HIPAA Notice of Privacy Practices
Julie Bjelland, LMFT | License #88019
Website: www.JulieBjelland.com
Updated: June 12, 2026
This notice explains how your personal and health information may be collected, used, stored, and protected. It also explains your privacy rights.
Please review this notice carefully. By participating in an autism assessment or consultation with Julie Bjelland, LMFT, you acknowledge that this HIPAA Notice of Privacy Practices has been made available to you.
Information Collected
During the assessment or consultation process, I may collect personal and health information, including:
Your name, contact information, date of birth, and emergency contact
Health history and background information relevant to the assessment or consultation
Prior diagnoses, medications, and current supports
Developmental history and lived experiences
Personal experiences, narratives, and self-reflections
Responses from intake forms, written questionnaires, and clinical interviews
Notes, observations, and clinical impressions from sessions
Information related to scheduling, payment, and legally required recordkeeping
This information may be used for assessment, consultation, clinical documentation, feedback, education, scheduling, payment, and legally required recordkeeping.
How Information Is Collected and Stored
Assessment and consultation information may be collected through secure electronic forms, written questionnaires, telehealth platforms, scheduling systems, payment systems, and clinical documentation systems.
Some assessment forms may ask for sensitive personal and health-related information, including information about developmental history, mental health, prior diagnoses, medications, sensory experiences, relationships, work or school functioning, and lived experience.
Electronic systems used in this practice are selected with privacy and confidentiality in mind. When outside companies or digital platforms may handle protected health information, reasonable efforts are made to use appropriate HIPAA-related privacy protections, including written privacy agreements when required.
Access to client information is limited to Julie Bjelland, LMFT, and administrative support staff who assist with scheduling, forms, communication, payment, or practice operations and who are expected to maintain confidentiality.
No electronic communication or digital storage system can be guaranteed to be completely secure. Please do not submit assessment forms from a public computer, shared device, public Wi-Fi network, or any setting where your privacy may be compromised.
Electronic Forms and Assessment Questionnaires
Written assessment questionnaires are an important part of the autism assessment and consultation process. These forms may include protected health information and sensitive personal narratives.
Please complete forms only through the links provided by this practice. Do not forward form links to others.
If you have concerns about using electronic forms, please contact me before submitting your information so we can discuss possible options.
Use of Protected Health Information
As a licensed psychotherapist, I am required by law to protect your protected health information, also called PHI. PHI includes information that identifies you and relates to your physical or mental health, care, or payment.
Your PHI may be used or disclosed for treatment, payment, health care operations, and other purposes required or permitted by law. Your PHI will not be shared without your written authorization except as required or permitted by law.
I am required by law to maintain the privacy and security of your protected health information. If a breach occurs that may have compromised the privacy or security of your information, I will notify you as required by law.
I do not sell your health information.
Disclosures Without Authorization
Your information may be disclosed without written authorization only when required or permitted by law, including:
If there is a serious threat of harm to yourself or someone else
If there is suspected abuse or neglect of a child, elder, or dependent adult
If disclosure is required by court order, subpoena, or other legal mandate
If disclosure is necessary to prevent or respond to a serious threat to health or safety
As otherwise required or permitted by law
Telehealth Privacy
Assessment and consultation sessions may take place by secure video. Telehealth has benefits, but also potential risks, including technology problems, interruptions, or privacy concerns if you are not in a private location.
You agree to be in a private setting during sessions and to use a secure internet connection whenever possible.
California Board of Behavioral Sciences guidance states that clinicians providing telehealth must obtain and document consent, inform clients of telehealth risks and limitations, provide license information, and make reasonable efforts to identify emergency resources in the client’s geographic area.
Communication Boundaries
Email and text communication are used primarily for scheduling, payment questions, form reminders, and other administrative or logistical matters.
Please avoid sending sensitive clinical information, detailed personal history, assessment responses, or urgent mental health concerns by regular email or text. Clinical information should be shared during sessions or through the assessment forms or other systems provided for that purpose.
Although reasonable safeguards are used, regular email and text messaging may not be fully secure. If you choose to send personal or health-related information by email or text, you understand there may be some privacy risk.
Payment Processing
Payments are processed through a secure third-party payment platform. Please do not include diagnostic, clinical, or sensitive health information in payment notes or payment-related messages.
Only the information needed to process payment, such as your name, email, payment amount, and transaction details, is used for payment purposes.
Your Privacy Rights
You have the right to:
Request access to your records
Request a correction or amendment if you believe information is incorrect
Request a list of certain disclosures made without your authorization
Request that communication happen through a specific method when reasonable
Request limits on certain uses or disclosures, though I may not always be required to agree
Receive a copy of this notice
File a complaint if you believe your privacy rights have been violated
Withdraw written authorization at any time, unless action has already been taken based on that authorization
Complaints
If you have concerns about your privacy or how your information is being handled, you may contact:
Julie Bjelland, LMFT
You may also contact the U.S. Department of Health and Human Services, Office for Civil Rights.
Office for Civil Rights
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
Phone: 415-437-8310
You will not be retaliated against for filing a privacy complaint.
Changes to This Notice
This notice may be updated from time to time. The most recent version will be available at www.JulieBjelland.com.
By participating in an autism assessment or consultation with Julie Bjelland, LMFT, you acknowledge that this HIPAA Notice of Privacy Practices has been made available to you.