HIPAA Notice of Privacy Practices
Effective Date: 11/11/25
DURDUNJI Therapy & Counseling, PLLC
Russell Durdunji, LMFT
A Note About This Document
This notice explains how your health information is protected by law and what your privacy rights are. While it's a legal document, it's here to inform you about how I safeguard your confidential information.
Your Rights Regarding Your Health Information
This Notice of Privacy Practices describes how your protected health information (PHI) may be used and disclosed, and how you can access it.
Federal law (the Health Insurance Portability and Accountability Act, or HIPAA) requires that I protect the privacy of your health information and provide you with this notice. I'm required by law to:
Keep your health information private.
Give you this notice of my legal duties and privacy practices.
Follow the terms of this notice.
State Laws: Arkansas and Tennessee state privacy laws provide additional protections for your health information beyond federal HIPAA requirements.
How I May Use and Disclose Your Health Information
1. For Treatment I may use and disclose your health information to provide, coordinate, or manage your therapy and related services. For example, I may consult with other healthcare providers involved in your care or refer you to another provider.
2. For Payment I may use and disclose your health information to bill and collect payment. For example, I may provide information to your insurance company or send you statements.
3. For Healthcare Operations I may use and disclose your health information for routine business operations such as quality improvement, training, and ensuring appropriate care.
4. Business Associates I may share your health information with third-party service providers (called "business associates") who assist with practice operations. These entities are legally required to protect your information.
Transparency Note: I use SimplePractice for my electronic health records, practice management, and telehealth platform. All business associates sign agreements requiring them to safeguard your information and use it only as directed.
5. Psychotherapy Notes I may keep psychotherapy notes—my personal notes separate from your official medical record. These notes have special protections under federal law. I won't use or disclose psychotherapy notes without your written authorization, except when:
I use them for your treatment.
I use them for my own training or supervision.
I need them to defend myself in legal proceedings you initiate.
They're required by law.
They're needed to prevent a serious threat to health or safety.
6. As Required or Permitted by Law I may use or disclose your health information without your authorization in these situations:
Legal requirements: When required by law (court orders, subpoenas, legal process).
Serious threats: To prevent imminent danger to you or others.
Public health: Reporting communicable diseases or adverse medication reactions.
Abuse/neglect: Suspected child abuse, elder abuse, or abuse of vulnerable adults.
Health oversight: Audits, investigations, or inspections by government agencies.
Legal proceedings: Responding to court orders or administrative tribunals.
Law enforcement: In response to warrants or to report certain injuries or crimes.
Government functions: Military, national security, or correctional institutions (if applicable).
Workers' compensation: If your treatment relates to a workplace injury.
Coroners/medical examiners: When performing duties authorized by law.
7. With Your Written Authorization For uses and disclosures not described above, I'll obtain your written authorization before using or disclosing your health information. Common examples include:
Sharing information with family members, friends, or other providers not involved in your care.
Releasing records to schools, employers, or attorneys.
You may revoke your authorization anytime by submitting a written request. However, I cannot take back any disclosures already made with your permission.
Your Rights Regarding Your Health Information
You have the following rights regarding your health information:
1. Right to Inspect and Copy You have the right to inspect and receive a copy of your health information, including medical and billing records. To request copies, submit a written request. I may charge a reasonable fee for copying and mailing. In limited circumstances, I may deny your request. If I do, you'll receive a written explanation and, in some cases, may request a review of the denial.
2. Right to Request an Amendment If you believe information in your record is incorrect or incomplete, you may request that I amend it. To request an amendment, submit a written request explaining your reasons. I may deny your request if:
The information wasn't created by me.
The information isn't part of the records I maintain.
You wouldn't be permitted to inspect or copy the information.
The information is accurate and complete.
If I deny your request, you'll receive a written explanation, and you may submit a statement of disagreement that will be included in your record.
3. Right to an Accounting of Disclosures You have the right to receive a list of certain disclosures I've made of your health information within the past six years (excluding disclosures for treatment, payment, healthcare operations, or those you authorized). To request an accounting, submit a written request specifying the time period (not to exceed six years).
4. Right to Request Restrictions You have the right to request restrictions on how I use or disclose your health information for treatment, payment, or healthcare operations. You also have the right to request limits on disclosures to family members or others involved in your care. I'm not required to agree to your request. If I do agree, I'll comply with the restriction unless the information is needed for emergency treatment.
Special Rule: If you pay out-of-pocket in full for a service and request that I not disclose information about that service to your health plan, I must agree to your request unless disclosure is required by law.
5. Right to Request Confidential Communications You have the right to request that I communicate with you about your health information in a certain way or at a certain location. For example, you may request that I contact you only at work or via email. I'll accommodate reasonable requests. To make a request, contact me and specify how or where you wish to be contacted.
6. Right to a Paper Copy of This Notice You have the right to receive a paper copy of this notice anytime, even if you previously agreed to receive it electronically. To obtain a paper copy, contact me.
7. Right to Be Notified of a Breach If there's a breach of your unsecured health information, I'll notify you as required by law.
My Duties
I'm required by law to:
Maintain the privacy of your health information.
Provide you with this notice of my legal duties and privacy practices.
Follow the terms of this notice currently in effect.
Notify you if I'm unable to agree to a requested restriction.
Accommodate your reasonable requests for confidential communications.
Changes to This Notice
I reserve the right to change this notice anytime. Any changes will apply to health information I already have as well as new information. If I make material changes to this notice, I'll provide you with a revised notice. The effective date of this notice is listed at the top of the first page.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with me or with the U.S. Department of Health and Human Services (HHS).
To file a complaint with me: Submit a written complaint describing your concern. You won't be retaliated against or penalized for filing a complaint.
To file a complaint with HHS: Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Phone: 1-877-696-6775 Website: www.hhs.gov/ocr/privacy/hipaa/complaints/
Questions or Concerns
If you have questions about this notice or want to exercise any of your rights, please contact:
Russell Durdunji, LMFT
DURDUNJI Therapy & Counseling, PLLC
Phone: (501) 808-2925
Email: legal@durdunjitherapy.com