Unfortunately, we are not on insurance panels and you need to contact your insurance company for their out-of-network policy. For more info please visit: https://www.ameliaislandpsychology.net/payments

Attending your scheduled appointments is very important. Your appointment time is dedicated to you. Missed appointments are missed opportunities for growth, as well as lost time that could have gone to helping others. If you are unable to attend a scheduled session, please cancel by phone or email at least 24 hours before; otherwise, the full session rate will be charged.

In-person sessions last approximately 60 minutes.

Payment is due on the day of service. We accept cash, checks, and all credit/debit cards. You can make payment in person, on the day of your appointment, or by providing us with authorization to run the credit card you choose to keep on file with us. For more info please visit: https://www.ameliaislandpsychology.net/payments

HIPAA Compliance Statement for Amelia Island Psychology
Purpose
Amelia Island Psychology is committed to fully complying with the Health Insurance Portability and Accountability Act
(HIPAA) Privacy Rule and the associated federal guidance on sharing information related to mental health. We
respect and protect the confidentiality and privacy of all protected health information (PHI), including sensitive mental
health information, and we ensure that disclosures are made only under legally permissible circumstances.
Scope
This statement applies to all members of the practice, including employees, contractors, and affiliated health care
professionals who have access to PHI in the course of providing psychological services.
1. Protection of Mental Health Information
We treat all protected health information (including mental health records) confidentially in accordance with HIPAA.
Mental health information is afforded the same baseline privacy protections as other health information under the
HIPAA Privacy Rule, with special protections for psychotherapy notes.
● Psychotherapy notes (session notes) are maintained separately from the rest of the medical record and are
disclosed only with specific patient authorization, except where otherwise permitted by law (e.g., mandatory
reporting requirements).

2. Use and Disclosure of PHI
We may use and disclose PHI only as permitted under HIPAA and relevant federal guidance:
● For Treatment: PHI may be shared with other health care providers and care coordination partners as
needed for treatment without requiring a separate authorization from the patient.
● Family, Friends, and Caregivers: With the patient’s consent, or when the patient is present and does not
object, we may share information directly relevant to the person’s involvement in the patient’s care or
payment for care.
● Emergencies and Safety Situations: In circumstances where a patient poses a serious and imminent risk to
themselves or others, PHI may be disclosed to appropriate persons (such as family members or law
enforcement) to prevent or lessen the threat, consistent with HIPAA and applicable law.
● Other Permitted Uses: PHI may also be disclosed as required by law (e.g., court orders, public health
reporting) or as necessary for payment and health care operations under HIPAA regulations.

3. Patient Rights
We uphold the following patient rights in accordance with HIPAA:
● Right to Access: Patients have the right to inspect and obtain a copy of their mental health records.
● Right to Amend: Patients may request corrections to their PHI if they believe the information is incorrect.

● Right to Restrict Disclosures: Patients may request limits on certain uses and disclosures of their PHI,
which we will review in compliance with federal regulations.

4. Training and Safeguards
All staff members, clinicians, and administrative personnel are trained on HIPAA requirements and this compliance
policy. We implement administrative, physical, and technical safeguards to prevent unauthorized access, use, or
disclosure of PHI.
5. Notice of Privacy Practices
We provide all patients with a Notice of Privacy Practices that explains in clear terms how their PHI may be used and
disclosed, and details their rights under HIPAA. This notice is available at intake and upon request.
Effective Date: March 2026
Contact: For questions or concerns regarding HIPAA compliance, please contact our Privacy Officer at
Privacy Officer: Dr. Jean Kerry
Phone: (904) 601-1026
Email: ameliaislandpsychology@gmail.com

Packet HIPAA:
Privacy & Confidentiality Notice
Mental Health Information – HIPAA Compliance Summary
Our Commitment to Your Privacy
Amelia Island Psychology is committed to protecting the privacy and confidentiality of your health information. We
follow the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and federal guidance regarding
the sharing of mental health information.
Your mental health information is considered Protected Health Information (PHI) and is kept confidential except as
permitted or required by law.
How We May Use or Share Your Information
We may use or disclose your health information in the following ways:
1. For Treatment
We may share information with other healthcare providers involved in your care to coordinate treatment.
2. For Payment
We may share necessary information with your insurance company or other payers to process claims and obtain
payment.
3. For Health Care Operations
We may use your information for practice management activities such as quality improvement, supervision, or staff
training.

4. With Your Permission
We will obtain your written authorization before sharing your information for purposes not otherwise permitted under
HIPAA.
5. With Family or Others Involved in Your Care
If you are present and able to make decisions, we will ask your permission before sharing relevant information with
family members, caregivers, or others involved in your care. You may object to such disclosures.
6. Safety Situations
If we believe there is a serious and imminent threat to your health or safety, or the safety of others, we may disclose
relevant information to appropriate individuals (such as family members, emergency responders, or law enforcement)
consistent with federal and state law.
7. When Required by Law
We may disclose information when required by law (e.g., court orders, mandatory reporting of abuse or neglect).
Special Protection for Session Notes
Session notes (personal notes kept by your therapist documenting or analyzing session conversations) receive
special protection under HIPAA. These notes will not be disclosed without your specific written authorization, except
in very limited circumstances permitted by law.
Your Rights
Under HIPAA, you have the right to:
1. Request access to your records
2. Request a copy of your records
3. Request corrections (amendments)
4. Request limits on certain disclosures
5. Request confidential communications (e.g., alternative mailing address)
6. Receive a copy of our full Notice of Privacy Practices
7. File a complaint if you believe your privacy rights have been violated
You may file a complaint with our Privacy Officer or directly with the U.S. Department of Health & Human Services
without fear of retaliation.
Questions or Concerns?
If you have questions about privacy or how your information is handled, please contact:
Privacy Officer: Dr. Jean Kerry
Phone: (904) 601-1026
Email: ameliaislandpsychology@gmail.com