Notice of Privacy Practices

Effective date: May 15, 2026

This notice describes how your protected health information may be used and disclosed and how you can access this information. Please review it carefully.

My Commitment to Your Privacy

I am committed to protecting your health information. As part of providing psychological services, I create and maintain records about your care. This notice explains how I may use and share your health information, your rights, and my legal responsibilities.

How I May Use and Share Your Information

I may use or disclose your health information for treatment, payment, and health care operations. This may include coordinating care with other providers, billing or verifying insurance coverage, processing claims, scheduling, recordkeeping, compliance, and practice management.

Uses Requiring Your Written Authorization

I will generally need your written authorization before using or disclosing your information for purposes other than treatment, payment, health care operations, or as otherwise allowed by law. You may revoke an authorization in writing at any time, except to the extent I have already acted based on it.

Limits to Confidentiality

• Serious risk of harm to you or another person
• Suspected abuse, neglect, or exploitation of a child, elder, or vulnerable adult
• Court orders or other legal requirements
• Health oversight, public health, or safety requirements
• Workers’ compensation matters, when applicable
• As otherwise required by federal or state law

Your Rights

• Request a copy of your health records
• Request corrections to your records
• Request limits on certain uses or disclosures
• Request confidential communications
• Receive a list of certain disclosures
• Receive a paper copy of this notice
• File a complaint if you believe your privacy rights have been violated

My Responsibilities

I am required to maintain the privacy and security of your protected health information, provide this notice, follow the terms of the notice currently in effect, and notify you if a breach occurs that may compromise your information.

Practice Information

Dr. Cheryl Smith Psychology is based in Florida and provides services through a virtual office only. Dr. Smith is licensed in FL, AR, TN, CA, and PA and is a PSYPACT participating psychologist.

Questions or Complaints

If you have questions about this notice or your privacy rights, contact Dr. Cheryl Smith at 615-618-5166 or drcherylfsmith@gmail.com. Please do not include sensitive clinical information in email.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.

This notice is a website draft and should be reviewed against current HIPAA requirements, state requirements, client forms, and professional/legal guidance before publishing.