THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE READ IT CAREFULLY.

My commitment to your privacy:

My practice is dedicated to maintaining the privacy of your personal health information as part of providing professional care. I am also required by law to keep your information private. These laws are complicated, but I must give you this important information.

I will use the information about your health, which I get from you or from others, mainly to provide you with treatment, to arrange payment for our services, and for some other business activities that are legally referred to as “health care operations.” After you have read this NPP, I will ask you to sign a Consent Form to let me use and share your information. If you do not consent and sign this form, I cannot treat you.

If I (or you) want to use or disclose (send, share, release) your information for any other purposes, I will discuss this with you and ask you to sign an authorization form to allow this. Of course, I will keep your health information private but there are sometimes when the law requires me to share it. 

The exceptions to privacy are:

• Harm to others: If I learn from you about a helping professional who may have acted unethically, the law requires me to report this person to their regulatory body or association. In making this report, I may have to release your name and what I learned from your disclosure.
• Harm to self or others: I may need to arrange for additional help if I suspect (or learn from someone) about safety concerns that involve you or others, such as: (a) you are threatening to (and/or seem to be at) serious risk for harming yourself or others, (b) you are in medical distress, (c) someone is seriously threatening to hurt you/is hurting you, (d) you may be putting a person(s) in serious danger, and/or (e) there are possible criminal activities (past/current) that may pose a risk to the safety of a person(s)
• Additional safety issues: (a) if you arrive to a session where there is suspicion of using drugs or alcohol, that limits your ability to give consent. Your therapist may need to reschedule the session and will warn you not to drive to prevent injury to self/others, (b) if the therapist feels unsafe in session, the therapist in conjunction with the Program Director/Clinical Director will make a referral for you to see a new therapist, (c) if there is a conflict of interest that compromises your therapist or your care, then a referral will need to be made.
• Legal matters: I may have to release details about you if: (a) a judge requests your file, (b) you share specific information about witnessing/being involved in illegal activities (past or present), (c) you plan to/have launched an ethical complaint and/or legal litigation against the agency then your counsellor will need to share their observations/thoughts about you and any information in your counselling file with those on our professional team.
•  Consultation/Supervision: Your counsellor might consult with a supervisor or other counselling professionals for the purpose of providing the best services possible to you. This will not include any identifying information about you.

Your rights regarding your health information:

• You can ask me to communicate with you about your health and related issues in a particular way or at a certain place that is more private for you. For example, you can ask me to call you at home and not at work to schedule or cancel an appointment. I will try my best to do as you ask.
• You have the right to ask me to limit what I tell people involved in your care or the payment for your care, such as family members and friends. While I do not have to agree to your request, if I do agree, I will keep our agreement except if it is against the law, or in an emergency, or when the information is necessary to treat you.  
• You have the right to look at the health information I have about you such as your medical and billing records. You can even get a copy of these records, but I may charge you. Contact me to arrange how to see your records.
• If you believe the information in your record is incorrect or missing important information, you can ask me to make some kinds of changes to your health information. You must make this request in writing and send it to your therapist. You must tell me the reasons you want to make the changes.
• You have a right to copy of this notice. If I change this NPP, I will post the new version in my waiting area and you can always get a copy of the NPP from me.
• You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with our Privacy Officer and with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care I provide you in any way.  

If you have any questions regarding this notice or other privacy policies, please discuss them with me.