Notice of Privacy Practices for Designated Clinical Services

Effective Date: September 27, 2026

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical and mental-health information about you may be used and disclosed and how you can access this information. Please review it carefully.

Services Covered by This Notice

This Notice of Privacy Practices applies only to designated clinical psychotherapy services provided through The Reconnection Experience, LLC, including clinical relationship intensives.

This notice does not apply to nonclinical consulting, coaching, psychoeducational programs, retreats, organizational facilitation, or other nonclinical relational-growth services. Those services are governed by their respective agreements and privacy terms.

Protected Health Information, or PHI, includes information that identifies you and relates to your mental or physical health, assessment, treatment, healthcare services, or payment for healthcare services.

Your Rights

You have the right to:

obtain an electronic or paper copy of your clinical record
ask us to correct your clinical record
request confidential communications
ask us to limit certain uses or disclosures
receive an accounting of certain disclosures
obtain a copy of this notice
authorize someone to act for you
file a complaint if you believe your privacy rights have been violated

Obtain a Copy of Your Record

You may ask to inspect or obtain an electronic or paper copy of your clinical record and other health information maintained about you.

We will usually provide a copy or summary within 30 days of receiving your request. A reasonable, cost-based fee may apply when permitted by law.

Access may be limited or denied in certain circumstances permitted by law. If access is denied, you will receive an explanation and information about any available review rights.

Ask Us to Correct Your Record

You may ask us to correct health information that you believe is inaccurate or incomplete.

We may deny the request, but we will explain the reason in writing, generally within 60 days. You may have the right to submit a written statement of disagreement for inclusion in the record.

Request Confidential Communications

You may ask us to contact you in a particular way or at a particular location.

For example, you may request that we use a particular telephone number, email address, or mailing address. We will accommodate reasonable requests.

Ask Us to Limit What We Use or Share

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations.

We are not required to agree to every request. If we agree, we will follow the restriction except when disclosure is necessary for emergency treatment or otherwise required by law.

If you pay for a healthcare service completely out of pocket, you may ask us not to disclose information about that service to your health insurer for payment or healthcare operations. We will honor that request unless disclosure is required by law.

Receive an Accounting of Disclosures

You may request an accounting of certain disclosures made during the six years before the date of your request.

The accounting generally will not include disclosures made for treatment, payment, or healthcare operations; disclosures you authorized; disclosures made directly to you; or certain other disclosures excluded by law.

One accounting during a 12-month period will be provided without charge. A reasonable, cost-based fee may apply to additional requests made during the same period.

Receive a Copy of This Notice

You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically.

Choose Someone to Act for You

If a person has legal authority to act as your personal representative, that person may exercise your privacy rights and make decisions concerning your health information.

We may require documentation establishing that authority before taking action.

File a Privacy Complaint

You may file a complaint if you believe your privacy rights have been violated.

To file a complaint with The Reconnection Experience, contact:

Privacy Officer: Chey-Anne Wilson, IMFT
Telephone: 937-308-4599
Online: www.reconnectionexperience.net/contact

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/hipaa/filing-a-complaint

You will not be retaliated against for filing a complaint.

Your Choices

In certain situations, you may tell us how you want your health information used or disclosed.

You may direct us to:

share relevant information with family members, close friends, or others involved in your care or payment for your care
share information during a disaster-relief situation
communicate with another healthcare provider or support person when authorized or otherwise permitted by law

If you are unable to communicate your preference, we may disclose limited information when we reasonably determine that doing so is in your best interest or is necessary to lessen a serious and imminent threat to health or safety.

Written Authorization

Written authorization is generally required before we use or disclose PHI for:

marketing purposes
the sale of PHI
most uses or disclosures of psychotherapy notes
purposes not otherwise described in this notice or permitted by law

The Reconnection Experience does not sell PHI or use PHI for fundraising.

If you provide written authorization, you may revoke it in writing at any time. Revocation will not affect uses or disclosures already made in reliance on the authorization.

How We Typically Use or Disclose Your Information

1. Treatment

We may use and disclose PHI to provide, coordinate, or manage your clinical services.

This may include consultation or communication with other healthcare professionals involved in your care when permitted by law and clinically appropriate.

Example: With appropriate permission or legal authority, your therapist may coordinate with another provider involved in your treatment.

2. Healthcare Operations

We may use and disclose PHI to operate the clinical portion of The Reconnection Experience and support the quality and administration of services.

Healthcare operations may include:

scheduling
clinical consultation
quality improvement
credentialing
compliance activities
record management
business administration
technology support
legal, accounting, and insurance functions
reviewing the effectiveness and quality of services

3. Payment

We may use and disclose PHI to bill for services and obtain payment.

This may include providing limited information to payment processors, insurers, benefit administrators, or other responsible payers when applicable and permitted by law.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose PHI without written authorization when the disclosure is permitted or required by federal or Ohio law.

Public Health and Safety

We may disclose PHI for legally authorized public-health and safety purposes, including:

reporting suspected abuse or neglect of a child, older adult, or other protected person
preventing or reducing a serious and imminent threat to a person or the public
reporting certain communicable diseases or other public-health concerns
reporting adverse events when required by law

Only information reasonably necessary for the authorized purpose will be disclosed.

Compliance With the Law

We will disclose PHI when federal or Ohio law requires it.

This may include disclosures to the U.S. Department of Health and Human Services to demonstrate compliance with federal privacy requirements.

Health Oversight and Licensing Activities

We may disclose PHI to legally authorized health-oversight agencies for activities such as audits, investigations, inspections, licensure matters, or disciplinary proceedings.

Judicial and Administrative Proceedings

We may disclose PHI in response to a valid court or administrative order or other legally enforceable process.

Mental-health records and confidential communications may receive additional protection under Ohio law. We will evaluate subpoenas, records requests, and other legal demands under applicable confidentiality, privilege, and authorization requirements before disclosing information.

Law-Enforcement and Government Requests

We may disclose PHI for law-enforcement purposes or other governmental functions only as permitted or required by law.

Workers’ Compensation

We may disclose PHI as authorized by and necessary to comply with workers’ compensation or similar laws.

Medical Examiners and Funeral Directors

We may disclose PHI to a coroner, medical examiner, or funeral director as permitted by law following an individual’s death.

Research

We will use or disclose PHI for research only when the applicable legal authorization, waiver, or other required protections are in place.

Ohio Mental-Health Confidentiality

Ohio law and professional ethics may provide mental-health records and communications with protections beyond the general HIPAA requirements.

When Ohio law provides greater privacy protection than federal law, The Reconnection Experience will follow the more protective requirement.

Confidential mental-health information generally will not be disclosed without written authorization unless disclosure is permitted or required by law. Circumstances may include:

suspected abuse or neglect that must be reported
a clear and present or serious and imminent danger
a valid court order or other legally enforceable requirement
a legally authorized licensing-board or health-oversight investigation
another circumstance in which disclosure is specifically permitted or required by law

Clinical Services Involving Couples or Families

Clinical relationship intensives may involve more than one participant.

The clinical informed-consent documents will identify the client or clients, explain how the clinical record is maintained, and describe the confidentiality and record-access expectations applicable to the service.

Information concerning more than one participant may appear within the same clinical record.

Requests to access, amend, restrict, or disclose a multi-participant record will be evaluated under applicable law, professional ethics, and the clinical-service agreement.

This notice does not independently determine which individual or relationship unit is considered the client.

Minors and Personal Representatives

A parent, legal guardian, or other legally authorized personal representative may generally exercise privacy rights on behalf of a minor or another person.

However, federal or Ohio law may allow a minor to consent to certain services or may otherwise limit a representative’s access to particular information. We will apply the law governing the specific circumstances.

Substance-Use-Disorder Records

To the extent that The Reconnection Experience maintains substance-use-disorder patient records protected by 42 CFR Part 2, those records receive additional protection.

Part 2 records will not be used or disclosed in any civil, criminal, administrative, or legislative investigation or proceeding against you unless authorized by your written consent or by a qualifying court order accompanied by the required subpoena or other legal process.

The Reconnection Experience does not use Part 2 records for fundraising.

Electronic Systems and Carepatron

The Reconnection Experience may use Carepatron as a designated platform for clinical intake, scheduling, communication, documentation, payment, and record management.

Information submitted through Carepatron in connection with an accepted clinical service may become part of the clinical or administrative record, as applicable.

The public website contact form is not a clinical-intake system and should not be used to submit PHI or confidential clinical information.

Our Responsibilities

The Reconnection Experience is required to:

maintain the privacy and security of PHI
provide this notice explaining its legal duties and privacy practices
follow the terms of the notice currently in effect
notify affected individuals following a breach of unsecured PHI when required by law
limit uses and disclosures to those permitted or required by law
provide individuals with the privacy rights described in this notice

We will not use or disclose PHI in a manner not described in this notice unless you authorize it in writing or the use or disclosure is otherwise permitted or required by law.

Changes to This Notice

The Reconnection Experience may change the terms of this notice and make the revised notice effective for all PHI it maintains, including information created or received before the revision.

The current notice will be available:

on www.reconnectionexperience.net
through Carepatron for clinical clients
upon request

The effective date at the beginning of the notice will identify the current version.

Contact

For questions, privacy requests, complaints, or additional information concerning this notice, contact:

Chey-Anne Wilson, IMFT
Privacy Officer
The Reconnection Experience, LLC
Dayton, Ohio
937-308-4599
www.reconnectionexperience.net/contact

The Reconnection Experience