top left image
top right image
bottom left image
bottom right image


Privacy Notice
All My Relations

Sandy Seeber, LPC, CHTP
112 South Spruce Street
Winston-Salem, NC 27101
Phone: 336.724.1822 Fax: 336.724.2241
Email Sandy

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

1. I. My Responsibilities
The confidentiality of your personal health information is very important to me. Your health information includes both clinical (symptoms, diagnoses, treatments) and administrative (billing, dates) material. Generally speaking, I am required to:

  • Maintain the privacy of your health information as required by law;
  • Provide you with this Notice of my duties and privacy practices regarding the health information about you that I collect and maintain;
  • Follow the terms of this Notice currently in effect.

2. II. Uses and Disclosures of Information
Under federal law, I am permitted to use and disclose personal health information for
treatment, payment, and health care operations without authorization. Whenever possible, I will obtain your consent before disclosing any such information. Here are some examples to clarify these terms:

Treatment: I consult with your therapist or family doctor about your condition.

Payment: Your health information is disclosed to your insurer to obtain reimbursement. In these situations, I will disclose only the minimum amount of information necessary.

Health Care Operations: This refers to administrative activities such as services or audits that relate to the operation of my practice.

3. III. Other Uses and Disclosures
In the following situations I may be ethically or legally obligated to use or disclose your personal information without authorization:

Serious Threat to Health or Safety

I may disclose your health information to protect you or others from a serious threat of harm by you.

Abuse, Neglect, or Domestic Violence

If you give me information which leads me to suspect child abuse, neglect, or death due to maltreatment of a child; or that a disabled adult is in need of protective services, I must report such information to the county Department of Social Services. If asked by the Director of Social Services to turn over information relevant to a child protective services investigation, I must do so.


If you are an unemancipated minor under North Carolina law, there may be circumstances in which I disclose health information about you to a parent, guardian, or other person acting in loco parentis, in accordance with my legal and ethical responsibilities.


If you are a parent of an unemancipated minor, and are acting as the minor’s personal representative, I may disclose health information about your child to you under certain circumstances. For example, if I am legally required to obtain your consent as your child’s personal representative in order for your child to receive care from us, I may disclose health information about your child to you.

In some circumstances, I may not disclose health information about an unemancipated minor to you. For example, if your child is legally authorized to consent to treatment (without separate consent from you), consents to such treatment, and does not request that you be treated as his or her personal representative, I may not disclose health information about your child to you without your child’s written authorization.

Judicial or Administrative Proceedings

In cases where you are involved in a court proceeding and a request is made for your personal health information, this information is privileged under state law and I will not release it without your consent or a court order.

Health Care Oversight

I may disclose health information about you for oversight activities authorized by law or to an authorized health oversight agency to facilitate auditing, inspection, or investigation related to my provision of health care, or to the health care system.

Required By Law

I may disclose health information about you as required by federal, state, or other applicable law. You will be notified, as required and when allowed by law, of any such disclosures.

4.          IV.      Psychotherapy Notes
Psychotherapy notes may be disclosed only after you have given written authorization to do so. (Limited exceptions exist, e.g. in order for me to prevent harm to yourself or others, and to report child abuse/neglect). You cannot be required to authorize the release of your psychotherapy notes in order to obtain health-insurance benefits for your treatment, or enroll in a health plan. Psychotherapy notes are also not among the records that you may request to review or copy (see discussion of your rights in section VII below). If you have any questions, feel free to discuss this subject with me.

5.          V.         Your Health Information Rights
Under the law, you have certain rights regarding the health information that I collect and maintain about you. This includes the right to:

  • Request that I restrict certain uses and disclosures of your health information; I am not, however, required to agree to a requested restriction.
    • Request that I communicate with you by alternative means.  I will accommodate reasonable requests for such confidential communications; for example, if you do not want a family member to know you are seeing me I can send correspondence to an alternate address.
    • Request to review, or to receive a copy of, the health information about you that is maintained in my files and the files of my business associates (if applicable). If I am unable to satisfy your request, I will tell you in writing the reason for the denial and your right, if any, to request a review of the decision.
    • Request that I amend the health information about you that is maintained in my files and the files of my business associates (if applicable). Your request must explain why you believe my records about you are incorrect, or otherwise require amendment. If I am unable to satisfy your request, I will tell you in writing the reason for the denial and tell you how you may contest the decision, including your right to submit a statement (of reasonable length) disagreeing with the decision. This statement will be added to your records.
    • Request a list of my disclosures of your health information. This list, known as an “accounting” of disclosures, will not include certain disclosures, such as those made for treatment, payment, or health care operations.
    • Request a paper copy of this Notice.
    • In order to exercise any of your rights described above, you must submit your request in writing to me. If you have questions about your rights, please speak with me in person or by phone during normal office hours.

6.          VI.      For More Information or to Report a Problem

Psychotherapy notes may be disclosed only after you have given written authorization to do so. (Limited exceptions exist, e.g. in order for me to prevent harm to yourself or others, and t

If you need further information or want to contact me for any reason regarding the handling of your health information, please direct any communications to:
Sandy Seeber LPC 311 High Street, Suite 104 Winston-Salem, NC 27101 (336) 724-1822

If you believe your privacy rights have been violated, you may file a written complaint by mailing it or delivering it to me. You may complain to the Secretary of Health and Human Services (HHS) at:

Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019;

I cannot, and will not, make you waive your right to file a complaint with HHS as a condition of receiving care from me, or penalize you for filing a complaint with HHS.

7.          VII.   Revisions to this Notice

I reserve the right to amend the terms of this Notice. If this Notice is revised, the amended terms shall apply to all health information that I maintain, including information about you collected or obtained before the effective date of the revised Notice. If the revisions reflect a material change to the use and disclosure of your information, your rights regarding such information, my legal duties, or other privacy practices described in the Notice, I will promptly distribute the revised Notice, make copies available to my patients and others, and post it at Effective Date:  May 25, 2014.