Notice of Privacy Practices

Your Privacy

Questions? Contact our Privacy Officer, Kachina Mooney, at 412-444-5174 or Kachina@goglotherapy.com.

Your rights

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

• Get a copy of your records. You can ask to see or get a copy of your health and billing records. We will provide a copy or a summary, usually within 30 days of your request, and may charge a reasonable, cost-based fee.

• Ask us to correct your records. You can ask us to correct information you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.

• Request confidential communications. You can ask us to contact you in a specific way (for example, a particular phone number or email) or to send mail to a different address. We will say yes to all reasonable requests.

• Ask us to limit what we use or share. You can ask us not to use or share certain information for treatment, payment or our operations. We are not required to agree if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will say yes unless a law requires us to share it.

• Get a list of those we’ve shared information with. You can ask for a list of the times we’ve shared your information in the six years before your request, who we shared it with, and why. We will include all disclosures except those for treatment, payment and operations, and certain others (such as any you asked us to make). We provide one list a year for free.

• Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.

• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights. We will confirm they have this authority before we act.

• File a complaint if you feel your rights are violated. Contact our Privacy Officer (below), or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue SW, Washington, DC 20201; 1-877-696-6775; www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

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Your choices

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

• You can tell us whether to share information with family, close friends or others involved in your care, or in a disaster relief situation. If you can’t tell us your preference (for example, if you are unconscious), we may share information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.

• We never share your information for marketing, never sell your information, and never share psychotherapy notes without your written permission, except where the law allows (for example, to defend ourselves in a legal action you bring).

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Our uses and disclosures

Treatment. We use your information to provide your care and may share it with other professionals who are treating you, such as when your therapist consults with a clinical supervisor. Interns are supervised by a licensed clinician who follows these same rules.

Running our practice. We use your information to run the practice, improve your care and contact you when needed, for example to send appointment reminders.

Billing for services. We use and share your information to bill and get payment from health plans or other entities, for example giving your insurer information about the services you received.

Other ways we may share information, when the law allows or requires it:

• Preventing harm: to prevent or lessen a serious threat to your health or safety, or the health or safety of others.

• Abuse and neglect reporting: to report suspected abuse or neglect of a child, older adult or dependent adult, as Pennsylvania law requires.

• Complying with the law: with federal or state agencies when the law requires it, including the Department of Health and Human Services to show we comply with privacy law.

• Health oversight and public health: for audits, licensing and investigations by oversight agencies, and for public health activities.

• Legal proceedings: in response to a court order, or a subpoena where the law permits.

• Law enforcement and government functions: for law enforcement purposes or special government functions, as the law allows.

• Workers’ compensation: for workers’ compensation claims, as the law allows.

• Coroners and medical examiners: when an individual dies.

Pennsylvania law. Pennsylvania law gives extra protection to mental health records and to records of drug and alcohol treatment. Where state or federal law is more protective of your privacy than HIPAA, we follow the more protective law. In most cases this means we will ask for your written consent before sharing mental health information.

Technology we use. We keep records and handle intake, scheduling and billing through SimplePractice, a secure electronic health record system, and we offer virtual sessions through secure video. These vendors are required to protect your information.

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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 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 here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

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Changes to this notice

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 on request, in our offices and on our website.

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Contact our Privacy Officer

Kachina Mooney, Founder and Owner

Go Glo Therapy LLC

134 S. Highland Ave., Suite 3-12, Pittsburgh, PA 15206

412-444-5174 · Kachina@goglotherapy.com

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Effective October 16, 2026