Collective Wellness
Carrie Daub, LMHC
2348 Third St S
Jacksonville Beach, FL 32250
904-833-3703
carrie@collectivewellness-llc.com

Effective Date: October 6, 2026

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.

When it comes to your health information, you have certain rights.

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

We may say "no" to your request, but we'll tell you why in writing within 60 days.

You can ask us to contact you in a specific way, such as by home, office, or cell phone, or to send mail to a different address.

We will say "yes" to all reasonable requests.

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no," for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.

You can ask for a list, or accounting, of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures, such as any you asked us to make.

We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

This notice is also available on the Collective Wellness website.

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

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

You can complain if you feel we have violated your rights by contacting us using the information below.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting:

https://www.hhs.gov/hipaa/filing-a-complaint/index.html

We will not retaliate against you for filing a complaint.

For certain health information, you can tell us your choices about what we share.

• 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
   

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

• Marketing purposes
   
• Sale of your information
   
• Most sharing of psychotherapy notes
   

We may contact you for fundraising efforts, but you can tell us not to contact you again.

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

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

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

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

Example: We use health information about you to manage your treatment and services.

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

We are 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.

We have to meet many conditions in the law before we can share your information for these purposes.

We can share health information about you for certain situations such as:

• Preventing disease
   
• Helping with product recalls
   
• Reporting adverse reactions to medications
   
• Reporting suspected abuse, neglect, or domestic violence
   
• Preventing or reducing a serious threat to anyone's health or safety
   

We can use or share your information for health research.

We 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 we're complying with federal privacy law.

We can share health information about you with organ procurement organizations.

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

We can use or share health information about you:

• For workers' compensation claims
   
• For law enforcement purposes or with a law enforcement official
   
• With health oversight agencies for activities authorized by law
   
• For special government functions such as military, national security, and presidential protective services
   

We can share health information in response to a court or administrative order, or in response to a subpoena.

To the extent that we have your substance use disorder patient records subject to 42 CFR Part 2, we will not share that information for investigations or legal proceedings against you without:

1. Your written consent; or
    
2. A court order and a subpoena.
    

Florida law provides additional confidentiality protections for communications between a licensed mental health counselor and a client. Florida law also recognizes psychotherapist-patient privilege for communications and records related to the diagnosis or treatment of a mental or emotional condition.

Confidentiality may have exceptions when disclosure is permitted or required by law, including circumstances involving a serious and imminent threat to health or safety, abuse or neglect reporting requirements, court orders, or other legally authorized disclosures.

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 the privacy or security of your information.

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

We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Collective Wellness uses Headway for scheduling and, when applicable, insurance-related services and billing support.

Existing clients may use the secure communication features available through Headway for clinical communication. Regular email and social media are not intended for confidential clinical communication.

Please do not send sensitive or confidential mental health information through email, Instagram, or other social media platforms.

We can 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 and on the Collective Wellness website.

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

Carrie Daub, LMHC
Collective Wellness
2348 Third St S
Jacksonville Beach, FL 32250
Phone: 904-833-3703
Email: carrie@collectivewellness-llc.com

Privacy Contact: Carrie Daub, LMHC

You may also contact the U.S. Department of Health and Human Services Office for Civil Rights if you have concerns about your privacy rights:

https://www.hhs.gov/hipaa/filing-a-complaint/index.html