Journey by Etsuko J, LLC
Effective Date: October 25, 2026
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. My Commitment to Your Privacy
I understand that information about you and your mental health care is personal. I am committed to protecting your privacy and maintaining the confidentiality of your protected health information (PHI).
I create and maintain records of the care and services you receive through Journey by Etsuko J, LLC. These records help me provide quality care and meet applicable legal and professional requirements.
I am required by law to protect your PHI, provide you with this notice of my legal duties and privacy practices, and follow the terms of the notice currently in effect.
If I create or maintain records protected by 42 C.F.R. Part 2, I will comply with the additional legal requirements that apply to those records.
2. How I May Use and Disclose Your Health Information
The following describes common ways I may use or disclose your PHI. Other uses or disclosures may be permitted or required by law.
For treatment. I may use your PHI to provide, coordinate, or manage your mental health care. When appropriate, this may include consulting with another health care professional involved in your care.
For payment. I may use or disclose your PHI as necessary to receive payment for services, including preparing invoices, processing payments, or addressing payment-related questions.
For health care operations. I may use or disclose your PHI for appropriate practice-related activities, such as quality improvement, administrative functions, and compliance with legal or professional requirements.
For appointments and practice communications. I may contact you about appointments, scheduling, services, or other matters related to your care. You may request reasonable alternative ways or locations for these communications.
Additional protections for certain substance use disorder records. If records I create or maintain are protected under 42 C.F.R. Part 2, certain uses and disclosures otherwise permitted under HIPAA for treatment, payment, and health care operations may be subject to stricter requirements. Information disclosed under applicable rules may also be subject to redisclosure by the recipient, and the information may no longer be protected by the same federal privacy standards.
3. When Your Written Authorization Is Required
For uses and disclosures not described in this notice or otherwise permitted by law, I will obtain your written authorization before using or disclosing your PHI.
This generally includes disclosures to other individuals or organizations for purposes unrelated to your care, payment, or health care operations, as well as uses of your information for marketing when authorization is required.
You may revoke an authorization in writing at any time, except to the extent that I have already acted in reliance on it.
4. Uses and Disclosures Permitted or Required by Law
In certain circumstances, I may use or disclose your PHI without your written authorization when permitted or required by applicable law. These circumstances may include:
- Legal requirements: When disclosure is required by federal, state, or other applicable law.
- Serious threats to health or safety: When necessary to help prevent or lessen a serious and imminent threat, as permitted by law.
- Abuse, neglect, or domestic violence: When reporting is required or permitted by applicable law.
- Court proceedings and legal processes: In response to qualifying court orders or other lawful processes, consistent with applicable privacy protections.
- Health oversight: For authorized audits, investigations, inspections, or other oversight activities.
- Law enforcement and other legally authorized purposes: When the applicable legal requirements for disclosure are met.
- Workers’ compensation: When disclosure is authorized or required under applicable workers’ compensation laws.
- Other legally authorized circumstances: As permitted or required by applicable privacy laws and regulations.
I will limit disclosures to what is permitted or required under the applicable law.
Additional protections in legal proceedings for certain substance use disorder records: If records are protected by 42 C.F.R. Part 2, those records, or testimony that reveals their contents, generally may not be used or disclosed against you in civil, criminal, administrative, or legislative proceedings unless you provide specific written consent or a court order authorizes the use or disclosure in accordance with Part 2.
5. Your Rights Regarding Your Health Information
You have the following rights concerning your PHI, subject to applicable legal requirements and exceptions.
Right to access your records. You may request to inspect or obtain a copy of your PHI maintained in your record, subject to applicable exceptions. I will respond within the time required by law and may charge a reasonable, legally permitted fee.
Right to request an amendment. If you believe information in your record is incorrect or incomplete, you may request an amendment in writing. I may deny the request in certain circumstances permitted by law, and I will provide a written explanation if required.
Right to request restrictions. You may ask me to limit how I use or disclose your PHI for treatment, payment, or health care operations. I am not required to agree to every request, except where applicable law requires a restriction.
Right to confidential communications. You may request that I contact you in a particular way or at a particular location. I will accommodate reasonable requests as required by law.
Right to an accounting of disclosures. You may request an accounting of certain disclosures of your PHI made during the period permitted by law. This right does not apply to every disclosure, including many disclosures made for treatment, payment, and health care operations. If applicable, you may also have a right to request an accounting of disclosures specifically involving records protected under 42 C.F.R. Part 2.
Right to a copy of this notice. You may request a paper or electronic copy of this Notice of Privacy Practices, even if you previously agreed to receive it electronically.
Right to appoint a personal representative. A person legally authorized to act on your behalf may exercise certain rights concerning your PHI, subject to applicable law and verification of that authority.
6. My Legal Duties
I am required by law to maintain the privacy of your PHI, provide this notice describing my legal duties and privacy practices, and notify you following a breach of unsecured PHI when notification is required by law.
I reserve the right to change this notice and make the revised notice applicable to PHI I maintain, as permitted by law. Any revised notice will include an effective date and will be made available upon request and on my website.
7. Questions, Complaints, and Contact Information
If you have questions about this notice or believe your privacy rights have been violated, you may contact me directly. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
Journey by Etsuko J, LLC
Privacy Contact: Etsuko James, LMFT
Phone: 678-629-1700
Email: hello@iametsukoj.com
Mailing address: Available upon request
You may contact the U.S. Department of Health and Human Services, Office for Civil Rights, through its complaint information page:
https://www.hhs.gov/hipaa/filing-a-complaint/index.html
Filing a complaint will not result in retaliation against you.