Notice of Privacy Practices

Effective date: Date to be added

Restored Serenity Counseling Services is committed to protecting the privacy of your health information. This notice explains how we may use and share your protected health information, your rights regarding that information, and our legal responsibilities under the Health Insurance Portability and Accountability Act (HIPAA) and Illinois law.

Additional protections under Illinois law

Mental health information is given special protection in Illinois under the Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110). In many situations, Illinois law requires your written consent before we share mental health information, even when HIPAA would otherwise allow it. Whenever Illinois law is more protective of your privacy than federal law, we follow Illinois law.

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your health record

You can ask to see or get an electronic or paper copy of your health record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Psychotherapy notes, which are kept separate from the rest of your record, have additional legal protections and are generally not included.

Ask us to correct your health record

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say no to your request, but we will tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, by home or cell phone) or to send mail to a different address. We will say yes to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say no if it would affect your care. If you pay for a service or health care item out of pocket in full, you can ask us not to share that information with your health insurer for payment or operations purposes. We will say yes unless a law requires us to share that information.

Get a list of those with whom we've shared information

You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting our Privacy Officer using the information at the end of this notice. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We do not engage in fundraising.

Our uses and disclosures

We typically use or share your health information in the following ways. Where Illinois law requires your written consent for these purposes, we will ask for it.

Treat you

We can use your health information and share it with other professionals who are treating you. Example: with your consent, your therapist may consult with your physician about your care.

Run our practice

We can use your health information to run our practice, improve your care, and contact you when necessary. Example: we use health information to manage your treatment and services and to send appointment reminders.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. Example: we give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good. We have to meet many conditions in the law, including Illinois law, before we can share your information for these purposes.

• Help with public health and safety issues, such as reporting suspected abuse or neglect of a child, an older adult, or a person with a disability, and preventing or reducing a serious threat to anyone's health or safety.
• Comply with the law, including sharing information with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
• Do research only under the conditions required by law.
• Work with a medical examiner or coroner when an individual dies.
• Address workers' compensation, law enforcement, and other government requests, such as for health oversight activities authorized by law and for special government functions like military, national security, and presidential protective services.
• Respond to lawsuits and legal actions, such as in response to a court or administrative order. Illinois law provides additional protections for mental health records in legal proceedings.

For more information, see HHS: Notice of Privacy Practices for Protected Health Information.

Information about minors

Illinois law sets specific rules about when a parent or guardian may access a minor's mental health records and when a minor may consent to certain counseling services on their own. Your therapist will explain how these rules apply to your family during the intake process.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Contact our Privacy Officer

If you have questions about this notice or would like to exercise any of your rights, please contact: