Updated September 7, 2025
Mulberry Therapeutic Services
2680 E Main St, Ste 227
Plainfield, IN 46168-2830
Niki Dula, MSW, LCSW – (765) 787-1196
Your Privacy Matters
Your health information is personal and protecting it is very important. This notice explains how I use and share your health information, the rights you have, and the rules I follow to keep your information safe.
I am required by law to:
– Keep your protected health information (PHI) private.
– Give you this notice of my legal duties and privacy practices so you understand your rights.
– Follow the rules described here.
– Let you know if these rules change. I can change the terms of this notice, and such changes will apply to all information I have about you. This new notice will be available upon request, in my office, and on my website.
How Your Information May Be Used
Your health information may be used or shared in these ways:
– Treatment & Care: To share with other providers involved in your care so you get the best support possible. For example, if I consult with another provider about your treatment. This can be done without your written authorization in order to assist me in diagnosis or treatment of your mental health condition.
– Payment & Operations: To receive payment, bill insurance or manage normal office business.
– Legal Requirements: Sometimes I may be required to share your information by law, such as when ordered by a court.
These examples don’t cover every situation, but all uses will fall within these categories.
Access to Your Records
Only you or your legal personal representative has the right to access your records.
A health care provider or health plan may send copies of your records to another provider or health plan only as needed for treatment or payment or with your permission.
The Privacy Rule does not require the health care provider or health plan to share information with other providers or plans.
When Your Permission Is Needed
Some information requires your written permission before I can share it:
– Psychotherapy Notes: I keep special notes for therapy sessions called psychotherapy notes. Psychotherapy notes are notes that a mental health professional takes during a conversation with a patient. You do not have the right to access a provider’s psychotherapy notes. They are kept separate from the patient’s medical and billing records. These are only shared with your written consent, except in rare cases like emergencies, legal defense, or as required by law. Disclosures may also be required to help avert a serious threat to the health and safety of others.
– Marketing & Sales: I will never use your information for marketing or sell your information.
Times I May Share Without Your Permission
In certain cases, I can share your information without asking you first, such as:
– When required by state or federal law.
– To report abuse or prevent serious threats to health or safety.
– For health oversight activities like audits.
– For law enforcement, court orders, or legal proceedings.
– With coroners, medical examiners, or for research (under strict conditions).
– For military or national security purposes.
– For workers’ compensation claims.
– To remind you of appointments or share information about health services I provide.
Sharing with Family or Friends
I can share information with family members, friends, or others involved in your care or payment if you request for me to do so. I need your written permission to share information about your care. In emergencies, I may share first and check with you afterward.
Your Rights
You have important rights when it comes to your health information:
– Request Limits: Ask me not to use or share certain information. I may say no if it could affect your care, or unless I am required by law to share that information.
– Restrictions for Self-Pay: If you pay for something fully out-of-pocket, you can request that I don’t share it with your insurance.
– Choose How I Contact You: You can ask me to reach you in a certain way (e.g., at work or a different address).
– See & Get Copies: You can request a copy of your records (except psychotherapy notes). I’ll provide them within 30 days and may charge a small fee.
– List of Disclosures: You can ask for a list of times I’ve shared your information (other than for treatment, payment, or operations).
– Correct Your Records: If something is wrong or missing, you can ask me to fix it.
– Get a Copy of This Notice: You can ask for a paper or email copy anytime, even if you already received one electronically.
I will not use or share your information other than as described here unless you give me permission in writing. You may change your mind about this at any time. Let me know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
You may file a complaint if you feel your rights have been violated by contacting:
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.,
Washington, D.C. 20201
1-877-696-6775