NOTICE OF PRIVACY PRACTICES

A Quiet Knowing Counseling, LLC
Meg Chuhran, LICSW
Boston, Massachusetts
(617) 299-6485
Meg@aquietknowing.com

Effective Date: September 16, 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 health record contains personal information about you and your health. Information that may identify you and relates to your past, present, or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”).

This Notice of Privacy Practices describes how I may use and disclose your PHI in accordance with applicable federal and Massachusetts law. It also describes your rights regarding your PHI and my legal responsibilities regarding its privacy.

I. MY LEGAL DUTIES

I am required by law to maintain the privacy and security of your PHI, to provide you with this notice of my legal duties and privacy practices, and to follow the privacy practices described in this notice while it is in effect.

I will notify you as required by law if a breach occurs that compromises the privacy or security of your unsecured PHI or other personal information subject to applicable breach notification requirements. I will also comply with applicable federal and Massachusetts breach notification laws.

I may change the terms of this Notice of Privacy Practices when my privacy practices or applicable legal requirements change. Any revised notice will apply to PHI that I already maintain as well as information I receive in the future. I will make the revised notice available as required by law. The current notice will also be available upon request and may be provided through the client portal or posted on my website.

I will not use or disclose your PHI other than as described in this Notice of Privacy Practices unless you provide written authorization or the use or disclosure is otherwise permitted or required by law.

II. HOW I MAY USE AND DISCLOSE YOUR PHI

I may use or disclose your PHI without obtaining additional written authorization when permitted or required by law, including for treatment, payment, health care operations, and the purposes described below.

For Treatment

I may use and disclose your PHI to provide, coordinate, or manage your health care and related services. This may include consultation with other health care professionals involved in your care when appropriate. When consultation or coordination of care is necessary, I will disclose only the information reasonably necessary for that purpose and will take appropriate steps to protect your privacy.

Psychotherapy notes receive additional protection under federal law. Most uses or disclosures of separately maintained psychotherapy notes require your written authorization.

For Payment

I may use and disclose your PHI as necessary to obtain payment for services provided to you. This may include activities such as determining eligibility or coverage, processing or facilitating payment, responding to questions concerning payment or benefits, or providing information necessary for reimbursement or out-of-network claims when applicable.

If it becomes necessary to use collection processes because of unpaid fees, I may disclose the minimum amount of PHI reasonably necessary for collection purposes.

For Health Care Operations

I may use or disclose your PHI as necessary to support my health care operations. These activities may include quality assessment, professional review, licensing, compliance, legal or accounting services, and other activities necessary to operate my practice.

I may disclose PHI to third-party service providers that perform services for my practice, such as electronic health record, billing, administrative, or technology services, when permitted by law and when the required privacy protections are in place.

As Required by Law

I may use or disclose your PHI when federal, state, or other applicable law requires me to do so.

Public Health

I may use or disclose your PHI for public health activities permitted or required by law, including activities intended to prevent or control disease, injury, or disability, or as otherwise directed by a public health authority when authorized by law.

Abuse, Neglect, or Exploitation

I may disclose PHI when I am required or permitted by law to report suspected abuse, neglect, or exploitation, including circumstances involving children, older adults, or persons with disabilities. As a Massachusetts mandated reporter, I may be required to make reports to the appropriate state authority when the legal standard for reporting is met.

Health Oversight

I may disclose PHI to a health oversight agency for activities authorized by law, including investigations, inspections, audits, licensure, disciplinary proceedings, or other oversight of the health care system.

Judicial and Administrative Proceedings

I may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process when the disclosure is permitted or required by applicable law. Massachusetts law generally recognizes a social worker-client privilege concerning communications related to the diagnosis or treatment of a client's mental or emotional condition. That privilege has exceptions established by law, including certain court-ordered evaluations and proceedings, circumstances involving the client's own legal claims against the social worker, and other circumstances specified by law.

Serious Threats to Health or Safety

I may use or disclose PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of you or another person, when permitted or required by law. Massachusetts law also establishes specific circumstances in which a social worker may be required to take reasonable precautions when a client communicates an explicit threat to kill or inflict serious bodily injury upon an identified person and the statutory requirements are met.

Public Health and Workers' Compensation

I may disclose PHI for authorized public health activities (such as controlling disease) or to the extent necessary to comply with laws relating to workers' compensation or similar programs established by law.

Law Enforcement & Specialized Government Functions

I may disclose PHI to law enforcement officials or for specialized military, national security, or intelligence activities only when strictly authorized or required by law.

Appointment Reminders and Health-Related Communications

I may use your PHI to contact you about appointments, scheduling, treatment-related matters, or other health-related services and benefits.

Business Associates

I may use or disclose PHI to individuals or organizations that perform services on my behalf when those services require access to PHI. When required by law, these parties must agree to appropriately safeguard your information.

III. OTHER USES AND DISCLOSURES

Family Members, Friends, or Others Involved in Your Care

I may disclose limited PHI to a family member, close friend, or another person whom you identify as being involved in your care or payment for your care when permitted by law. When appropriate, I will give you an opportunity to agree or object to such a disclosure. In emergency situations or when you are unable to communicate your preference, I may make a disclosure based on my professional judgment and applicable law.

Other Uses and Disclosures Requiring Your Written Authorization

Uses and disclosures of your PHI that are not described in this notice will generally require your prior written authorization unless otherwise permitted or required by law. For example, most uses or disclosures of psychotherapy notes require written authorization.

If you provide written authorization, you may revoke that authorization in writing at any time, except to the extent I have already taken action in reliance on the authorization or the authorization was obtained as a condition of insurance coverage and other applicable law permits reliance on it.

Marketing and Sale of PHI

I will not use or disclose your PHI for marketing purposes when an authorization is required by law without obtaining your written authorization. I will not sell your PHI without your written authorization when authorization is required by law.

Substance Use Disorder Records

To the extent that I create or maintain substance use disorder patient records that are subject to the federal confidentiality protections of 42 CFR Part 2, those records will be handled in accordance with the additional protections applicable to Part 2 records.

When Part 2 applies, information protected by Part 2 may have greater restrictions on its use and disclosure than ordinary PHI. In particular, Part 2 generally limits the use or disclosure of protected records in civil, criminal, administrative, or legislative investigations or proceedings against a patient unless the requirements of Part 2 are satisfied, including the patient's written consent or a qualifying court order and subpoena.

Highly Confidential Information

Massachusetts law provides additional protections for certain HIV-related and genetic information, and disclosures will be made only as permitted or required by applicable law, including any required specific written authorization.

IV. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding the PHI that I maintain about you.

Right to Inspect and Obtain a Copy

You generally have the right to inspect and obtain a copy of PHI contained in your designated record set. You may request your records in writing. I will respond within the time required by applicable law. In certain limited circumstances, I may deny access as permitted by law. If access is denied, I will provide you with a written explanation and, when applicable, information about your right to have the denial reviewed.

You may request your records in electronic or paper form when available in that form. I may charge a reasonable, cost-based fee when permitted by law.

Psychotherapy notes that are maintained separately from the rest of your medical record are not generally subject to the HIPAA right of access.

Right to Request an Amendment

If you believe that PHI I maintain about you is incorrect or incomplete, you may request that I amend the information. I am not required to agree to every requested amendment. If I deny your request, I will provide you with a written explanation and information about your right to submit a statement of disagreement, as provided by law.

Right to an Accounting of Disclosures

You generally have the right to request an accounting of certain disclosures of your PHI made by me during the period specified by law.

The accounting does not include certain disclosures, including many disclosures made for treatment, payment, and health care operations, disclosures made directly to you, and other disclosures excluded by law.

I will provide an accounting as required by law. One accounting during a specified 12-month period is generally provided without charge; I may charge a reasonable, cost-based fee for additional requests as permitted by law.

Right to Request Restrictions

You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. I am not required to agree to most requested restrictions. If I agree to a restriction, I will comply with it except when the information is needed for emergency treatment or when otherwise permitted or required by law.

If you pay for a service completely out of pocket and in full, you may request that I not disclose information about that service to your health plan for payment or health care operations purposes. I will agree to that request unless disclosure is otherwise required by law.

Right to Request Confidential Communications

You have the right to request that I communicate with you about your PHI by a particular means or at a particular location. For example, you may request that I contact you at a different telephone number, email address, mailing address, or other location. I will accommodate a reasonable request when required by law.

Right to Choose Someone to Act for You

If you have a legally authorized personal representative, such as a legal guardian or someone with applicable authority to act on your behalf, that person may generally exercise your privacy rights and make decisions regarding your PHI to the extent permitted by law. I may require documentation establishing that person's authority before acting on their request.

Right to Receive a Copy of This Notice

You have the right to receive a paper copy of this notice upon request, even if you have agreed to receive the notice electronically. This notice will also be made available electronically through the client portal or website when applicable.

V. MASSACHUSETTS CONFIDENTIALITY AND PRIVILEGE

Massachusetts law provides additional protections for communications between a licensed social worker and a client concerning the diagnosis or treatment of the client's mental or emotional condition.

These protections are subject to exceptions established by law. These may include certain circumstances involving threats of dangerous activity, court-ordered examinations, proceedings in which a client places their mental or emotional condition at issue, proceedings involving the social worker, certain child-related proceedings, mandated reporting obligations, and other circumstances established by Massachusetts law.

When federal and Massachusetts privacy or confidentiality requirements both apply, I will comply with the requirements applicable to the particular disclosure.

VI. YOUR RIGHT TO FILE A COMPLAINT

If you believe that your privacy rights have been violated, you may file a complaint with me or with the U.S. Department of Health and Human Services, Office for Civil Rights.

You may contact me at:

Meg Chuhran, LICSW
A Quiet Knowing Counseling, LLC
(617) 299-6485
Meg@aquietknowing.com

You may contact the U.S. Department of Health and Human Services, Office for Civil Rights at:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775

I will not retaliate against you for filing a complaint.

VII. EFFECTIVE DATE

This Notice of Privacy Practices is effective as of September 16, 2026.

I may revise this notice when my privacy practices or applicable legal requirements change. The current version will be available upon request and may be made available through the client portal or on my website.