon Designated Privacy Contact
Your-Self Holistic Center 285 Washington Street, Suite 4 North Easton, Massachusetts 02356
Business Telephone: 508-556-1135 Email: sarah.iha.practitoner@gmail.com
This Notice will be:
The client's Acknowledgment of Receipt of the Notice of Privacy Practices must be maintained as a separate form.
Signing the acknowledgment confirms that the client received or was given access to this Notice.
Signing the acknowledgment does not authorize unrelated uses or disclosures of the client's protected health information.
Reading this Notice does not require any signature. When you're ready, you may complete the separate Acknowledgment of Receipt.