Notice of Privacy Practices

Your Information. Your Rights. My Responsibilities.

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

I. My Commitment to Your Privacy

I, Marianela Fajardo, LCSW, am committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how I may use and disclose your protected health information (PHI) and your rights regarding that information. I am required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to provide you with this notice and to follow its terms.

  • I am required by law to maintain the privacy and security of your protected health information.

  • I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  • I must follow the duties and privacy practices described in this notice and give you a copy of it.

  • I will not use or share your information other than as described in this notice unless you tell me I can in writing. If you tell me I can, you may change your mind 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.

II. Your Rights Regarding Your Health Information

  • Right to Access: You have the right to inspect and obtain a copy of your clinical record. I may charge a reasonable fee for copying. Requests must be made in writing. In limited circumstances, I may deny access (e.g., if I determine that access would be harmful to you), and you have the right to have that denial reviewed.

  • Right to Request Amendments: You have the right to request that I amend your clinical record. I may deny the request if I did not create the record, if the information is accurate and complete, or if the information is not part of the record you are permitted to inspect. Requests must be made in writing with a supporting reason.

  • Right to an Accounting of Disclosures: You may request a list of disclosures I have made of your PHI, other than for treatment, payment, health care operations, and certain other exceptions. Requests must be made in writing.

  • Right to Request Restrictions: You may request restrictions on certain uses and disclosures of your PHI. I am not required to agree to a restriction unless you pay for a service entirely out of pocket and request that I not disclose that information to your health plan.

  • Right to Confidential Communications: You may request that I communicate with you by alternative means or at alternative locations (for example, only at a specific phone number or by mail to a specific address).

  • Right to Choose Someone to Act for You: If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

    • I will make sure the person has this authority and can act for you before I take any action.

  • Right to a Paper Copy: You may request a paper copy of this notice at any time.

  • Right To File a Complaint if You Feel Your Rights are Violated: You can complain if you feel I have violated your rights by contacting me, as the Privacy Officer for my practice, and my address and phone number is: 9245 SW 157th St, Suite 203, Miami, FL 33157. 786-530-1401.

    • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

    • I will not retaliate against you for filing a complaint.

III. Your Choices

For certain health information, you can tell us your choices about what I share. If you have a clear preference for how I share your information in the situations described below, talk to me. Tell me what you want me to do, and I will follow your instructions.

In these cases, you have both the right and choice to tell me to:

  • Share information with your family, close friends, or others involved in your care or payment for your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory

In these cases I never share your information unless you give me written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

If I have your substance use disorder patient records, subject to 42 CFR part 2, I will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.

IV. How I May Use and Disclose Your Health Information

For Treatment: I may use or disclose your PHI to provide, coordinate, or manage your mental health treatment. For example, if I refer you to a psychiatrist for a medication evaluation, I may share relevant clinical information with that provider to facilitate your care.

For Payment: I may use or disclose your PHI to obtain reimbursement for services I provide. For example, I may submit your diagnosis and treatment dates to your insurance company for payment of session fees.

For Health Care Operations: I may use or disclose your PHI for practice operations such as quality improvement, professional consultation (with identifying information removed when possible), training, and compliance activities.

V. Uses and Disclosures Not Requiring Authorization

I am allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. I have to meet many conditions in the law before I can share your information for these purposes.  

In all cases, including those listed below, if I have substance use disorder patient records about you, subject to 42 CFR part 2, I cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

  • Comply with the Law: I will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I am complying with federal privacy law.

  • Abuse or Neglect Reporting: If I have reasonable cause to believe a child, elderly person, or dependent adult is being abused or neglected, I am required by law to report to the appropriate authorities.

  • Serious Threat to Health or Safety: If I believe you pose an imminent danger to yourself or others, I may disclose relevant information to appropriate persons to prevent harm (consistent with duty to warn/protect laws in Florida or Texas).

  • Judicial and Administrative Proceedings: In response to a valid court order. I will resist subpoenas that are not accompanied by a court order or your authorization, consistent with applicable law.

  • Law Enforcement: In limited circumstances required by law, such as reporting certain types of wounds or injuries.

  • Health Oversight: To a health oversight agency for activities authorized by law, such as audits, investigations, or licensure proceedings.

  • Coroners, Funeral Directors, Organ Donation: As required by law.

  • Workers' Compensation: To comply with workers' compensation laws.

  • Respond to lawsuits and legal actions: I can share health information about you in response to a court or administrative order, or in response to a subpoena.

VI. Changes to the Terms of this Notice

I can change the terms of this notice, and the changes will apply to all information I have about you. The new notice will be available upon request, in my office, and on my website.

VII. Other Instructions for Notice

  • Effective Date of this Notice: January 1, 2026

  • I will not share your mental health treatment records without your written consent unless it is for treatment or another law requires me to share the information.