Notice of Privacy Practices

Cultivate Your Essence

Effective Date: July 1, 2026

THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH 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

At Cultivate Your Essence ("we," "us," or "the Practice"), we are committed to protecting the privacy of your health information. We understand that information about you and your health is personal, and we are dedicated to keeping it confidential.

We are required by law to:

Keep your protected health information ("PHI") private and secure;
Provide you with this Notice describing our legal duties and privacy practices regarding your PHI;
Follow the terms of the Notice currently in effect; and
Notify you if there is a breach of your unsecured PHI.

"Protected health information" (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related care.

How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose your PHI. Not every use or disclosure will be listed, but all the ways we are permitted to use and disclose information fall within one of the categories below.

For Treatment:

We may use and disclose your PHI to provide, coordinate, or manage your care and related services. This includes sharing information with other professionals involved in your treatment. For example, with your consent, we may consult with a psychiatrist, primary care physician, or another therapist involved in your care.

For Payment:

We may use and disclose your PHI so that we can bill and collect payment for the services you receive. For example, we may provide information to your health insurance company to obtain authorization or reimbursement for services. We may also provide a superbill or statement that includes limited information such as diagnosis, dates, and types of service.

For Health Care Operations:

We may use and disclose your PHI to support the business activities of the Practice. This may include quality assessment, staff training and supervision, scheduling, business management, and administrative activities.

Appointment Reminders and Communications:

We may contact you (by phone, text, email, or mail) to remind you of appointments or to provide information about your care. Please let us know if you prefer a specific method of contact or wish to limit these communications.

Uses and Disclosures That May Be Made Without Your Authorization:

We may use or disclose your PHI without your authorization in the following circumstances, subject to the limits set by law:

When required by law — federal, state, or local.
To prevent a serious threat to health or safety — to lessen a serious and imminent threat to the health or safety of you or others.
Abuse, neglect, or domestic violence — to appropriate authorities as required or permitted by law.
Public health activities — such as reporting to public health authorities as authorized by law.
Health oversight activities — such as audits, investigations, and licensure activities by oversight agencies.
Judicial and administrative proceedings — in response to a court order, subpoena, or other lawful process, consistent with applicable law.
Law enforcement — under specific and limited circumstances permitted by law.
Coroners, medical examiners, and funeral directors — as authorized by law.
Workers' compensation — as authorized by and to the extent necessary to comply with workers' compensation laws.
Specialized government functions — such as military, national security, or protective services, as permitted by law.

Uses and Disclosures That Require Your Written Authorization:

Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization.

In particular, the following generally require your authorization:

Psychotherapy notes (see below);
Marketing purposes;
Sale of your PHI; and
Most other uses and disclosures not otherwise described here.

You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Special Protection for Psychotherapy Notes:

Because we provide mental health services, certain information receives heightened protection. "Psychotherapy notes" are notes recorded by a mental health professional documenting or analyzing the contents of a counseling session, kept separate from the rest of your record. In most cases, we will not use or disclose psychotherapy notes without your specific written authorization, except in limited circumstances permitted by law (for example, for our own training or to defend against a legal action you bring).

Additional State-Law Protections:

State law may provide greater protection for certain categories of information, including mental health, substance use, and other sensitive information. Because the Practice serves clients in Illinois and Georgia, we follow the more protective of applicable federal and state requirements. (Illinois clients: the Illinois Mental Health and Developmental Disabilities Confidentiality Act may apply. Please confirm all state-specific requirements with your legal/compliance advisor — see note at the end.)

Your Rights Regarding Your Health Information:

You have the following rights regarding the PHI we maintain about you:

Right to Inspect and Copy — You may request to inspect and obtain a copy of your PHI, including an electronic copy where readily producible. We may charge a reasonable, cost-based fee. In limited circumstances, we may deny access, and you may request a review of that denial.
Right to Request an Amendment — If you believe information in your record is incorrect or incomplete, you may request that we amend it. We may deny your request under certain circumstances and will explain why in writing.
Right to an Accounting of Disclosures — You may request a list of certain disclosures we have made of your PHI, subject to legal exceptions.
Right to Request Restrictions — You may request that we limit how we use or disclose your PHI. We are not required to agree to all requests. However, if you pay for a service or item in full, out of pocket, you may request that we not disclose that information to your health plan for payment or operations, and we will honor that request as required by law.
Right to Request Confidential Communications — You may request that we communicate with you in a certain way or at a certain location (for example, only by mail to a specific address).
Right to a Paper Copy of This Notice — You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Right to Be Notified of a Breach — You have the right to be notified if there is a breach of your unsecured PHI.
Right to Revoke Authorization — Where you have given written authorization, you may revoke it in writing at any time, except to the extent we have already acted on it.

To exercise any of these rights, please submit your request in writing to the contact listed below.

Our Responsibilities:

We are required by law to maintain the privacy and security of your PHI.
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 provide you with a copy of it.
We will not use or share your information other than as described here unless you tell us we may in writing. If you tell us we may, you may change your mind at any time by letting us know in writing.

Changes to This Notice:

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any information we receive in the future. The current Notice will be posted on our website and available at our office. Each Notice will display its effective date.

Complaints:

If you believe your privacy rights have been violated, you may file a complaint with the Practice using the contact information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for

Civil Rights:

Online: www.hhs.gov/ocr/privacy/hipaa/complaints/
Mail: U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201
Phone: 1-877-696-6775

You will not be penalized or retaliated against for filing a complaint.

Contact Information:

If you have questions about this Notice or wish to exercise any of your rights, please contact our office:

Practice: Cultivate Your Essence
Email: info@cultivateyouressence.com
Phone: 708-654-1929
Mailing Address: 111 West Jackson Blvd, Suite 1700, Chicago, IL 60604
Locations Served: Chicago, IL & Atlanta, GA