Notice of Privacy Practices
Notice of Policies and Practices to Protect the Privacy of Your Health Information
This Notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
Good Life Center for Mental Health, LLC may use or disclose your protected health information (PHI) for treatment, payment, and health care operations with your consent.
Definitions:
PHI refers to information in your health record that could identify you.
Treatment refers to the direct provision of services, coordination of care, and consultation related to your health care (e.g., when your provider consults with your primary care physician or another mental health professional).
Payment is when we obtain reimbursement for your health care (e.g., disclosing PHI to your health insurer to obtain payment or determine eligibility).
Health Care Operations are activities related to the performance and operation of our practice (e.g., quality assessment and improvement, audits, administrative services, case management, and care coordination).
Use applies to activities within our practice, such as sharing and analyzing information that identifies you.
Disclosure applies to activities outside our practice, such as releasing, transferring, or providing access to your information to other parties.
II. Uses and Disclosures Requiring Your Written Authorization
Uses and disclosures of PHI outside of treatment, payment, and health care operations require your written authorization, except as permitted or required by law (see Section III).
You may revoke an authorization at any time in writing, except to the extent that action has already been taken in reliance on it or if the authorization was obtained as a condition of insurance coverage and the law gives the insurer the right to contest a claim under the policy.
Psychotherapy Notes: Your provider may keep Psychotherapy Notes, which are kept separate from your medical record and receive additional protection under HIPAA. Most uses and disclosures of Psychotherapy Notes require your written authorization, and insurers cannot require your authorization as a condition of coverage or penalize you for refusing to authorize disclosure of Psychotherapy Notes.
III. Uses and Disclosures Permitted or Required by Law Without Your
Authorization
We may use or disclose PHI without your authorization in the following circumstances:
Child Abuse: If there is reasonable cause to believe that a child has been subjected to abuse, we must report this to the New Jersey Division of Child Protection and Permanency.
Adult and Domestic Abuse: If there is reasonable cause to believe that a vulnerable adult is the subject of abuse, neglect, or exploitation, we must report to the county adult protective services provider.
Health Oversight: If a state regulatory body (e.g., New Jersey State Board of Psychological Examiners; New Jersey Board of Social Work Examiners) issues a subpoena, we may be compelled to testify and produce relevant records.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about the professional services you received and/or your records, such information is privileged under state law. We will not release this information without your written authorization or a court order, except when the evaluation is for a third party or court ordered (you will be informed in advance).
Serious Threat to Health or Safety: If you communicate a threat of imminent serious physical violence against a readily identifiable person (or yourself) and we believe you intend to carry out that threat, we must take steps to warn and protect. Steps may include: arranging hospitalization; advising law enforcement; warning the intended victim (or parents of a minor victim); and notifying your parents if you are under 18 years old. To reduce the risk of harm from firearms, we may be required by law to notify law enforcement if we believe there is an imminent risk of harm.
Worker's Compensation: If you file a worker compensation claim, we may be required to release relevant information to participants in the case as authorized by law.
Public Health Disclosures: We may disclose PHI, including substance use disorder information, to public health authorities when required or permitted by law, consistent with HIPAA and 42 CFR Part 2.
IV. Special Protections for Substance Use Disorder (SUD) Information - 42 CFR Part 2
Certain records related to the diagnosis, treatment, or referral for treatment of a Substance Use Disorder (SUD) are protected by federal law (42 CFR Part 2) and have additional confidentiality protections beyond HIPAA. Although this practice is NOT a Part 2 program, we may receive records that are protected under 42 CFR Part 2. When we receive such information, we safeguard it in accordance with federal law.
Consent Requirement: We generally may not disclose Part 2 records without your written consent, except as allowed by law. A single written consent may authorize future uses and disclosures, subject to any limits you specify.
Limitations and Prohibitions: Part 2 records may not be used or disclosed in legal proceedings without your written consent or a specific court order.
Additional restrictions may apply to re-disclosure, even for treatment, payment, or health care operations, if your consent limits re-disclosure.
Re-disclosure Notice: Any authorized disclosure of Part 2 records must include a notice that federal law (42 CFR Part 2) prohibits unauthorized re-disclosure of this information.
Patient Rights: In addition to HIPAA rights, you have the right to request restrictions on disclosures of your Part 2 records; to revoke consent (except to the extent already relied upon); and to receive an accounting of disclosures of Part 2 information as applicable.
Breach Notification: Breach notification requirements apply to Part 2 records consistent with HIPAA.
V. New Jersey Duty to Warn and Protect (N.J.S.A. 2A:62A-16)
Under New Jersey law, mental health professionals-including psychologists and licensed clinical social workers-generally have no duty to warn or protect unless specific criteria are met.
A duty is incurred only when: (1) a patient communicates a threat of imminent, serious physical violence against a readily identifiable person or themselves and a reasonable professional believes the patient intends to act; or (2) circumstances indicate the patient intends to carry out an act of imminent, serious physical violence, even without a direct statement.When this duty is triggered, we may warn the intended victim, notify law enforcement, arrange hospitalization, or take other clinically appropriate steps to reduce the risk of harm.
VI. New Jersey Firearms Notification (2018 Amendment to N.J.S.A. 2A:62A-16)
When a duty to warn or protect arises, New Jersey law requires us to provide your identifying information to the municipal police department where you reside (or to the New Jersey State Police if there is no full-time municipal department).
Law enforcement may use this information to determine whether you have been issued any firearms permits and whether firearm seizure or other action is appropriate under New Jersey law.
VII. Psychologist / Licensed Clinical Social Worker -Patient Privilege (N.J.S.A. 45:14B-28)
Communications between a licensed psychologist / licensed clinical social worker and a client are protected under New Jersey law and generally may not be disclosed.
Limited exceptions apply, including when your mental condition is placed at issue in specified legal proceedings, or when disclosure is required to discharge a duty to warn or protect under N.J.S.A. 2A:62A-16.
VIII. Your Rights Regarding PHI
Right to Request Restrictions - You have the right to request restrictions on certain uses and disclosures of your PHI (including SUD information). We are not required to agree to a requested restriction, but we will consider your request.
Right to Receive Confidential Communications - You may request that we communicate with you by alternative means or at alternative locations (e.g., billing to a different address).
Right to Inspect and Copy - You have the right to inspect or obtain a copy of PHI and billing records that we use to make decisions about you for as long as the PHI is maintained. We may deny access in certain circumstances, but you may have a right to have the denial reviewed.
Right to Amend - You have the right to request an amendment of PHI for as long as the PHI is maintained. We may deny your request in certain circumstances; we will explain how you may disagree or submit a statement of disagreement.
Right to an Accounting of Disclosures - You generally have the right to receive an accounting of disclosures of PHI for which you did not provide authorization, including Part 2 disclosures as applicable.
Right to a Paper Copy - You have the right to obtain a paper copy of this Notice upon request, even if you agreed to receive it electronically.
IX. Fundraising Communications
We may contact you for fundraising purposes. You have the right to opt out of receiving any fundraising communications, and instructions for opting out will be included in each fundraising communication. Your decision to opt out will not affect your ability to receive treatment or benefits. At this time, our practice does not use PHI for fundraising.
X. Redisclosure of Information
Information disclosed pursuant to the HIPAA Privacy Rule may be redisclosed by the recipient and may no longer be protected by HIPAA. However, information protected under 42 CFR Part 2 remains subject to federal redisclosure restrictions and may not be redisclosed without your written consent or as otherwise permitted by law.
XI. Our Duties
We are required by law to maintain the privacy of PHI and to provide you with this Notice of our legal duties and privacy practices.
We reserve the right to change our privacy policies and practices and to make the new provisions effective for all PHI we maintain. If we revise this Notice, we will post the updated Notice on our website and make it available in our office. Active patients will be informed of material changes.
XII. Questions and Complaints
If you have questions about this Notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, please discuss them with your provider.
If you believe your privacy rights have been violated and wish to file a complaint, you may send your written complaint to: Craig Springer, PhD, Privacy Officer, Good Life Center for Mental Health, LLC, 830 Morris Tpke Suite 405, Short Hills, NJ 07078.
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will provide the appropriate address upon request. We will not retaliate against you for filing a complaint.
XIII. Effective Date
This Notice is effective February 16, 2026.