Notice of Privacy Practices for Gresham Counseling and Therapy LLC Effective Mar 2021
Gresham Counseling and Therapy LLC
Mailing address: PO Box 865, Gresham, OR 97030
Phone: 503-766-9083 | firstname.lastname@example.org | GreshamCounseling.com
This Notice of Privacy Practices describes how we (Gresham Counseling and Therapy LLC and our professionals and staff) may use and disclose medical and mental health information about you (the client) and how you can get access to and control this information. Please review this notice carefully.
Your health record contains personal information about you and your health. This information about you may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (PHI).
Get an electronic or paper copy of your 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. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your record: You can ask us to correct health information about you that you think is incorrect or incomplete. 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 using the information on page 1. 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.
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 may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
We can use your PHI to do the following:
Treat you: We can use your health information and share it with other professionals who are treating you.
Example: A counselor treating you for a disorder asks a medical doctor about your overall health. A counselor who is no longer practicing gives your PHI to a custodian or records or new healthcare provider.
Run our practice: 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 to manage your treatment and services, schedule services, manage electronic health records, contact you for communication about services, share documents with you, or collect information about you.
Bill you: 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, send invoices or statements to you, or process payments through financial institutions that require your name and other contact information.
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, 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:
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, endangerment of elderly persons or children or vulnerable persons, and domestic violence; and preventing or reducing a serious threat to anyone’s health or safety (e.g. threatened suicide, homicide, assault). We also report animal abuse, neglect, and cruelty and animal cruelty threats.
Do research: We can use or share your information for health research.
Comply with the 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.
Respond to organ and tissue donation requests: We can share health information about you with organ
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; and 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.
Our Adherence to Legal Requirements
We use and disclose PHI in compliance with the Health Insurance Portability and Accountability Act (HIPAA), regulations under HIPAA, the HIPAA Privacy and Security Rules, Oregon laws, and the administrative rules of the Oregon Board of Licensed Professional Counselors.
● We are required by law to maintain the privacy and security of your PHI.
● We will let you know promptly if a breach occurs that may have compromised the privacy or security of
● We must follow these 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
● We adhere to the more stringent privacy requirements for disclosures found in the Oregon Board of
Licensed Professional Counselors and Therapists Code of Ethics, Oregon Administrative Rules, and
Oregon Revised Statutes.
● We are mandated reporters in the State of Oregon and are required to report suspected abuse,
neglect and endangerment of a child (under 18 years old), and elderly person (65 years and older),
and persons with mental disabilities (e.g. developmental disability, mental illness), even if you
insist that we do not. We also report animal abuse.
● For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Obtaining More Information
For more information about privacy issues, please contact our Privacy Official, Kristen Beck, using the contact information above. For more information visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Changes to the Terms of this Notice
We may 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 and on our website.