Privacy Policies

This notice describes how health information may be used and disclosed and how you can get access to this

information. Please Review it carefully.

1. My Pledge Regarding Health Information:

I understand that health information about you and your health care is personal. I am committed to

protecting health information about you. I create a record of the care and services you receive from me. I

need this record to provide you with quality care and to comply with certain legal requirements. This notice

applies to all of the records of your care generated by this mental health care practice. This notice will tell you

about the ways in which I may use and disclose health information about you. I also describe your rights to

the health information I keep about you, and describe certain obligations I have regarding the use and

disclosure of your health information. I am required by law to:

• Make sure that protected health information ("PHI") that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• I can change the terms of this Notice, and such changes will apply to all informationI have about you.

The new Notice will be available upon request, in my office, and on my website.

2. How I May Use and Disclose Health Information About You:

The following categories describe different ways that I use and disclose health information. For each category

of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure

in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall

within one of the categories.

• For Treatment Payment, or Healthcare Operations: Federal privacy rules (regulations) allow health care

providers who have direct treatment relationship with the patient/client to use or disclose the

patient/client's personal health information without the patient's written authorization, to carry out the

health care provider's own treatment, payment or health care operations. I may also disclose your

protected health information for the treatment activities of any health care provider. This too can be

done without your written authorization. For example, if a clinician were to consult with another licensed

health care provider about your condition, we would be permitted to use and disclose your personal

health information, which is otherwise confidential, in order to assist the clinician in diagnosis and

treatment of your mental health condition. Disclosures for treatment purposes are not limited to the

minimum necessary standard. Because therapists and other health care providers need access to the

full record and/or full and complete information in order to provide quality care. The word "treatment"

includes, among other things, the coordination and management of health care providers with a third

party, consultations between health care providers and referrals of a patient for health care from one

health care provider to another.

• Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to

a court or administrative order. I may also disclose health information about your child in response to a

subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if

efforts have been made to tell you about the request or to obtain an order protecting the information

requested.

3. Certain Uses and Disclosures Require Your Authorization:

Psychotherapy Notes - I do keep "psychotherapy notes" as that term is defined in 45 CFR Åò 164.501, and any

use or disclosure of such notes requires your Authorization unless the use or disclosure is:

• A. For my use in treating you.

• B. For my use in training or supervising mental health practitioners to help them improve their skills in

group, joint, family, or individual counseling or therapy.

• C. For my use in defending myself in legal proceedings instituted by you.

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• D. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

• E. Required by law and the use or disclosure is limited to the requirements of such law.

• F. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy

notes.

• G. Required by a coroner who is performing duties authorized by law.

• H. Required to help avert a serious threat to the health and safety of others.

Marketing Purposes - As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

Sale of PHI - As a psychotherapist, I will not sell your PHI in the regular course of my business.

4. Certain Uses and Disclosures Do Not Require Your Authorization:

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the

following reasons:

• When disclosure is required by state or federal law, and the use or disclosure complies with and is

limited to the relevant requirements of such law.

• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or

preventing or reducing a serious threat to anyone's health or safety.

• For health oversight activities, including audits and investigations.

• For judicial and administrative proceedings, including responding to a court or administrative order,

although my preference is to obtain Authorization from you before doing so.

• For law enforcement purposes, including reporting crimes occurring on my premises.

• To coroners or medical examiners, when such individuals are performing duties authorized by law.

• For research purposes, including studying and comparing the mental health of patients who received one

form of therapy versus those who received another form of therapy for the same condition.

• Specialized government functions, including, ensuring the proper execution of military missions;

protecting the President of the United States; conducting intelligence or counterintelligence operations;

or, helping to ensure the safety of those working within or housed in correctional institutions.

• For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I

may provide your PHI in order to comply with workers' compensation laws.

• Appointment reminders and health related benefits or services. I may use and disclose your PHI to

contact you to remind you that you have an appointment with me. I may also use and disclose your PHI

to tell you about treatment alternatives, or other health care services or benefits that I offer.

5. Certain Uses and Disclosures Require You to Have the Opportunity to Object:

Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person

that you indicate is involved in your care or the payment for your health care, unless you object in whole or in

part. The opportunity to consent may be ontained retroactively in emergency situations.

6. You Have the Following Rights With Respect to Your PHI:

• The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use

or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to

agree to your request, and I may say "no" if I believe it would affect your health care.

• The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to

request restrictions on disclosures of your PHI to health plans for payment or health care operations

purposes of the PHI pertains solely to a health care item or a health care service that you have paid for

out-of-pocket in full.

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• The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way

(for example, home or office phone) or to send mail to a different address, and I will agree to all

reasonable requests.

• The Right to See and Get Copies of Your PHI. Other than "psychotherapy notes", you have the right to get

an electronic or paper copy of your medical record and other information that I have about you. I will

provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30

days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.

• The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in

which I have disclosed your PHI for purposes other than treatment, payment, or health care operations,

or for which you provided me with an Authorization.

• I will respond to your request for an accounting is disclosures within 60 days of receiving your

request. The list I will give you will include disclosures made in the last six years unless you request

a shorter time. I will provide the list to you at no charge, but if you make more than one request in

the same year, I will charge you a reasonable cost based fee for each additional request.

• The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece

of important information is missing from your PHI, you have the right to request that I correct the

existing information or add the missing information. I may say "no" but I will tell you why in writing

within 60 days of receiving your request.

• The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this

Notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to

receive this Notice via email, you also have the right to request a paper copy of it.

What I am legally and ethically obligated to do and not to do with the information you share with me is one of

the most important things to understand. Ordinarily, anything yo ushare with me is strictly confidential,

whether you say it in person, say it on the telephone, write it in a letter, put it in an email or a text; however,

100% confidentiality is not guaranteed. The ability to trust me is central to the work you will do in therapy.

Below explains what you need to know about your rights to privacy as it pertains to our therapeutic work

together.

Record Keeping

*I am obligated by State Laws, Federal Laws, and The Mental Health Counselor Code of Ethics to maintain

what is known as a clinical case record. I am required to document specific information you provide to me

about yourself and information relevant to your treatment in this clinical case record. Information that does

not relate specifically to your treatment may not be included in the clinical record. Information shared with

me when we are not in session, included but not limited to emails, text messages, and voicemails may be

included in your case record as well. In all cases, however, anything you tell me is treated with the strictest of

confidence.

Access to Records/Information

In most cases you are permitted to have reasonable access to information contained in your clinical case

record. State and federal laws, as well as my professional ethics code govern access to case record. In the

event you wish to recirw your case record, please address this with me and we can discuss the specifics

around your situation. Your overall health and stability is of the utmost importance to me and as such, I am

obligated to assess the potential consequences of granting you access to your record. Laws allow me to take

several steps to prevent harm from access to your record, including but not limited to:

• providing assistance in interpreting your records

• limiting access to your records

• limiting access to portions of your records

• withholding access to the entire record

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• providing you with a summary of your case record

In the event that some or all of the records are withheld from you, I will provide you with my rationale for

taking this action.

Disclosure without Consent

I am ethically and legally obligated to bring any concern regarding your health and safety and the health and

safety of others to the attention of the appropriate authority. If this is necessary, I will make every attempt to

inform you of the need to disclose confidential information before the disclosure occurs and to obtain your

prior written consent to disclose this confidential information.

According to State Law and Federal Law, there are three circumstances in which I would be required by law

to reveal confidential information about you without your consent. The first situation would be if I had reason

to believe that you were in serious danger of harming yourself or at serious risk for harming another person. I

am required to do this for your protection and the protection of others. Examples of people I may contact

include the police, mobile response, your partner/spouse, close family members or your emergency contact.

The second situation would be if I believed that you were hurting, abusing, or neglecting a child, an elderly

person, or a disabled person in your care. I am required to take this action for their protection. The third

situation would be in the event of a court order compelling me to release your clinical record to a court of law

others legally allowed to make this request.

Release with Consent

If you and I mutually decide that I should provide some or part of your confidential information to another

professional such as your insurance company, your attorney or your doctor, you will be asked to sign a

specific and time-limited "Authorization for Use or Disclosure of Information". You will know exactly what is

to be released, to whom, and how the information will be used. You will be able to stipulate the time period in

which the release is to be in effect and you will be able to revoke the release at any time. You will also be

given the opportunity to review what will be released prior to my doing so. However, be advised that I am

prohibited by law to redact/remove any pertinent information from your clinical case record. Doing so would

be considered a federal crime. You are permitted to bring to my attention any inaccuracies you believe to

exist in your clinical case record and I will take these under advisement.