TEMPLATE FOR THERAPISTS
HIPAA Notice of Privacy Practices
A HIPAA Notice of Privacy Practices isn't optional—it's a federal requirement. But most of the templates clinicians are using were written for general healthcare settings, stripped of anything state-specific, and haven't been updated to reflect how modern practices actually operate. They cover the basics and stop there.
This template doesn't stop there.
This is a complete, plain-language HIPAA Notice of Privacy Practices designed specifically for mental health private practice—solo and group. It meets all federal requirements under 45 CFR §164.520 and goes significantly further in the areas most generic templates skip entirely.
It includes a state law section that names the additional privacy protections that frequently supersede HIPAA for mental health records—because if you practice in a state with its own Mental Health Records Act, federal law isn't the whole story and your clients deserve to know that. It includes a dedicated AI tools disclosure section, because if you use AI-assisted notetaking, transcription, or documentation tools, HIPAA requires you to disclose that—and most templates were written before that question existed. It addresses psychotherapy notes specifically, explaining the distinction between personal clinical impressions and standard progress notes and the additional protections that apply to each.
It covers 42 CFR Part 2 for practices that treat substance use disorders, minor client privacy rights and state-specific consent exceptions, record retention requirements including what happens after a client dies, breach notification obligations in plain language, and a complete client rights section covering access, amendment, restrictions, confidential communications, and the right to opt out.
Throughout, the document provides separate language for solo and group practices—clearly marked so you know exactly what to keep and what to remove for your structure.
Every placeholder is marked in red. Teal clinician notes explain legal requirements, flag state-specific decisions, and identify the sections that are optional based on your practice type.You have a HIPAA Notice that came with your EHR, hasn't been updated in years, and doesn't reflect how your practice actually operates—and especially if any of these sound familiar:
You practice in a state with its own mental health records law and your current notice doesn't mention it
You use AI-assisted notetaking, transcription, or documentation tools and aren't sure if that needs to be disclosed—it does
You maintain separate psychotherapy notes and want clients to understand what that means and what protections apply
You work with minor clients and need your notice to address parental access rights and state-specific consent exceptions
You've scaled from solo to group practice and your current notice still says "I" throughout
You want a document that meets the federal standard and actually explains your clients' rights in language they can understand
1. Download and open—The template is a .docx file. Open it in Microsoft Word or Google Docs.
2. Choose your practice structure first—Throughout the document, separate language is provided for solo and group practices, clearly marked. Delete the version that doesn't apply before doing anything else.
3. Replace the red brackets—Fill in your practice name, physical address, contact information, EHR and telehealth platforms, licensed states, Privacy Officer details, and effective date.
4. Complete the state law section—Add the specific state privacy laws that apply to your practice. If you're unsure what applies, this is the section to confirm with your attorney before finalizing.
5. Review the teal notes—Teal clinician notes explain legal requirements, flag optional sections, and identify where state-specific decisions need to be made. Read every one. Delete all notes before finalizing.
6. Remove optional sections that don't apply—The substance use disorder records section, minor clients section, and AI tools section are each marked optional. Keep what applies, remove what doesn't.
7. Remove the clinician instruction page—This must be removed before distributing to clients.
8. Save as a PDF—When your edits are complete, save a final version as a PDF before sending to clients or uploading to your EHR.
9. Document receipt—HIPAA requires a good-faith effort to obtain a signed acknowledgment of receipt and documentation of when and how it was provided. The "for practice use only" section at the bottom is built for exactly that—use it.
10. Have it reviewed—This document must be reviewed by a licensed attorney and/or your malpractice carrier before distribution. HIPAA violations can result in civil penalties up to $1.9 million per violation category per year. Do not distribute a draft.
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