This is the text of the current Notice of Privacy Practices for Gresham Counseling and Therapy LLC Effective 08 May 2020. You will need to log into the client portal and sign this document online after your initial phone consultation and before your first session. (Do not print out or send in this page. It is for reference only.)
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: 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, 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 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; 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 your information.
- 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 your mind.
- 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.
- 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.
For the remainder of this document, the words “I” and “my” refers to the person signing this document, and the “counselor” refers to Kristen B. Beck, MS LPC.
My signature verifies that I have read, understood, reviewed, and agreed to the complete content of this document; have received a copy of this document either in print or digital format; have asked appropriate persons (e.g. the counselor, my insurance organization representative, my case worker, etc.) any questions I have about the information contained in this document; have been assisted by the counselor if I requested such assistance to ensure my understanding of the content of this document; have the legal authority to consent to the use of Protected Health Information (PHI) of the client; and am giving my informed consent for use of PHI of the client as disclosed in this document.
Superseding Other Documents: I understand that this document supersedes all prior written or oral agreements with respect to the content of this document.
Term of Agreement: I understand that this agreement shall remain in effect until a new Notice of Privacy Practices is in effect and I will be required to agree to any updated Notice of Privacy Practices to continue receiving counseling services from the counselor; otherwise, the counselor-client relationship will be terminated after a period of 90 days.
Severability: I understand that if any provision of this document should be determined to be void or unenforceable, the validity and effectiveness of the remaining provisions shall not be affected.
Electronic Signature: If this document is completed and signed in an electronic format, I consent and agree to the use of my electronic signature in lieu of paper signatures to electronically sign paperless documents required by Gresham Counseling and Therapy LLC, including this document, and will be bound to any documents electronically signed the same as if I had received a paper copy of the document and signed it by hand with an ink pen. I also consent to the collection of the IP address and any other identifying information of the device used in the signing of this document.