Notice of Privacy Practices

This notice describes how health information may be used and disclosed and how you can get access to this information

I. My pledge regarding your health information:

Information about you and your health is very personal, and I understand the importance of protecting this information. To provide you with quality service and comply with legal requirements, I keep a record of your care and the services provided by me. This notice applies to all of the records of your care created by this mental health clinician. The notice below will describe how your health information may be used or disclosed. You also have rights in regards to your health information that I may keep. This document will explain the obligations and limits that I have regarding disclosure and use of your health information. 

What the law requires of me

  • To make sure that all protected health information (PHI) that may include information that identifies you is kept private.
  • To provide you with this notice of my legal obligations and privacy practices in regards to your health information.
  • Follow the terms of the notice that is currently in effect. 

Please note that I reserve the right to change the terms of this notice, and all changes will apply to any information that I have about your. The new notice will be available upon request, on this website, or in my office. 

II. How your health information may be used or disclosed:

The following categories describe different ways that I may use or disclose your health information. Not every use or disclosure within a category may be listed below, but all of the ways I am permitted to use or disclose information will fall within one or more of these categories. 

  • For treatment payment, or health care operations: Federal privacy rules and regulations allow health care providers who have direct treatment relationship with you to use or disclose PHI without written authorization. to carry out the health care provider's treatment , payment, or health care operations. I may also disclose our protected health information for treatment activities of another health care provider involved in your care. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your conditions we would be permitted to use and disclose your PHI, which is otherwise confidential, in order to assist the provider in diagnosis and treatment of your medical/mental health condition. Disclosures for treatmnet prurposes are not limited to the minimum necessary standard, Because mental health and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals  of a patient for health care from one health care provider to another.
  • Lawsuits and disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. 
  • To business associates: There are some services provided by Aurora Therapeutic Services, LLC through contracts with business associates. Examples include accounting, legal, training, and consulting services. Information shall be made available to business associates consistent with their need to know for purposes of providing services. 

III. Certain uses and disclosures require your authorization:

Psychotherapy Notes, If I keep "psychotherapy notes", which is a very limited category of notes that are kept separate from your other medical records, The term is defined in 45 CFR § 164.501, and may use or disclosure of such notes requires your authorization to use or disclose is :

  • For my use in treating you. 
  • For my use in training or supervising mental health practitioners to help  improve their skills in group, joint, family, or individual counseling or therapy. If they are used for this purpose, I will remove your name and other identifying information. 
  • For use in defending my self in legal proceedings brought on by you.
  • For use by Secretary of Health and Human Services to investigate my compliance with HIPPA.
  • Required by law and the use of disclosure is limited to the requirements of such law.
  • Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. 
  • Required by a coroner who is performing duties authorized by law.
  • Required to help avert a serious threat to the health and safety of others. 
  • Marketing purposes. As a health care provider, I will not use or disclose your PHI for marketing purposes.
  • Sale of PHI. As a health care provider I will not sell your PHI in the regular course of my business. 

IV. Certain uses and disclosures do not require your authorization:

Subject to certain limitation in the law, I can use and disclose your PHI without your authorization for reasons including but not limited to the following:

  • When disclosure is required by state or federal law, and the use of disclosure complies with and is limited to the relevant requirements of such law.
  • For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone's health or safety.
  • For health oversight activities, including audits and investigations.
  • For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain and authorization from you before doing so.
  • For law enforcement purposes, including reporting crimes occurring on my premises. 
  • to coroners or medical examiners, when such individuals are performing duties authorized by law. 
  • For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy fro the same condition.
  • Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or , helping to ensure the safety of those working within or housed in correctional institutions. 
  • For workers' compensation purposes. Although my preference is to obtain an authorization from you, I may provide your PHI in order to comply with workers' compensation laws, Information covered by workers' compensation laws my not be covered by HIPPA.
  • Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives. or other health care service or benefits that I may offer.

V. Certain uses and disclosures require you to have the opportunity to object:

Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. You have the following rights with respect to your PHI:

  • The right to request limits on uses and disclosures of your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your health care.
  • The right to request restrictions for out of pocket expenses paid for in full. You have the right to request restrictions on disclosures of your PHI to health care plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out of pocket in full. You should understand that all related services must also be paid for out of pocket in full to ensure the restrictions apply. For example, if you have insurance cover treatment that is based on a treatment plan that you paid for out of pocket, the insurance company may have a right to see the records related to the intial treatment plan in order to find medical necessity for the later services.
  • The right to choose how I send PHI to you. You have the right to ask me to contact you in a specific way (for example, home, or office phone) or to send mail to a different address, and I will agree to all reasonable requests, in my discretion.
  • The right to see and get copies of your PHI. Other than "psychotherapy notes," you have the right to get and electronic or paper copy of your medical record and other information that I have about you. I will provide you with a cop of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable cost based fee for doing so. 
  • The right to get a list of the disclosures I have made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provide me with an authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless. you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request. 
  • The right to correct or update your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving your request. If I say "no" you have the right to provide a written statement to be included in your file. 
  • The right to get a paper or electronic copy of this notice. You have the right to get a paper copy of this notice, and you have the right to request to receive this notice by email. Even if you have agreed to receive this notice vial email, you also have the right to request a paper copy of it. 

Right to revoke authorization/permissions

If you provide me permission to use or disclose medical informaiton about you, you may revoke that permission, in writing, at any time. If you revoke your permission,we will no longer use or disclose medical informaiton about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided you. Your substance abuse records received by a person or entity pursuant to your written authorization may not be re-disclosed without your written consent.

Questions/Exercising your rights:

If you have any questions about this notice or would like to exercise any of the rights contained herein, please contact me (Theresa Hudgins) at 1901 North Hemmer Road Suite 209, Palmer, AK 99645; 907-531-0585.


If you believe your privacy rights have been violated, you may file a complaint with Aurora Therapeutic Services, LLC or with the Secretary of Department of Health and Human Services. To file a complaint with Aurora Therapeutic Services, LLC contact Theresa Hudgins. All complaints must be submitted in writing. You will not be retaliated against or penalized for filing a complaint. The Secretary of DHSS can be reached at:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue. S.W.

Room 509F, HHH Building

Washington, D.C. 20201

Updated 6/1/2024