Privacy Policy

Part 2: Notice of Privacy Practices

MIGHTY MINDFUL WELLNESS LLC
NOTICE OF PRIVACY PRACTICES

Your Information. Your Rights. Our Responsibilities.

Effective Date: 10/28/2026
Privacy Contact: Shariyfa Polite
Telephone:(432) 309-4336
Email:connect@mightymindfulwellness.com
Mailing Address: 7821 Cheaha Drive Raleigh, NC 27616
Website:https://www.mightymindfulwellness.com/

It's safe to slow down here.

IMPORTANT INFORMATION ABOUT YOUR PRIVACY

This notice describes how your protected health information may be used or disclosed, how we protect that information, and how you can exercise your privacy rights.

Please review this notice carefully.

Mighty Mindful Wellness LLC provides outpatient mental health services, including individual psychotherapy, adolescent therapy, family therapy, and services delivered through telehealth.

We respect the sensitive nature of mental health treatment and are committed to protecting your privacy.

This notice applies to protected health information maintained by Mighty Mindful Wellness LLC and its authorized workforce members, including clinicians, administrative staff, and other personnel acting on behalf of the practice.

We follow applicable federal and state privacy laws. Where state law provides greater privacy protection than federal law, we follow the more protective requirement when applicable.

SECTION 1. YOUR RIGHTS

1.1 Right to Access Your Health Records

You have the right to request access to, inspect, or obtain copies of your health information contained in a designated record set.

You may request records in paper or electronic form.

We generally respond within 30 days of receiving your request, subject to applicable legal extensions and any shorter state deadline.

Reasonable, legally permitted fees may apply.

Certain information, including separately maintained psychotherapy notes, may be excluded from the HIPAA right of access. Other federal or state laws may provide additional rights.

1.2 Right to Request Corrections

You may request corrections to health information you believe is inaccurate or incomplete.

We may deny a request when permitted by law, but we will explain the reason in writing.

We generally respond within 60 days, subject to applicable legal extensions and any stricter state requirements.

1.3 Right to Confidential Communications

You may request that we communicate with you through particular methods or at specific locations.

For example, you may request:

• Communication through a designated phone number
• Messages through our secure patient portal
• Correspondence sent to a particular mailing address

We will accommodate reasonable requests.

1.4 Right to Request Restrictions

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

We are not generally required to agree to every requested restriction.

However, when you pay in full out of pocket for a healthcare service, you may request that information about that service not be disclosed to your health plan for payment or healthcare operations. We must honor that request unless disclosure is otherwise required by law.

1.5 Right to an Accounting of Disclosures

You may request an accounting of certain disclosures of your protected health information made during the preceding six years.

The accounting will not include disclosures that are excluded from this requirement under applicable law.

One qualifying accounting is provided without charge during a 12-month period. Additional requests may involve a reasonable, cost-based fee.

1.6 Right to Receive This Notice

You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically.

1.7 Right to Designate a Personal Representative

A person legally authorized to act on your behalf may exercise certain privacy rights for you.

We will verify the person's authority and apply any relevant limitations, including laws governing minors, guardianship, and safety concerns.

1.8 Right to File a Complaint

You may file a complaint if you believe your privacy rights have been violated.

You may contact the Mighty Mindful Wellness LLC Privacy Contact listed above.

You may also submit a complaint to:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Phone: 1-877-696-6775
Website: https://www.hhs.gov/hipaa/filing-a-complaint/

We will not retaliate against you for filing a complaint.

SECTION 2. HOW WE USE AND DISCLOSE YOUR INFORMATION

2.1 Treatment

We may use your health information to provide, coordinate, and manage mental health treatment.

Examples include:

• Assessing symptoms and treatment needs
• Developing treatment plans
• Documenting progress
• Coordinating care with other healthcare professionals
• Obtaining clinical consultation

We will comply with applicable state confidentiality requirements and obtain your authorization when required.

2.2 Payment

We may use or disclose information as permitted by law to collect payment for services, process transactions, maintain billing records, and resolve payment matters.

We may disclose information to your health plan for payment.

Additional authorization or restrictions may apply to mental health records under state law.

2.3 Healthcare Operations

We may use or disclose information as legally permitted for legitimate practice operations, including:

• Quality improvement
• Clinical supervision and consultation
• Credentialing and professional review
• Compliance and audits
• Administrative management
• Billing and financial records
• Practice technology and security

We limit access to authorized individuals who need information to perform their responsibilities.

2.4 Business Associates and Service Providers

We may work with vendors that provide necessary services to our practice, such as electronic health records, billing, secure communications, and technology support.

When HIPAA requires it, we enter into Business Associate Agreements and require appropriate safeguards for protected health information.

SECTION 3. CONFIDENTIALITY AND ITS LIMITS

Your therapy conversations and clinical records are confidential and protected by applicable laws.

There are circumstances in which we may be required or permitted to disclose information without your written authorization.

3.1 Threats to Health or Safety

We may use or disclose relevant information when legally permitted or required to prevent or lessen a serious threat to health or safety.

Examples may involve:

• Serious and imminent danger of suicide or severe self-harm
• Specific threats of serious harm toward another person
• Circumstances requiring emergency evaluation or protective intervention

Whether information may or must be disclosed depends on applicable law, the circumstances, and clinical assessment.

Disclosure will be limited as required by law.

3.2 Suspected Child Abuse or Neglect

Our clinicians are subject to mandatory-reporting laws.

When applicable law requires a report concerning suspected child abuse, neglect, exploitation, or trafficking, we will notify the appropriate authority.

The legal threshold, reporting agency, timing, and required information may differ by state.

3.3 Abuse, Neglect, or Exploitation of Vulnerable Adults

We may be required to report suspected abuse, neglect, exploitation, or other qualifying circumstances involving older adults, disabled adults, or vulnerable adults.

We follow the reporting obligations that apply to the circumstances and jurisdiction.

3.4 Court Orders, Subpoenas, and Legal Proceedings

Your participation in therapy does not automatically make your records available in legal proceedings.

We evaluate subpoenas, court orders, and other legal requests before disclosing information.

A subpoena alone does not necessarily authorize disclosure of protected psychotherapy records.

We may require your written authorization, a legally sufficient court order, additional legal safeguards, or another legally recognized basis before releasing information.

We will follow applicable federal and state protections for mental health information and psychotherapy notes.

3.5 Required Reporting and Government Oversight

We may disclose information when required or expressly permitted by applicable law for:

• Public health reporting
• Health oversight activities
• Licensing investigations
• Legally authorized law enforcement requests
• Workers' compensation matters
• Certain judicial or administrative proceedings
• Reporting required by child or adult protective services laws

Applicable conditions and confidentiality protections must be met before disclosure.

3.6 Other Legally Permitted Disclosures

Where applicable law permits or requires it, we may disclose health information for certain research activities, to coroners or medical examiners, for organ donation coordination, or for other legally authorized purposes.

These disclosures are subject to the relevant legal conditions and restrictions.

SECTION 4. SPECIAL PROTECTIONS FOR MENTAL HEALTH INFORMATION

4.1 Psychotherapy Notes

Psychotherapy notes, as defined by HIPAA, receive additional privacy protections when they are maintained separately from the rest of the medical record.

We generally will not use or disclose psychotherapy notes without your written authorization unless a specific legal exception applies.

Psychotherapy notes are distinct from ordinary progress notes, diagnoses, treatment plans, and other records maintained as part of your designated record set.

4.2 State-Specific Mental Health Confidentiality

Your mental health records may receive greater protection under the laws of the state applicable to your treatment or records.

Mighty Mindful Wellness LLC follows additional restrictions when required, including laws governing written consent, treatment disclosures, record access, privileged communications, and disclosure in legal proceedings.

We do not assume that HIPAA permission alone is sufficient for every mental health record disclosure.

4.3 Substance Use Disorder Records

Certain substance use disorder treatment records are subject to additional federal confidentiality protections under 42 CFR Part 2.

To the extent we receive, maintain, or use records protected by Part 2, we will follow the applicable consent, redisclosure, privacy, and legal-proceeding restrictions.

Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against a patient without the patient's written consent or the court process required by Part 2.

Additional requirements may apply to records originating from federally assisted substance use disorder treatment programs.

SECTION 5. YOUR CHOICES ABOUT DISCLOSURE

You may express preferences concerning certain disclosures to family members, close friends, caregivers, or others involved in your care or payment for your care.

We will consider your preferences and follow all applicable privacy requirements.

In limited circumstances, such as an emergency when you cannot communicate your wishes, we may make a disclosure permitted by law and consistent with professional judgment.

Where state law requires written authorization, we will obtain it before sharing information.

5.1 Marketing and Sale of Information

We will not sell your protected health information.

We will not use or disclose your protected health information for marketing activities requiring authorization without obtaining that authorization.

5.2 Written Authorization

For uses or disclosures requiring your written authorization, we will obtain permission before proceeding.

You may revoke an authorization in writing, subject to legal limitations and actions already taken in reliance on the authorization.

SECTION 6. PRIVACY AND CONFIDENTIALITY FOR ADOLESCENT CLIENTS

Mighty Mindful Wellness LLC provides outpatient mental health services to adolescents ages 12–17 in North Carolina, Virginia, Pennsylvania, Illinois, Delaware, Maryland, and Texas.

We recognize that adolescence is an important stage of emotional development, self-discovery, and growing independence.

Our goal is to provide a safe, supportive therapeutic environment where adolescents feel comfortable expressing themselves while maintaining appropriate parent or guardian involvement.

We respect the privacy rights of adolescent clients and follow applicable federal and state laws governing consent, confidentiality, parental access, and disclosure of mental health information.

6.1 Consent for Treatment

When required by law, a parent or legal guardian must provide informed consent before an adolescent begins psychotherapy.

Mighty Mindful Wellness LLC may request documentation verifying an individual's legal authority to consent to treatment, including custody or guardianship documentation when appropriate.

Certain states permit adolescents to independently consent to outpatient mental health treatment under specific circumstances.

When these laws apply, we will honor the adolescent's legally recognized consent rights and comply with applicable confidentiality requirements.

A parent or guardian's consent to treatment does not automatically authorize unrestricted access to all therapy communications or clinical records.

6.2 Confidentiality During Therapy

We encourage adolescent clients to speak openly about their emotions, experiences, relationships, and personal concerns.

We recognize that trust and privacy are important components of effective psychotherapy.

Information shared during sessions is protected by applicable confidentiality laws.

However, adolescent confidentiality is not absolute. Certain disclosures may be required or permitted by law, including situations involving safety concerns, suspected abuse or neglect, or other legally recognized circumstances.

We explain these limits to adolescent clients and their parents or guardians during the informed consent process.

6.3 Parent and Guardian Involvement

We believe appropriate family involvement can support an adolescent's emotional well-being and treatment progress.

When permitted or required by law, we may communicate with parents or legal guardians regarding:

• General treatment goals and progress
• Current mental health concerns and diagnoses
• Treatment recommendations
• Services provided or needed
• Significant concerns about safety or well-being
• Other information that parents or guardians are legally entitled to receive

The amount and type of information shared will depend on applicable law, the circumstances of treatment, and the adolescent's privacy rights.

We will not automatically disclose the details of every therapy conversation solely because a parent or guardian consented to treatment.

6.4 Adolescent Privacy and Access to Mental Health Records

Adolescents and their parents or legal guardians may have different rights concerning the use, disclosure, and access to mental health records.

These rights depend on applicable federal and state laws, including circumstances in which an adolescent may independently consent to treatment.

Where legally permitted, we may consider whether disclosure could negatively affect an adolescent's safety or well-being.

Requests for access to records will be evaluated individually and handled in accordance with applicable privacy laws.

Psychotherapy notes maintained separately from the clinical record receive additional protection under federal law.

6.5 State-Specific Adolescent Rights

Mighty Mindful Wellness LLC follows the applicable laws governing adolescent mental health services in the following states:

North Carolina: Parental or legal guardian consent is generally obtained for outpatient psychotherapy provided by our clinicians unless another legally recognized basis permits the minor to consent. Parent and guardian access to records is subject to applicable privacy laws and exceptions.

Virginia: Minors have statutory authority to consent to outpatient treatment for mental illness or emotional disturbance and to exercise certain rights concerning records related to those services.

Pennsylvania: Adolescents age 14 and older may independently consent to voluntary outpatient mental health treatment. Parents or legal guardians may also consent to treatment for minors. Record disclosure and access are governed by applicable state law.

Illinois: Adolescents age 12 and older may independently request outpatient counseling or psychotherapy, subject to statutory conditions. Illinois law also provides specific protections governing adolescent access to mental health records and parental access.

Delaware: Adolescents age 14 and older may independently consent to voluntary outpatient mental health treatment. Parents or legal guardians may also consent to treatment for minors, subject to applicable law.

Maryland: Adolescents age 12 and older who are determined to be mature and capable of providing informed consent may independently consent to certain mental health services. Privacy and parental disclosure are subject to additional statutory protections.

Texas: Minors may independently consent to counseling in certain legally defined circumstances, including counseling related to suicide prevention, chemical dependency, or abuse. Other outpatient treatment generally requires consent from an authorized individual unless another legal exception applies.

In all states, we follow the law applicable to the circumstances of the client's treatment and records.

6.6 Safety Concerns and Mandatory Reporting

Confidentiality may be limited when disclosure is legally required or permitted to protect an adolescent or another individual.

Examples include:

• Suspected child abuse or neglect
• Serious threats of harm toward another person
• Serious concerns involving suicide or self-harm
• Suspected exploitation or other circumstances requiring mandatory reporting
• Other disclosures required by applicable law

We follow applicable state reporting requirements and professional obligations.

When clinically appropriate and legally permitted, we work with adolescents and their families to address safety concerns collaboratively.

6.7 Our Commitment to Adolescents and Families

At Mighty Mindful Wellness LLC, we believe adolescents deserve to feel safe, respected, and heard throughout their therapeutic experience.

We also recognize the valuable role parents and guardians can play in supporting their child's mental health.

We strive to balance adolescent privacy, appropriate family involvement, professional responsibilities, and legal requirements.

At the beginning of treatment, we discuss confidentiality expectations with adolescent clients and their parents or guardians, including what information may be shared and the circumstances under which disclosure may occur.

SECTION 7. TELEHEALTH AND ELECTRONIC RECORDS

Mighty Mindful Wellness LLC provides therapy through electronic systems and telehealth technology.

We use Jane as our practice management and electronic health record platform.

We maintain administrative, technical, and physical safeguards designed to protect health information.

These may include controlled access, secure authentication, appropriate contractual protections, and other safeguards required by law.

No electronic system can guarantee that security risks will never occur.

7.1 Electronic Communication

We may communicate with you about scheduling, billing, clinical coordination, and other practice matters through approved communication methods.

We encourage the use of designated secure communication channels for sensitive health information.

7.2 Telehealth Privacy

Telehealth sessions may involve electronic transmission of protected health information.

We take reasonable steps to maintain privacy and confidentiality during virtual services.

Clients are encouraged to participate from a private environment when possible.

7.3 Security Incidents

If a breach occurs that triggers legal notification obligations, we will notify affected individuals and appropriate authorities in accordance with applicable federal and state law.

SECTION 8. OUR LEGAL RESPONSIBILITIES

Mighty Mindful Wellness LLC is required to:

1. Maintain the privacy and security of protected health information.
2. Follow the privacy practices described in the notice currently in effect.
3. Provide a copy of this notice upon request.
4. Notify affected individuals when legally required following a breach.
5. Respect applicable patient rights.
6. Obtain written authorization when required.
7. Follow applicable state laws providing additional protection.
8. Restrict information access and disclosures as required by law.

We will not use or disclose your information outside the circumstances described in this notice unless authorized by you in writing or otherwise permitted or required by law.

SECTION 9. CHANGES TO THIS NOTICE

We reserve the right to revise this Notice of Privacy Practices.

Revisions may apply to health information we already maintain, as permitted by law.

An updated notice will be available upon request and posted on our website.

The effective date of the current notice will appear at the beginning of the document.

SECTION 10. QUESTIONS OR CONCERNS

If you have questions about this notice, your health information, or your privacy rights, please contact:

Mighty Mindful Wellness LLC
Privacy Contact: Shariyfa Polite
Phone: (432) 309-4336
Email: connect@mightymindfulwellness.com
Address: 7821 Cheaha Drive Raleigh, NC 27616

Effective Date: 10/28/2026

Mighty Mindful Wellness LLC

It's safe to slow down here.