Notice of Privacy Practices

Effective date: October 30, 2026

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

1. Commitment to your privacy

As a Licensed Clinical Mental Health Counselor Supervisor (LCMHCS) and Licensed Clinical Addiction Specialist (LCAS) in the State of North Carolina, I am committed to maintaining the privacy and confidentiality of your Protected Health Information (PHI). PHI includes information about your physical or mental health condition, the provision of health care to you, or payment for health care services.

I am required by federal and state law to:

• Maintain the privacy of your PHI.
• Provide you with this Notice of my legal duties and privacy practices.
• Abide by the terms of this Notice currently in effect.
• Notify you promptly following a breach of your unsecured PHI.

2. How your Protected Health Information (PHI) may be used and disclosed

I may use or disclose your PHI for treatment, payment, and health care operations without your written authorization in the following situations:

A. Treatment

I may use and disclose your PHI to provide, coordinate, or manage your health care and related services. Example: consulting with another healthcare provider or supervisor regarding your care or in coordinating referrals.

B. Payment

I may use and disclose your PHI to bill and collect payment for treatment services provided to you. Example: submitting a claim to your health insurance company, third-party payer, or processing credit card/electronic payments.

C. Health care operations

I may use and disclose your PHI for business operations necessary to maintain quality care, including clinical supervision, compliance reviews, licensing board audits, business planning, and administrative activities.

3. Special protections for specific types of information

Because of my dual licensure and special laws governing mental health and substance use records in North Carolina, additional privacy protections apply:

A. Substance Use Disorder (SUD) records (42 CFR Part 2)

Information related to substance use disorder treatment, diagnosis, or referral is protected under federal regulations (42 CFR Part 2). In general, I cannot disclose any information identifying you as receiving substance use treatment unless:

1. You consent in writing.
2. The disclosure is allowed by a court order, or
3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

Violations of 42 CFR Part 2 are a federal offense.

B. Psychotherapy notes

Psychotherapy notes are notes taken during a counseling session that are kept separate from the rest of your clinical record. Use or disclosure of psychotherapy notes requires your explicit written authorization, except in limited circumstances (such as defense in a legal action brought by you, or threats to health/safety).

C. Telehealth services

When delivering services via telehealth:

• I utilize HIPAA-compliant, encrypted audio/video platforms designed to secure your electronic PHI (ePHI).
• You are responsible for ensuring you are in a private, secure location during telehealth sessions to protect your own privacy.
• Electronic transmissions, while encrypted, carry inherent technical risks. Every effort is made to safeguard digital communications.

4. Uses and disclosures required or permitted by law without authorization

Under North Carolina and federal law, I may use or disclose your PHI without your consent or authorization under specific exceptions:

• Child abuse or neglect: If I have reasonable cause to suspect that a child is abused, neglected, or dependent under NC law, I am required to report it to the local Department of Social Services (DSS).
• Disabled adult abuse or neglect: If I have reasonable cause to suspect an adult with a disability or an elder adult is in need of protective services due to abuse, neglect, or exploitation, I must report this to DSS.
• Serious threat to health or safety: If you express an explicit, serious threat of imminent physical violence against a clearly identified individual, or if you pose an imminent risk of serious physical harm to yourself, I may disclose necessary PHI to protect safety (e.g., notifying law enforcement or the intended victim).
• Court orders and legal proceedings: If ordered by a judge in a court of law, or pursuant to specific statutory mandates, I may be required to disclose PHI.
• Judicial/administrative audits or oversight: To health oversight agencies (e.g., the NC Board of Licensed Clinical Mental Health Counselors or the NC Addictions Specialist Professional Practice Board) for audits, investigations, or disciplinary proceedings.
• Health oversight and public health activities: For public health risks or worker's compensation claims as required by North Carolina state statutes.

5. Other uses and disclosures require your written authorization

Any other uses and disclosures not described in this Notice (such as sending records to an attorney, disability evaluator, or employer) will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent that action has already been taken in reliance on it.

6. Your individual rights regarding your PHI

You have the following rights regarding the medical and mental health information I maintain about you:

1. Right to inspect and copy: You have the right to inspect and receive a copy of your clinical record and billing statements. I may charge a reasonable, cost-based fee for copies. Under certain circumstances, access may be denied if disclosure is deemed clinically harmful, in which case you may request a review of the denial.
2. Right to request electronic copies: If your records are maintained electronically, you have the right to request an electronic copy of your record in a readily usable format.
3. Right to amend: If you feel that PHI I have about you is incorrect or incomplete, you may ask to amend the record. The request must be in writing with a reason supporting it. I may deny the request under certain conditions, but you will be allowed to submit a written statement of disagreement.
4. Right to an accounting of disclosures: You have the right to request a list of certain disclosures of your PHI made for purposes other than treatment, payment, operations, or those authorized by you.
5. Right to request restrictions: You have the right to request restrictions on how your PHI is used or disclosed for treatment, payment, or operations. I am not required to agree to your request, except if you request that I not disclose PHI to a health plan for payment or health care operations and you pay out-of-pocket in full for the service prior to treatment.
6. Right to confidential communications: You have the right to request that I communicate with you about health matters in a specific way or at a specific location (e.g., calling a personal cell phone instead of work, or sending mail to a P.O. Box).
7. Right to a paper copy of this Notice: You have the right to receive a paper or digital copy of this Notice at any time upon request.

7. Changes to this Notice

I reserve the right to revise or change the terms of this Notice of Privacy Practices at any time. The new terms will apply to all PHI I maintain, including information created or received prior to the change. Revised notices will be posted on my website, made available in my physical office, and provided electronically upon request.

8. Questions and complaints

If you believe your privacy rights have been violated, or if you have questions about this Notice or my privacy practices, please contact:

David Zealy-Wright, LCMHCS, LCAS
David Zealy-Wright Counseling
(828) 813-1378
[email protected]

North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC)
Post Office Box 77819
Greensboro, North Carolina 27417
844-622-3572
[email protected]

You may also file a formal written complaint with the U.S. Department of Health and Human Services (HHS):

Office for Civil Rights (OCR)
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll-Free: 1-800-368-1019 / TDD: 1-800-537-7697
www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be penalized or retaliated against in any way for filing a complaint.