Notice of Privacy Practices

The Sassy Shrink LLC
Jaclyn Borgia, Licensed Professional Counselor
Effective Date: 11.13.26

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.

Your Privacy Matters

At The Sassy Shrink LLC, I take your privacy seriously.

As a licensed professional counselor providing psychotherapy and applicable emotional support animal (ESA) evaluations, I understand that the information you share in a clinical setting is personal and sensitive.

This Notice of Privacy Practices explains how your protected health information (PHI) may be used or disclosed, your rights regarding that information, and my legal responsibilities for protecting it.

This notice applies to clinical services provided by The Sassy Shrink LLC that are subject to HIPAA.

Coaching is a separate service and is not automatically subject to HIPAA. Information collected through general website activities is also addressed in my separate Website Privacy Policy.

How I May Use and Share Your Health Information

HIPAA permits certain uses and disclosures of your health information without requiring separate written authorization. Other uses and disclosures require your permission.

Treatment

I may use or share relevant health information to provide, coordinate, or manage your care.

For example, with appropriate legal authorization or when otherwise permitted, I may communicate with another healthcare professional involved in your treatment.

Payment

I may use or disclose information necessary to collect payment for clinical services.

For example, information may be used to process payments, maintain billing records, or provide documentation for insurance reimbursement.

Healthcare Operations

I may use or disclose information as reasonably necessary to operate my clinical practice.

This can include maintaining records, managing appointments, conducting quality improvement activities, meeting professional obligations, and working with authorized service providers.

For example, I use an electronic health record system to maintain clinical documentation and manage practice operations.

Service providers that handle protected health information on behalf of my practice are subject to applicable HIPAA requirements, including business associate agreements when required.

Other Situations Where Information May Be Shared

Federal and state laws permit or require certain disclosures without your written authorization.

Depending on the circumstances and applicable legal requirements, these may include:

  • Reporting suspected abuse, neglect, or other situations when reporting is legally required

  • Preventing or reducing a serious threat to someone's health or safety

  • Complying with public health reporting requirements

  • Responding to lawful health oversight activities

  • Complying with applicable workers' compensation laws

  • Responding to certain law enforcement requests

  • Complying with court orders, subpoenas, or other lawful legal processes

  • Responding to certain government requests authorized by law

  • Providing information to medical examiners, coroners, or funeral directors when legally permitted

  • Supporting legally authorized health research

  • Responding to organ or tissue donation requests when applicable

  • Complying with other federal or state legal requirements

These disclosures are subject to applicable restrictions and safeguards. I do not disclose information simply because someone requests it.

When Pennsylvania or New Jersey law provides stronger privacy protections than HIPAA, those additional protections may apply.

Your Choices About Sharing Information

In certain situations, you may tell me whether you want your information shared with family members, close friends, or others involved in your care or payment for your care.

You may also express preferences regarding disclosures for disaster relief.

If you are unable to communicate your preferences, information may be shared when legally permitted and when I determine that doing so is in your best interest.

I will consider your preferences and follow applicable privacy laws.

Uses and Disclosures Requiring Written Authorization

Certain uses and disclosures of your information generally require your written authorization.

These include:

  • Most uses and disclosures of separately maintained psychotherapy notes

  • Uses of protected health information for marketing when authorization is required

  • The sale of protected health information

  • Other uses or disclosures not otherwise permitted or required by law

You may revoke an authorization in writing at any time, except to the extent that action has already been taken in reliance on that authorization.

I do not sell patient health information.

Special Protections for Psychotherapy Notes

Psychotherapy notes receive additional protections under HIPAA when they meet the legal definition of psychotherapy notes and are maintained separately from the regular clinical record.

In most circumstances, I must obtain your written authorization before using or disclosing these notes.

Certain limited exceptions apply under federal law.

Regular clinical documentation, including diagnoses, treatment plans, progress notes, and appointment information, is not automatically classified as psychotherapy notes under HIPAA.

Substance Use Disorder Treatment Records

Certain substance use disorder treatment records are protected by additional federal confidentiality requirements under 42 CFR Part 2.

If The Sassy Shrink LLC receives or maintains records subject to Part 2, those records will be handled according to the applicable additional protections.

Part 2 records, and testimony describing their contents, generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you unless the requirements of federal law are met, including appropriate written consent or a qualifying court order and accompanying legal process.

Where applicable, Part 2 records may be used or disclosed for treatment, payment, and healthcare operations in accordance with a valid consent and governing law.

Additional restrictions may apply to redisclosure and the use of these records.

Your Rights Regarding Your Health Information

You have important rights concerning your protected health information.

1. Request Access to Your Records

You may request to inspect or receive an electronic or paper copy of health information maintained in your designated record set.

I will generally respond within 30 days, as required by HIPAA, subject to permitted extensions and exceptions.

A reasonable, cost-based fee may apply to certain requests.

Some information, including separately maintained psychotherapy notes, may be excluded from the right of access under applicable law.

2. Request Corrections

If you believe information in your record is inaccurate or incomplete, you may request an amendment.

I may deny a request under circumstances permitted by law, but I will provide an explanation in writing.

I will generally respond within 60 days, subject to legally permitted extensions.

3. Request Confidential Communications

You may ask me to contact you in a particular way or at a specific location.

For example, you may request that appointment communications be sent to a particular email address or phone number.

I will accommodate reasonable requests.

4. Request Restrictions

You may request limits on how certain health information is used or disclosed for treatment, payment, or healthcare operations.

I am not generally required to agree to every requested restriction.

However, if you pay in full out of pocket for a service and request that information about that service not be disclosed to your health plan for payment or healthcare operations, I must generally honor that request unless disclosure is required by law.

5. Request an Accounting of Disclosures

You may request an accounting of certain disclosures of your protected health information made during the six years preceding your request.

Some disclosures, including many made for treatment, payment, and healthcare operations, are excluded from this accounting under HIPAA.

One accounting within a 12-month period is generally provided without charge. Additional requests may be subject to a reasonable, cost-based fee.

6. Request a Copy of This Notice

You may request a paper copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.

7. Designate a Personal Representative

If someone has legal authority to act on your behalf, that person may exercise certain privacy rights for you.

I will verify the person's authority before providing access or taking action.

8. File a Privacy Complaint

If you believe your privacy rights have been violated, you have the right to file a complaint.

You may contact The Sassy Shrink LLC directly using the contact information below.

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 SW
Washington, DC 20201
Phone: 1-877-696-6775
Website: https://www.hhs.gov/hipaa/filing-a-complaint/

You will not be retaliated against for filing a privacy complaint.

My Responsibilities to You

The Sassy Shrink LLC is required by law to:

  • Maintain the privacy and security of protected health information

  • Provide this notice explaining applicable legal duties and privacy practices

  • Follow the terms of the Notice of Privacy Practices currently in effect

  • Notify affected individuals following a breach of unsecured protected health information when required by law

  • Respect applicable federal and state confidentiality requirements

  • Provide access to privacy rights as required by law

I take these responsibilities seriously and use appropriate safeguards to protect the information entrusted to my practice.

Electronic Records and Telehealth

I provide clinical services through telehealth and use electronic systems to manage clinical records, scheduling, and communication.

These systems may include Sessions Health and other authorized providers used for clinical practice operations.

I take reasonable steps to protect electronic health information and use appropriate safeguards and service-provider agreements where required.

Electronic communication can involve privacy risks. I encourage clients to use designated secure clinical communication methods for sensitive information.

Emotional Support Animal Evaluations

When I provide an ESA evaluation as a clinical service, information collected during the evaluation may be part of your protected health information.

If an ESA letter or other documentation is issued, it may contain limited information relevant to the requested accommodation.

Information will be disclosed to a housing provider or another third party only as permitted or required by applicable law or with appropriate authorization.

An ESA evaluation does not guarantee that documentation will be issued or that a housing accommodation will be approved.

Changes to This Notice

I reserve the right to update this Notice of Privacy Practices as laws, professional requirements, or practice operations change.

When permitted by law, changes may apply to protected health information already maintained by my practice.

The current notice will be available on my website and upon request.

Material revisions will be made available as required by applicable law.

Questions or Privacy Concerns

If you have questions about this notice, want to exercise your privacy rights, or have concerns about how your health information is handled, please contact:

The Sassy Shrink LLC
Privacy Contact: Jaclyn Borgia, LPC
Email: contact@thesassyshrink.com
Phone: 215-907-7992
Mailing Address: 510 Cambria Avenue Suite 201 Bensalem PA 19020

Effective Date: 11/13/2026