Notice of Privacy Practices

My commitment

I am required by law to keep your protected health information (PHI) private, to give you this notice of my legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How I may use and disclose your health information without your authorization

For treatment

To provide and coordinate your care. For example, with your permission I may consult with your physician or another clinician involved in your treatment.

For payment

To bill and be paid for services. For example, providing a superbill or receipt containing dates of service and diagnostic codes so you can seek out-of-network reimbursement.

For health care operations

For activities that support the practice, such as quality review, clinical consultation and supervision, and record keeping.

As required or permitted by law

• When there is a reasonable suspicion of abuse or neglect of a child, an elderly person, or a vulnerable adult.
• When there is a serious and imminent threat of harm to you or to an identifiable other person.
• In response to a court order, subpoena, or other lawful legal process.
• To report abuse by a health care provider, and for certain public health and safety activities.
• To health oversight agencies, and to the Secretary of Health and Human Services for compliance investigations.

Uses and disclosures that require your written authorization

Most other uses require your written authorization, including marketing, any sale of PHI, and most disclosures to third parties you name. You may revoke an authorization in writing at any time. A revocation does not undo disclosures already made in reliance on it.

Psychotherapy notes

Psychotherapy notes are the notes I keep separate from your medical record documenting the contents of a session. They receive extra protection: with limited exceptions set out in law, they will not be disclosed without your specific written authorization, and an authorization for psychotherapy notes cannot be combined with an authorization for anything else.

Your rights

• Access and copies. To inspect and receive a copy of your record, in the form you request when readily producible. A reasonable, cost-based fee may apply.
• Amendment. To ask me to amend information you believe is incorrect or incomplete. I may deny the request, and will explain why in writing.
• Accounting of disclosures. To receive a list of certain disclosures made in the six years before your request.
• Request restrictions. To ask me to limit what I use or disclose. I am not required to agree, except that I must agree to withhold information from a health plan for a service you paid for entirely out of pocket.
• Confidential communications. To ask that I contact you by a particular method or at a particular address.
• A paper copy of this notice on request, at any time.
• Breach notification. To be notified if a breach occurs that compromises the privacy or security of your information.

My legal duties

I am required by law to maintain the privacy and security of your PHI, to notify you following a breach of unsecured PHI, and to abide by the terms of this notice while it is in effect. I reserve the right to change this notice, and to make the revised notice effective for information I already hold as well as information I receive in the future. The current notice will always be available on this page, and if the change is significant I will tell you by email and raise it at your next session.

If you are an Ontario client

HIPAA is United States law. If you live in Ontario, your health information is governed instead by Ontario’s Personal Health Information Protection Act (PHIPA), and I act as a health information custodian under that Act. In practice the protections are close to the ones described above: I collect only what I need to provide your care, I use and disclose it only with your consent or where the law requires or permits it, and I keep it secure.

Under PHIPA you have the right to see and get a copy of your record, to ask me to correct information you believe is wrong, to withdraw or withhold your consent to a use or disclosure, and to be told if your information is lost, stolen or accessed by someone who should not have seen it.

Please raise any concern with me first. If we cannot resolve it, you may complain to the Information and Privacy Commissioner of Ontario, 2 Bloor Street East, Suite 1400, Toronto, ON M4W 1A8, at 1-800-387-0073 or 416-326-3333 (TDD/TTY 416-325-7539). You will not be retaliated against, penalized, or refused service for making a complaint.

Your sessions run on a HIPAA-compliant platform whose servers are in the United States. PHIPA does not prohibit health information being stored outside Ontario or Canada, provided appropriate privacy and security safeguards are in place.

If you believe your privacy rights have been violated

Please contact me first, so I have the chance to make it right. You may also file a written complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or at www.hhs.gov/ocr/privacy/hipaa/complaints.

You will not be retaliated against, penalized, or refused service for filing a complaint.

Contact

Privacy contact: Samantha Rajchel, LCSW (Florida), RSW (Ontario) — Privacy Officer
therapy@samantharajchel.com
This practice is fully virtual and has no public office address. For postal correspondence, email me and I will provide a mailing address.
(561) 459-8299
Effective date: 26 August 2026