Effective Date: 31/05/2025
Provider: Tiffany Parkes-Moscova, MSW, LCSW — Glow & Heal Therapy

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.

Your Rights

You have the right to:

• Get a copy of your mental health and medical record

• Ask us to correct your record

• Request confidential communication

• Ask us to limit the information we share

• Get a list of those with whom we’ve shared your information

• Get a copy of this privacy notice

• Choose someone to act for you

• File a complaint if you feel your rights are violated

Your Choices

You can tell us your preferences for how we share your information in the following situations:

• Sharing information with your family, close friends, or others involved in your care

• Sharing information in a disaster relief situation

• Including your information in a therapy or practice directory

• Contacting you for appointment reminders or follow-up

We will never share your information for marketing or sale purposes without your written permission.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

Treatment

We can use your health information to provide you with therapeutic services and share it with other professionals involved in your care.

Payment

We may use and share your information to bill and receive payment from health plans or other entities, if applicable (e.g., for generating a Super Bill for out-of-network insurance reimbursement).

Practice Operations

We use your information to run our practice, improve your care, and contact you when necessary.

Other Ways We May Use or Share Your Information

We are allowed or required to share your information in other ways—usually in ways that contribute to public good, such as public health or research. However, we must meet many legal conditions before doing so. These include:

• Preventing disease

• Reporting suspected abuse, neglect, or domestic violence

• Responding to lawsuits and legal actions

• Responding to law enforcement requests

• Complying with health oversight agencies (for audits or investigations)

We will always limit our disclosures to the minimum necessary.

Our Responsibilities

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

• We will let you know promptly if a breach occurs that may have compromised your information.

• We must follow the duties and privacy practices described in this notice and provide you with a copy.

• We will not use or share your information other than as described here unless you tell us in writing to do so. You may revoke that permission at any time.

Complaints

If you believe your privacy rights have been violated, you can contact us directly or file a complaint with the U.S. Department of Health and Human Services.
We will not retaliate against you for filing a complaint.

To contact us fill out the contact form in the contact page or call us at 571 37 8218

Changes to This Notice

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