EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on October 6, 2023

NOTICE OF PRIVACY PRACTICES: THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

MY PLEDGE REGARDING HEALTH INFORMATION: 

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of my legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: 

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

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 own treatment, payment or health care operations. I 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.

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

CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

• Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For my use in treating you. b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For my use in defending myself in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.
• Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
• Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.

CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

• When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
• For health oversight activities, including audits and investigations.
• For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
• For law enforcement purposes, including reporting crimes occurring on my premises.
• To coroners or medical examiners, when such individuals are performing duties authorized by law.
• For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
• Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
• For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws. 10 Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

• Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

• The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
• The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
• The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
• The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, 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.
• The Right to Get a List of the Disclosures I Have Made.You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.
• The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
• The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

COMMUNICATION POLICY

As new technology develops there may be a need to update this policy. Clients will be notified in writing of any policy changes, and a copy of the updated electronic communications policy will be provided upon request. The most current version of this policy will be found online. It is important that as we communicate, we also protect the confidentiality that is vital to therapy.

Non-Secure Electronic Communication Overview

Email, text, and other forms of electronic messages provide convenient methods of communication. Please be advised that these methods, in their typical form, are not confidential means of communication. Therefore, IBIS Counseling and Consulting PC prefer to use email communication and text messaging only with your permission and only for administrative purposes unless we have made another arrangement. If you use these methods to communicate, there is a reasonable chance that a third party may be able to gain access to those messages. The types of parties that may intercept these messages include, but are not limited to:

• Those who have access to your phone, computer, or other devices that you use to read and write messages
• Your employer, if you use your work email to communicate with us
• Internet server administrators and others who monitor Internet traffic

If there are people in your life that you do not want to access these communications, please talk with us about ways to keep your communications safe and confidential.

Email

Email is not a confidential form of communication. Therefore, IBIS Counseling and Consulting PC chooses not to conduct counseling by email and discourages the use of email communication between clients and counseling staff, except for administrative purposes, such as arranging or changing appointments and for forwarding links to articles, meditations, books, and other resources to enhance your therapy. There is still a possibility that your privacy may be compromised when appointment times and resources are sent electronically. Please read below for more information:

No form of encryption is used by the IBIS Counseling and Consulting PC for outgoing emails.

IBIS Counseling and Consulting sends appointment reminders via email. If you do not wish to receive reminders via email, please inform us of that preference.

Emails will generally be responded to within 2 business days (unless we are unavailable for some reason), and if a response has not been received within that time, you can call 317-674-3277 to leave a message for your counselor. 

• Please identify the purpose of emails and their urgency in the subject line (for example: “Question- Non-urgent”, or “Cancellation, request to Reschedule-Urgent”)
• Email messages become part of your counseling records and may be shared with your record should the documents be subpoenaed by the courts or other governing agencies.
• You may revoke your consent for email communication at any time. You may discuss any questions or concerns with your counselor further in your next session.

Text Messaging 

IBIS Counseling and Consulting PC may send appointment reminders via text message. If you do not wish to receive reminders via text message, please inform me of that preference. While this is an easy and convenient way to send communication, it is also not secure, and you may want to consider the risks to your confidentiality surrounding your access to counseling services. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.

Below is a list of potential risks associated with the use of text messaging: 

• Communication issues can arise when communicating in text due to the lack of access to visual or voice cues, the possibility of limited space, and the chance of misunderstanding when using “shorthand” words or characters to represent meaning.
• A lost or misplaced cell phone, or a phone left in an insecure location, can inadvertently communicate to others that you are in counseling.
• Text messages are intended for booking, rescheduling, or canceling appointments and for links to resources to be made accessible to you for enhancing your therapeutic process. Should they be used inappropriately (for example, to “chat” or to engage in emotional support), the messages will not be responded to, and this may be discussed for clarification in your next session.
• Typically, text messages will be responded to within 1-2 business days unless we are unavailable. If you are in a crisis and if you have agreed to crisis contact, you may try to send a text message requesting a phone call, but if this is not responded to promptly, please call 911 or a local mobile crisis.
• All text messages become part of your counseling records and, as such, may be subject to being shared along with your record should the documents be subpoenaed by the courts or other governing agencies.
• You may revoke your consent for text message communication at any time. You are also welcome to discuss any questions or concerns with your counselor in your next session.

Third-Party Access to Communications 

• When you use electronic communication methods, such as email, texting, online video, etc., various technicians and administrators maintain these services, and who could access the content of those communications.
• If you use your work email to communicate electronically, your employer may access those communications. Similar issues may be involved in school email or other email accounts associated with organizations you are affiliated with.
• Furthermore, people with access to your computer, mobile phone, or other devices may gain access to your email or text messages. It is important to contemplate the risks involved if any of these persons were to access the messages exchanged with your counselor.

Sharing Electronic Communication with Others 

If you wish to publicly reveal information about your therapy through electronic communication with your counselor, please consult your counselor before doing so. 

Between Session Contact 

Between sessions, contact with your counselor is normally limited to short messages regarding scheduling sessions. Longer contact is possible by arrangement, and the charge will be prorated per your session fees. Phone calls lasting longer than 15 minutes will be considered additional counseling services and billed accordingly. 

Collection and Storage of Personal Information 

Storage and collection of client information is in accordance with HIPPA and in accordance with professional guidelines. 

Emergencies

IBIS Counseling and Consulting PC is not an emergency service. If you are in crisis or require emergency mental health assistance, please call 911, go to the emergency room of your nearest hospital, or contact a crisis line in your area.

Acknowledgment of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.