Legal Notices

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Amy B Therapy, PLLC
Effective Date: August 14, 2026

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.

This Notice of Privacy Practices describes how Amy B Therapy, PLLC (“Amy B Therapy,” “we,” “us,” or “our”) may use and disclose your protected health information (“PHI”) and describes your rights regarding your health information.

“Protected Health Information (PHI)” is individually identifiable health information that is created, received, maintained, or transmitted by Amy B Therapy, PLLC in connection with your health care.

You have the right to:

• Get a copy of your health information. You may request to inspect or obtain a copy of your health information maintained by us, subject to applicable law.
• Request corrections. You may ask us to correct health information that you believe is inaccurate or incomplete. We may deny a request as permitted by law.
• Request confidential communications. You may ask us to contact you in a particular way or at a particular location. We will consider reasonable requests.
• Ask us to limit what we use or disclose. You may request restrictions on certain uses or disclosures of your health information. We are not required to agree to every requested restriction. However, if you request a restriction on disclosure to a health plan for payment or health care operations concerning services you have paid for in full out of pocket, we will generally agree when required by HIPAA.
• Request an accounting of certain disclosures. You may request a list of certain disclosures of your health information made by us during the six years before your request, subject to applicable exceptions and limitations. Generally, you may receive one accounting in any 12-month period at no charge.
• Get a copy of this notice. You may request a paper copy at any time, even if you have agreed to receive it electronically.
• Choose someone to act for you. If someone has medical power of attorney or is your legal guardian, that person may exercise rights and make choices regarding your health information to the extent permitted by law. We will verify the person's authority before acting on their request.
• File a complaint. You may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

For certain health information, you may tell us your preferences about what we share. This may include information shared with a person involved in your care or payment for your care. You may also request that we communicate with you by an alternative means or at an alternative location when reasonably possible. For other uses and disclosures, we will obtain your written authorization when required by law.

We may use or disclose your PHI without your written authorization when permitted or required by applicable law. Examples include:

We may use and disclose your health information to provide, coordinate, or manage your counseling services. For example, we may communicate with another health care professional involved in your care when permitted by law.

We may use and disclose your health information as necessary to obtain or process payment for services. This may include disclosures to payment processors, billing services, or other entities that assist with payment activities.

We may use and disclose your health information for health care operations, such as administrative activities, quality assessment, compliance activities, record management, and other activities necessary to operate our practice.

We may disclose PHI to third-party service providers that perform services for us involving PHI, such as electronic health record, telehealth, billing, payment processing, or other administrative services. These entities are required to appropriately safeguard PHI through applicable agreements and legal requirements.

We may use or disclose your PHI when required to do so by federal, state, or local law.

We may disclose information when required or permitted by applicable law to report suspected abuse, neglect, or exploitation.

We may use or disclose PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, when permitted or required by applicable law.

We may disclose PHI in response to a court order, administrative proceeding, subpoena, discovery request, or other lawful process when permitted or required by applicable law. Additional protections and privileges may apply to communications between a licensed professional counselor and client.

We may disclose PHI to an appropriate health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure proceedings, disciplinary proceedings, and other oversight activities.

We may disclose PHI as authorized by or required under laws relating to workers' compensation.

We may disclose PHI for law enforcement purposes when permitted or required by applicable law.

We may disclose PHI for public health activities when permitted or required by law.

We may use or disclose PHI for other purposes permitted or required by federal or state law. Where applicable law provides greater privacy protection than HIPAA, we will follow the more protective requirement.

Most uses and disclosures of PHI for purposes other than those described in this notice require your written authorization.

For example, we generally will obtain your written authorization before using or disclosing your PHI for marketing or selling your PHI when authorization is required by law.

You may revoke an authorization in writing at any time, except to the extent that we have already relied on the authorization or another applicable legal exception applies.

Psychotherapy notes are treated differently from other PHI under HIPAA. Where applicable, we will obtain your written authorization before using or disclosing psychotherapy notes except as otherwise permitted or required by law.

Psychotherapy notes generally consist of notes maintained separately from the medical record that document or analyze the contents of conversations during a private, group, joint, or family counseling session. They do not include information such as treatment plans, progress notes, diagnoses, symptoms, treatment dates, treatment modalities, or other information maintained as part of the medical record.

Certain information relating to substance use disorder treatment may be subject to additional federal privacy protections. When applicable, Amy B Therapy, PLLC will comply with those additional requirements.

Amy B Therapy, PLLC is required by law to:

• Maintain the privacy and security of your protected health information.
• Provide you with this notice describing our legal duties and privacy practices.
• Follow the privacy practices described in this notice while it is in effect.
• Notify you as required by law if a breach occurs that may have compromised the privacy or security of your PHI.
• Follow applicable federal and state laws governing the confidentiality and disclosure of your health information.

We reserve the right to change this notice and make the revised notice applicable to all PHI we maintain. If we make a material change to our privacy practices, we will update this notice and make the revised notice available as required by law. The current version will be available on our website and upon request.

Your health information may be protected by federal and state confidentiality laws. Because Amy B Therapy provides services to clients located in North Carolina and Virginia, the specific laws governing confidentiality and disclosure may depend on the circumstances and the state in which services are provided.

Where applicable state law provides greater protection for your health information than federal law, we will comply with the more protective requirement.

Nothing in this notice is intended to limit any confidentiality protection, privilege, reporting obligation, or other requirement imposed by applicable law.

If you have questions or concerns about this notice or believe your privacy rights have been violated, you may contact:

Amy B Therapy, PLLC
Privacy Contact: Amy Bouldin
Email: amy@amybtherapy.com

Phone: (571) 454-9489
Mail: 11552 US 15 501 N, Ste 200
Chapel Hill, NC 27517

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775

Online: You may file a complaint through the HHS Office for Civil Rights complaint portal.

You will not be retaliated against for filing a complaint.

August 14, 2026

Under the federal No Surprises Act, individuals who are uninsured or who choose not to use their health insurance to pay for health care services have the right to receive a Good Faith Estimate of expected charges.

Amy B Therapy, PLLC will provide a Good Faith Estimate to eligible uninsured and self-pay clients as required by federal law. You may request a Good Faith Estimate when scheduling services or at any time before receiving services. 

A Good Faith Estimate provides an estimate of the expected charges for scheduled health care services. It is not a bill and does not guarantee the final amount you will be charged. 

If you are uninsured or are choosing not to use your insurance, please let Amy B Therapy, PLLC know when scheduling services. In most cases, you should receive a Good Faith Estimate when services are scheduled at least 3 business days in advance or when you request an estimate. 

If the amount you are billed is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process. 

For more information about your rights under the No Surprises Act and Good Faith Estimates, visit the CMS No Surprises Act website.

Amy B Therapy, PLLC follows the ethical standards and professional principles applicable to the practice of professional counseling. The American Counseling Association (ACA) Code of Ethics provides ethical guidance for professional counselors, including standards related to confidentiality, professional responsibility, counseling relationships, technology and distance counseling, and multicultural and diversity considerations.

American Counseling Association Code of Ethics (2014)