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.

Uses and Disclosures:

We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Continuity of care is part of treatment and your records may be shared with other providers to whom you are referred. We may use or disclose identifiable health information about you without your specific authorization in certain specific situations, but beyond those situations, we will ask for your written authorization before using or disclosing any identifiable health information about you. Exceptions to receiving your expressed written consent for release of information include:  1) being a danger to yourself or someone else, 2) if you should be found to be gravely disabled (unable to provide for your own food, clothing, shelter and medical needs), 3) the need for an emergency or urgent consultation with your physician regarding medication  4) A court ordered subpoena for records and 5) if you have information regarding a child or a dependent adult that is being abused.

Our office may contact you by phone periodically to schedule appointments or to settle fees.  If you have specific instructions about our contacting you, (such as contacting only at specific times or at specific locations / phone numbers) we will honor such requests when practicable and when made in writing, or respond in writing as to the reasons the restrictions cannot be honored. IndyPsych reserves the right to discontinue services to clients when such restrictions on reasonable communications jeopardize the quality of treatment and care.

Your rights:

In most cases, you have the right to look at or get a copy of health information about you. If you request copies, we will charge you only normal photocopy fees. You also have the right to receive a list of certain types of disclosures of your information that we made. If you believe that information in your record is incorrect, you have the right to request that we correct the existing information.

Our legal duty:

We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice. Before we make a significant change in our policies, we will change our notice and post the new notice in the waiting area. You can also request a copy of this notice at any time or you may print this page for your records. For more information about our privacy practices, contact the person listed below.


If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request.

Contact Person: 

Questions about this policy may be directed to your therapist or to Mark Dobbs, Psy.D at (317) 291-9007.