Notice of
Privacy Practices
Carly Stanton Therapy
Carly Stanton, LPC, MT-BC
1315 Walnut St., Ste. 801
Philadelphia, PA 19107
Phone: 754-287-9195
Email: carly@carlystantontherapy.com
Effective Date: August 17, 2026
Your Information. Your Rights. My Responsibilities.
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Your Rights
You have the right to:
Get a copy of your paper or electronic medical record.
Ask me to correct your paper or electronic medical record.
Request confidential communications.
Ask me to limit the information I use or share.
Get a list of certain people or organizations with whom I have shared your information.
Get a copy of this Notice of Privacy Practices.
Choose someone to act for you.
File a complaint if you believe your privacy rights have been violated.
Get an electronic or paper copy of your medical record
You may ask to see or receive an electronic or paper copy of your medical record and other health information I maintain about you. Ask me how to do this.
I will provide a copy or summary of your health information, usually within 30 days of your request. I may charge a reasonable, cost-based fee. Psychotherapy notes, as defined by HIPAA, are generally not included in the right of access.
Ask me to correct your medical record
You may ask me to correct health information you believe is incorrect or incomplete. I may deny your request in certain circumstances, but I will provide a written explanation within 60 days.
Request confidential communications
You may ask me to contact you in a specific way—for example, through a particular phone number, email address, or mailing address. I will agree to all reasonable requests.
Ask me to limit what I use or share
You may ask me not to use or share certain health information for treatment, payment, or practice operations. I am not required to agree to your request and may decline if it could affect your care.
If you pay for a service or healthcare item out of pocket in full, you may ask me not to share that information with your health insurer for payment or practice operations. I will agree unless a law requires me to share the information.
Get a list of certain disclosures
You may request a list, called an accounting of disclosures, of certain times I have shared your health information during the six years before your request, including with whom I shared it and why.
The list will not include disclosures for treatment, payment, or healthcare operations, disclosures you authorized, or certain other disclosures permitted by law. I will provide one accounting per 12-month period at no charge. I may charge a reasonable, cost-based fee for additional requests within the same 12-month period.
Get a copy of this Notice
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically. I will provide one promptly.
Choose someone to act for you
If someone has legal authority to act for you—such as a legal guardian or a person holding medical power of attorney—that person may exercise your rights and make choices about your health information. I will verify that person's authority before taking action.
File a complaint if you believe your rights are violated
You may contact me if you believe I have violated your privacy rights. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:
Phone: 1-877-696-6775
Website: hhs.gov/hipaa/filing-a-complaint
Mail: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201
I will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you may tell me your preferences about what I share. If you have a clear preference for how I share information in the situations below, tell me and I will follow your instructions when legally permitted.
You may tell me whether you want me to share information with:
Family members, close friends, or other people involved in your care or payment for your care.
A person you designate to receive information relevant to your care.
If you are unable to tell me your preferences, such as during an emergency, I may share information if I believe it is in your best interest and disclosure is permitted by law. I may also share information when needed to reduce a serious and imminent threat to health or safety.
I will not use or share your health information for the following purposes without your written authorization:
Marketing.
Sale of your information.
Most uses or disclosures of psychotherapy notes.
Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time. Revocation will not affect information already used or disclosed in reliance on your authorization.
Uses and Disclosures
To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
Treatment
I may use or share your health information with other professionals who are treating you in order to provide, coordinate, or manage your care.
Example: With your permission or when otherwise permitted by law, I may consult with another healthcare provider or make a referral to support your treatment.
Practice Operations
I may use and share your health information to operate my practice, improve the quality of care, maintain required records, and contact you when necessary regarding your care.
Example: I may use information about your care to manage treatment records, obtain consultation, or evaluate the quality of services provided.
Payment
I may use and share your health information to bill for services and obtain payment from you, your insurance plan, or another responsible party.
Example: I may provide information to your health insurance plan to verify benefits, submit a claim, or obtain payment for therapy services.
Other Permitted or Required Uses
In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
State-Law Confidentiality Protections: Pennsylvania and Florida provide additional confidentiality protections for mental-health communications and information. When applicable state law provides greater privacy protection than HIPAA, I will follow the more protective law. I will obtain appropriate authorization or consent before disclosing confidential mental-health information unless disclosure is otherwise permitted or required by applicable state or federal law, regulation, or court order, or is necessary under applicable law because of a qualifying threat or danger.
I may use or share your health information in other ways when permitted or required by applicable law, including:
Public health and safety: To complete reporting or other disclosures permitted or required by applicable law, including certain abuse or neglect reporting and disclosures involving qualifying threats to health or safety.
Health oversight: For legally authorized licensure, audits, inspections, investigations, or oversight activities.
Research: For research when permitted by law and subject to applicable privacy protections.
Compliance with law: To comply with state or federal law, including lawful requests from the U.S. Department of Health and Human Services related to HIPAA compliance.
Workers' compensation: For workers' compensation claims and similar programs, when permitted or required by applicable law.
Law enforcement: For law-enforcement purposes, when permitted or required by applicable law.
Judicial and administrative proceedings: In response to court orders or other legal process when disclosure is permitted or required by applicable law.
Coroners and medical examiners: When legally authorized.
Specialized government functions: For certain military, national-security, or protective-service activities, when permitted by law.
My Responsibilities
I am required by law to maintain the privacy and security of your protected health information.
I will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
I must follow the duties and privacy practices described in this Notice and provide you with a copy.
I will not use or share your health information other than as described in this Notice unless you give me written permission. If you give permission, you may change your mind at any time by notifying me in writing.
I may change the terms of this Notice. Changes will apply to all information I maintain about you. Any revised Notice will be available upon request, through the client portal, and on my website.
Contact Information
For questions about this Notice, your privacy rights, or to submit a request or complaint, contact:
Carly Stanton, LPC, MT-BC
Privacy Contact, Carly Stanton Therapy
1315 Walnut St., Ste. 801
Philadelphia, PA 19107
Phone: 754-287-9195
Email: carly@carlystantontherapy.com