For Patients: Updated Notice of Privacy Practices
Practice: NY LCSW-R #053553 | Telehealth Practice
Last Updated: 05/06/2026
Version: V.1
THIS NOTICE DESCRIBES HOW MEDICAL AND OTHER HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
In Plain English:
Your privacy matters. In most situations, IAP will keep your therapy and health information private and will not share it unless you say it is okay, the law allows it, or the law requires it. This notice explains what information IAP may collect, how IAP may use or disclose it, how IAP works with technology and service providers, what rights you have regarding your information, and how to contact IAP with questions, privacy requests, or complaints. Read this document carefully.
Who We Are
This Notice of Privacy Practices describes the privacy practices of Inner Alchemy Psychotherapy, LLC ("IAP") and its workforce members and providers, including Lora Sasiela, LCSW-R, to the extent they provide services through IAP. IAP is required by law to maintain the privacy of protected health information ("PHI"), to provide you with notice of its legal duties and privacy practices, and to abide by the terms of the notice currently in effect.
This notice applies to PHI created, received, maintained, or transmitted by IAP in connection with the provision of psychotherapy and related health care services. It also applies to PHI maintained in electronic systems, client portals, billing platforms, telehealth systems, and other tools used to support IAP's operations.
2. What Is Protected Health Information?
Protected health information, or PHI, is information that identifies you or could reasonably be used to identify you and that relates to your past, present, or future physical or mental health or condition, the health care services provided to you, or payment for those services.
Examples of PHI may include your demographic information, contact information, appointment information, clinical records, diagnoses, treatment plans, session notes, billing records, payment records, communications about your care, and information created or transmitted in connection with telehealth services.
3. Important New York Confidentiality Protections
New York law strongly protects the confidentiality of mental health records. In general, IAP will not disclose confidential information about your treatment unless the disclosure is permitted or required by federal law, New York law, or you authorize the disclosure in writing.
In addition to HIPAA, New York law may provide extra protection for certain mental health information, HIV-related information, substance use disorder information, and other specially protected information. If a stricter state or federal confidentiality rule applies to a particular type of information, IAP will follow the stricter rule.
If you are receiving psychotherapy through IAP, your records are not automatically shared with family members, employers, schools, immigration authorities, law enforcement, or other third parties just because they ask. In most situations, IAP will require your written authorization unless a disclosure is otherwise permitted or required by law.
4. Our Duties Regarding Your Protected Health Information
IAP is required by law to:
maintain the privacy of your PHI;
provide you with this notice of IAP's legal duties and privacy practices with respect to your PHI;
abide by the terms of the notice currently in effect;
notify you following a breach of unsecured PHI when notice is required by applicable law; and
comply with applicable federal and New York laws governing the privacy and security of health information.
IAP reserves the right to change the terms of this notice and to make the revised notice effective for all PHI that IAP already maintains, as well as for any PHI IAP receives in the future. If this notice changes materially, IAP will make the revised notice available through its usual practice channels and upon request.
5. How IAP May Use and Disclose Your Protected Health Information Without Your Authorization
The following are categories of uses and disclosures that IAP may make without your written authorization, to the extent permitted or required by applicable law. Not every possible use or disclosure is listed, but all permitted uses and disclosures will fall within one or more of these categories.
6. Treatment
IAP may use and disclose your PHI to provide, coordinate, or manage your care and related services. For example, IAP may use your information to assess your needs, develop a treatment plan, document sessions, coordinate with other treatment providers, make referrals, or communicate with another provider involved in your care, when permitted by law and, where required, with your authorization.
7. Payment
IAP may use and disclose your PHI to obtain payment for services provided to you. Although IAP may operate as a self-pay practice and may not bill insurance directly, IAP may use or disclose PHI for billing, invoicing, payment processing, collections, issuing receipts, providing superbills or statements at your request, addressing payment disputes, or related payment activities. If you request documentation for out-of-network reimbursement, a superbill or similar document may include identifying and clinical information such as diagnosis codes, service dates, and procedure codes.
8. Health Care Operations
IAP may use and disclose your PHI for health care operations necessary to run the practice and support quality care. These activities may include quality assessment and improvement, training, supervision, peer or professional consultation, licensing and credentialing activities, business planning, auditing, legal and compliance review, fraud and abuse prevention, data security activities, customer service, and general administrative functions. When practical and appropriate, IAP will limit the information shared and may de-identify information where feasible.
9. Business Associates and Service Providers
IAP may disclose PHI to qualified third-party vendors, contractors, and service providers that perform functions on IAP's behalf, such as telehealth services, practice management, hosting, storage, billing, claims support, payment processing, secure communications, document management, information technology support, data backup, and security operations. When required by law, IAP will obtain satisfactory assurances that such parties will appropriately safeguard PHI.
10. Required by Law
IAP may use or disclose your PHI when such use or disclosure is required by federal, state, or local law, regulation, court order, warrant, subpoena, or other lawful process.
11. Public Health and Health Oversight Activities
IAP may disclose your PHI for public health activities or health oversight activities authorized by law, including disclosures to government agencies responsible for oversight of the health care system, professional licensure, benefit programs, audits, inspections, investigations, and related functions.
12. Abuse, Neglect, or Domestic Violence
IAP may disclose PHI as required or permitted by law to report suspected child abuse or maltreatment, abuse or neglect of vulnerable persons, or domestic violence. As applicable under New York law, IAP may be a mandated reporter in certain circumstances.
13. Serious Threat to Health or Safety
IAP may use or disclose PHI if IAP believes in good faith that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or the health or safety of another person or the public, consistent with applicable law and professional obligations.
14. Judicial and Administrative Proceedings
IAP may disclose PHI in response to a court order, administrative order, subpoena, discovery request, or other lawful process, as permitted or required by law. Where appropriate and legally permitted, IAP may seek to limit the scope of disclosure, object to the request, or notify you before disclosure.
15. Law Enforcement Purposes
IAP may disclose PHI for certain law enforcement purposes as permitted or required by law, including in response to lawful requests, to report certain crimes, or to help locate a suspect, fugitive, witness, or missing person, subject to applicable legal limits.
16. Coroners, Medical Examiners, and Certain Other Specialized Government Functions
IAP may disclose PHI to coroners, medical examiners, funeral directors, or for certain specialized government functions when authorized or required by law.
17. Workers' Compensation
IAP may disclose PHI as authorized or required by workers' compensation or similar laws.
18. Emergency Situations and Incapacity
If you are incapacitated or in an emergency circumstance, IAP may use or disclose PHI as permitted by law when necessary to protect your interests, facilitate emergency treatment, or respond to urgent safety concerns.
19. Psychotherapy Notes
To the extent IAP maintains psychotherapy notes as that term is defined under HIPAA, those notes are given special protection. Psychotherapy notes are different from the rest of your clinical record. In most circumstances, IAP will not use or disclose psychotherapy notes without your written authorization except as specifically permitted or required by law, such as for certain supervision, training, defense in legal proceedings brought by you, health oversight, or other limited purposes allowed by HIPAA.
20. Uses and Disclosures That Generally Require Your Written Authorization
Except as otherwise permitted or required by law, IAP will obtain your written authorization before:
using or disclosing PHI for purposes not otherwise described in this notice;
disclosing PHI to family members, friends, or other persons involved in your care when such disclosure is not otherwise permitted by law;
releasing records in response to many non-emergency requests from employers, schools, attorneys, or other third parties;
using or disclosing psychotherapy notes, except as otherwise permitted or required by law;
using or disclosing PHI for marketing purposes where authorization is required;
selling PHI; or
making other uses or disclosures for which authorization is required under HIPAA or New York law.
You may revoke an authorization at any time by giving IAP a written revocation, except to the extent IAP has already acted in reliance on that authorization.
21. Your Rights Regarding Your Protected Health Information
You have the following rights with respect to your PHI, subject to applicable legal limitations and conditions:
22. Right to Access and Obtain a Copy
You have the right to inspect and obtain a copy of PHI maintained in a designated record set, subject to limited exceptions. Requests should be made in writing using IAP's designated request method. IAP may provide records in paper or electronic form, or may provide a summary if you agree. IAP may charge a reasonable, cost-based fee to the extent permitted by law.
Access rights under HIPAA do not necessarily extend to psychotherapy notes as specially protected under HIPAA. In some circumstances, IAP may deny access in whole or in part as permitted by law. If access is denied, you may have the right to request a review of the denial in certain circumstances.
23. Right to Request an Amendment
You have the right to request that IAP amend PHI in a designated record set if you believe the information is incorrect or incomplete. Your request must be in writing and must explain why the amendment is requested. IAP may deny the request in circumstances permitted by law, including if IAP did not create the information, the information is accurate and complete, or the information is not part of the record subject to amendment.
24. Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures of your PHI made by IAP during the period required by law, excluding disclosures that are not required to be included under HIPAA, such as disclosures for treatment, payment, health care operations, and certain other exceptions.
25. Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your PHI for treatment, payment, or health care operations, or to persons involved in your care. IAP is not required to agree to every requested restriction, except where applicable law requires compliance. If IAP agrees to a restriction, IAP will comply with it except as otherwise permitted or required by law.
If you pay in full out of pocket for a specific item or service, you have the right to request that IAP not disclose PHI related solely to that item or service to a health plan for purposes of payment or health care operations, and IAP will comply with that request unless disclosure is otherwise required by law.
26. Right to Request Confidential Communications
You have the right to request that IAP communicate with you by alternative means or at alternative locations. For example, you may ask IAP to contact you only at a certain phone number, email address, mailing address, or through the client portal. IAP will accommodate reasonable requests as required by law.
27. Right to Receive a Copy of This Notice
You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive it electronically.
28. Right to Be Notified of a Breach
You have the right to be notified if IAP discovers a breach of your unsecured PHI and notification is required by law.
29. Special Considerations for Telehealth, Electronic Communications, and Data Security
Because IAP is a telehealth practice, PHI may be created, received, maintained, stored, or transmitted electronically through telehealth platforms, practice management systems, secure messaging tools, email, telephone, electronic billing systems, cloud storage, and other business technologies used to support care and operations.
IAP uses reasonable administrative, technical, and physical safeguards designed to protect PHI from unauthorized access, use, alteration, or disclosure. IAP is a small practice and may rely on qualified third-party vendors and service providers for portions of its infrastructure, hosting, storage, communications, and security operations. While IAP takes reasonable steps to work with service providers believed to be appropriate for these functions and to implement safeguards within its control, no method of electronic transmission, storage, or processing is completely secure, and absolute security cannot be guaranteed.
If you communicate with IAP by email, text message, voicemail, or other non-portal methods, those communications may involve greater privacy risks than communications through IAP's designated secure systems. IAP may respond using the communication method you use to contact IAP or another reasonable method unless prohibited by law or by your written request.
30. Minors and Personal Representatives
In some circumstances, a parent, guardian, or other personal representative may exercise rights on behalf of a client as permitted or required by law. However, under applicable New York and federal law, a parent, guardian, or personal representative may not always have a right to access all records or control all confidentiality decisions. IAP will follow the law that applies to the particular situation.
31. Complaints
If you believe your privacy rights have been violated, you may file a complaint with IAP using the contact information below or with the U.S. Department of Health and Human Services, Office for Civil Rights. IAP will not retaliate against you for filing a complaint.
You may also contact the New York State Education Department, Office of the Professions, or another appropriate New York agency if your concern relates to professional conduct, licensure, or confidentiality obligations under New York law.
32. Contact Information and Privacy Requests
If you have questions about this notice, wish to exercise your privacy rights, want to request records, restrictions, confidential communications, or amendments, or would like to submit a privacy request or complaint, please contact:
Inner Alchemy Psychotherapy, LLC
Provider: Lora Sasiela, LCSW-R
New York License Number: 053553
Mailing Address: 100 S. Broad Street, Ste 30, Philadelphia, PA 19110-1001
Practice Phone: 332-301-5538
General Email: inneralchemypsychotherapy@gmail.com
Privacy Request Method: Contact form at www.InnerAlchemyPsychotherapy.com
How to File a Complaint With HHS
You may file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.Washington, D.C. 20201
Toll-Free: 1-877-696-6775
Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Effective Date
This Notice of Privacy Practices is effective as of April 1, 2026.
Inner Alchemy Psychotherapy, LLC | Provider: Lora Sasiela, LCSW-R | NY License #053553 | Telehealth | New York State