NOTICE OF PRIVACY PRACTICES

**THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. PLEASE CHECK THE BOX AT THE END OF THE DOCUMENT TO ACKNOWLEDGE YOUR RECEIPT OF AND UNDERSTANDING OF ALL MATERIAL CONTAINED WITHIN THIS DOCUMENT. Thank you!

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law.

It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at  that time.

I.              HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

I.              For Treatment, Payment, or Health Care 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 treatment with patients/clients, payment or health care operations. We 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.

II.            Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We 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.

OUR USES AND DISCLOSURES

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

For Treatment

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your
overall health condition.

For Health Care Operations

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

*Example: We use health information about you to manage your treatment and services. *** **

For Payment

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. *

II. 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 an electronic or paper copy of your medical record

•      You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you.

•      We will provide a copy or more typically a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee for copies.

Ask us to correct your medical record

•      You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. I will typically provide you with a summary of treatment, 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.

•      We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

•      You can ask us to contact you in a specific way (for example, home or office 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 to your request, 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 for the purpose of payment or our operations with your health insurer. 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 the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will 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 us at

Kama Joy Schulte, MA, LCPC, ATR-BC • kamaschulte@sbcglobal.net • 773.480.8579.

•      You can 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.

III. 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

•      Include your information in a hospital directory

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.

IV. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

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 if this applies

In the rare case of fundraising:

•      We may contact you for fundraising efforts, but you can tell us not to contact you again.

V. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.

Additional Ways in Which We May 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, such as public health and research. We have to meet many conditions in the law before we can

share your information for these purposes. For more information

see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with Public Health and Safety Issues

We can share health information about you for certain situations such as:

•      Preventing disease

•      Helping with product recalls

•      Reporting adverse reactions to medications

•      Reporting suspected abuse, neglect, or domestic violence

•      Preventing or reducing a serious threat to anyone’s health or safety

For Research

We can use or share your information for health research.

Required by Law

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• We are required by Law to act as “mandatory reporters” of child or elder abuse or neglect.

• We are required by Law to assist in mandatory government agency audits or investigations.

• We are required by Law to disclose PHI as necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Respond to Organ and Tissue Donation Requests

We can share health information about you with organ procurement organizations.

Work with a Medical Examiner or Funeral Director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address Workers’ Compensation, Law Enforcement, and Other Government Requests

We can use or share health information about you:

•      For workers’ compensation claims

•      For law enforcement purposes or with a law enforcement official

•      With health oversight agencies for activities authorized by law

•      For special government functions such as military, national security, and presidential protective services

Respond to Lawsuits and Legal Actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

VI. 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. For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

VII. CHANGES TO THE TERMS OF THIS NOTICE

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

THIS NOTICE OF PRIVACY PRACTICES APPLIES TO THE FOLLOWING ORGANIZATIONS

•      Kama Joy Schulte, MA, LCPC, ATR-BC • kamaschulte@sbcglobal.net • 773.480.8579

•      Effective Date of this Notice March 1, 2023

•       “We never market or sell personal information.”