HIPAA Notice of Privacy Practices

(Website Version)

Soul II Soul Behavioral Health and Medicine LLC
Notice of Privacy Practices

Effective Date: March 2026

This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Our Commitment to Your Privacy

Soul II Soul Behavioral Health and Medicine LLC is committed to protecting the privacy of your health information.

We are required by law to maintain the privacy and security of your Protected Health Information (PHI) and to provide you with notice of our legal duties and privacy practices.

How We May Use and Disclose Your Health Information

We may use and disclose your health information for the following purposes:

Treatment

We may use your health information to provide, coordinate, or manage your mental health care.

Example:

• Communicating with therapists, physicians, or other healthcare providers involved in your care.

Payment

We may use or disclose your information to obtain payment for services.

Example:

• Submitting information to insurance companies

• Providing superbills

• Processing payment for services

Healthcare Operations

We may use your information for practice operations such as:

• Quality improvement

• Staff training

• Administrative functions

• Compliance with legal requirements

Required by Law

We may disclose health information when required by law, including:

• Court orders

• Public health reporting

• Suspected abuse or neglect

• Serious threats to health or safety

Emergencies

Information may be disclosed to prevent serious harm to you or others.

Uses Requiring Your Authorization

Certain uses of your information require your written authorization, including:

• Psychotherapy notes (with limited exceptions)

• Marketing communications

• Disclosure of information not otherwise permitted by law

You may revoke authorization at any time in writing.

Your Rights Regarding Your Health Information

You have the right to:

Access Your Records

You may request copies of your medical records.

Request Corrections

You may request amendments if you believe information is incorrect or incomplete.

Request Restrictions

You may request restrictions on certain uses or disclosures of your health information.

Confidential Communications

You may request that we contact you through alternative methods or locations.

Receive an Accounting of Disclosures

You may request a list of certain disclosures of your health information.

Receive a Copy of This Notice

You have the right to obtain a paper or electronic copy of this notice.

Our Responsibilities

We are required to:

• Maintain the privacy of your health information

• Provide you with this notice

• Follow the terms of this notice

• Notify you if a breach of your protected health information occurs

Changes to This Notice

We reserve the right to update this notice. Updated versions will be posted on our website and available upon request.

Questions or Complaints

If you believe your privacy rights have been violated, you may contact us:

Soul II Soul Behavioral Health and Medicine LLC
Frances Cybenko, MSN, PMHNP-BC
New Jersey, United States

You may also file a complaint with the U.S. Department of Health and Human Services.

You will not be penalized for filing a complaint.