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.

Kelly Family Therapy LLC (the “Practice”) is committed to protecting your privacy. We are required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. This Notice explains our legal duties and privacy practices, and your rights regarding PHI that we collect and maintain.

YOUR RIGHTS

To exercise any of these rights, submit a written request to the Practice at the contact information listed below.

1. Inspect and Copy PHI

  • You may request an electronic or paper copy of PHI. The Practice may charge a reasonable fee.

  • Requests may be denied if disclosure could endanger your life or another person's life. You may request a review of the denial.

2. Amend PHI

  • You may request corrections to PHI you believe is incorrect or incomplete. Requests should be in writing with a reason for the amendment.

  • The Practice may deny your request and will provide a written explanation. You may submit a statement of disagreement.

3. Request Confidential Communications

  • You may ask the Practice to communicate PHI in a specific way or location. We will accommodate all reasonable requests.

4. Request Restrictions

  • You may request restrictions on the use or sharing of PHI for treatment, payment, or health care operations. The Practice is not required to agree if it would affect your care.

  • If you pay out-of-pocket in full, you may request that PHI not be shared with your insurer.

  • You may request restrictions on sharing PHI with family or friends, specifying the restriction and recipients.

5. Obtain an Accounting of Disclosures

  • You may request a list of times your PHI has been shared (accounting) in the past 12 months at no charge; additional requests may incur a reasonable fee.

6. Receive a Copy of this Notice

  • You may request a paper copy of this Notice, even if you agreed to receive it electronically.

7. Designate a Personal Representative

  • Individuals with medical power of attorney or legal guardians can exercise your rights on your behalf.

8. File a Complaint

  • Contact the Practice:
    Kelly Family Therapy LLC
    135 Chenoweth Ln Ste 2, Louisville, KY 40207
    Caroline Kelly, LPCC-S
    502-309-9565

  • 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, call 1-877-696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints.

  • The Practice will not retaliate for filing a complaint.

9. Opt Out of Fundraising Communications

  • You may ask not to receive fundraising communications at any time.

OUR USES AND DISCLOSURES

1. Routine Uses

We may use or disclose PHI for:

  • Treatment – sharing PHI with professionals involved in your care.

  • Health care operations – improving care, contacting you, or managing the practice.

  • Billing – submitting PHI to insurance or third-party service providers (Business Associates) for administrative or payment purposes. All Business Associates are required to comply with HIPAA and our privacy policies.

2. Uses Without Authorization

We may disclose PHI without your authorization for:

  • Public health and safety: disease prevention, reporting adverse reactions, government investigations, serious threats, abuse/neglect reporting.

  • Legal compliance: court orders, subpoenas, law enforcement requests, specialized government functions, workers’ compensation.

  • Other requests: coroners, funeral directors, organ donation, approved research, inmates, Business Associates.

3. Uses With Your Opportunity to Object

  • Disclosures to family, friends, or others involved in your care if PHI directly relates to their involvement or if it is in your best interest.

4. Uses Based on Written Authorization

  • Marketing, sale of PHI, and psychotherapy notes require your written authorization.

  • You may revoke authorization in writing at any time.

CONFIDENTIALITY OF SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)

Occasionally, the Practice may receive SUD treatment information for referral or coordination purposes. These records are protected under federal law (42 CFR Part 2) and have stricter privacy protections than general HIPAA PHI.

If we receive SUD information:

  1. We will only use or disclose the information for purposes allowed by Part 2 or with the patient’s written consent.

  2. Redisclosure is prohibited unless authorized by the patient or permitted by law.

  3. Patients have the right to request limits on the use or disclosure of SUD information.

  4. We maintain administrative, technical, and physical safeguards to protect any SUD records.

Note: Our practice does not provide SUD treatment. We refer clients to qualified providers for SUD care. Any SUD records received from another provider are handled according to federal confidentiality requirements.

OUR RESPONSIBILITIES

  • Maintain the privacy and security of PHI.

  • Abide by the terms of this Notice and more stringent state or federal laws.

  • Amend the Notice as needed; changes apply to PHI collected and maintained by the Practice.

  • Notify you if PHI is compromised, including SUD information, according to applicable law.

CONTACT INFORMATION

Kelly Family Therapy LLC
135 Chenoweth Ln Ste 2, Louisville, KY 40207
Caroline Kelly, LPCC-S
502-309-9565

Last Updated: February 27, 2026
Version: 2.0