Notice of Privacy Practices
Forge Therapy, PLLC Effective Date: April 17, 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.
Our Commitment to Your Privacy
Forge Therapy, PLLC is committed to protecting your protected health information (PHI). We are required by law to maintain the privacy of your PHI, provide you with this notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect.
How We May Use and Disclose Your Health Information
We may use and disclose your PHI for the following purposes without your written authorization:
Treatment: We may use and share your health information to provide, coordinate, or manage your care. For example, we may share information with other providers involved in your treatment.
Payment: We may use and share your information to bill and collect payment for services. For example, we may share information with your insurance company to obtain reimbursement.
Health Care Operations: We may use and share your information for operational purposes, such as quality assessment, training, and administrative functions.
As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law.
Disclosures That May Be Made Without Your Authorization
In certain situations, we may disclose your PHI without your written authorization, including:
- To report suspected child abuse or neglect
- To report suspected abuse, neglect, or exploitation of a vulnerable adult
- When there is a serious and imminent threat to your safety or the safety of another person
- To comply with mandatory reporting laws in the states where we are licensed (Minnesota, North Dakota, Oklahoma, Oregon, and Florida)
- For public health activities as required by law
- In response to a court order or subpoena, subject to applicable protections
Uses and Disclosures That Require Your Written Authorization
For uses and disclosures beyond those listed above, we will ask for your written authorization. You may revoke that authorization at any time in writing. Revocation will not apply to disclosures already made.
This includes:
- Most disclosures of psychotherapy notes
- Marketing communications
- Sale of your health information
Your Rights Regarding Your Health Information
You have the right to:
Request restrictions on how we use or disclose your PHI for treatment, payment, or operations. We are not required to agree to every request, but will honor agreed-upon restrictions.
Request confidential communications. You may ask that we contact you in a specific way or at a specific location.
Inspect and receive a copy of your health information. You may request access to your records. We may charge a reasonable fee for copies.
Request an amendment to your records if you believe information is incorrect or incomplete. We may deny your request in certain circumstances.
Receive an accounting of disclosures. You may request a list of disclosures we have made of your PHI, with certain exceptions.
Receive a paper copy of this notice upon request, even if you have received it electronically.
Our Responsibilities
We are required to:
- Maintain the privacy of your PHI
- Provide you with this notice of our duties and privacy practices
- Notify you if there is a breach of your unsecured PHI
- Follow the terms of the notice currently in effect
We reserve the right to change the terms of this notice at any time. Changes will apply to PHI we already hold as well as new information. We will post the current notice on our website and make copies available upon request.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
To file a complaint with us: Forge Therapy, PLLC andi@forgetherapy.org 405-254-6206
To file a complaint with HHS: U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 1-877-696-6775 www.hhs.gov/ocr/privacy/hipaa/complaints
Contact Us
Forge Therapy, PLLC andi@forgetherapy.org 405-254-6206