Privacy Policy

Depth Counseling Services, P.C.
122 South Michigan Avenue, Suite 1441
Chicago, Illinois 60603

312-786-4990

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.

I. My Pledge Regarding Health Information

I understand that health rowabout 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. It 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.

II. 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 give some examples. Not every use or disclosure in a category will be listed, but all permitted uses and disclosures fall within these categories.

For Treatment, Payment, or Health Care Operations

Federal privacy rules allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s PHI without written authorization, in order to carry out treatment, payment, or health care operations.

Examples:

  • A clinician may consult with another licensed provider about your condition.
  • Coordination and management of health care providers with a third party.
  • Referrals of a patient for health care from one 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 in response to a subpoena, discovery request, or lawful process, but only if efforts have been made to notify you or to obtain a protective order.

III. Certain Uses and Disclosures Require Your Authorization

  1. Psychotherapy Notes – I keep psychotherapy notes as defined in 45 CFR §164.501. Any use or disclosure of these notes requires your authorization unless:
    • For my use in treating you.
    • For my use in training or supervising mental health practitioners.
    • For defending myself in legal proceedings instituted by you.
    • For investigations by the Secretary of Health and Human Services.
    • Required by law.
    • Required by health oversight activities.
    • Required by a coroner.
    • Required to avert a serious threat to health/safety.
  2. Marketing Purposes – I will not use or disclose your PHI for marketing purposes.
  3. Sale of PHI – I will not sell your PHI in the regular course of business.
    • No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.

IV. Certain Uses and Disclosures Do Not Require Your Authorization

Subject to certain limitations, I may use and disclose your PHI without authorization:

  • When required by state or federal law.
  • For public health activities (e.g., suspected abuse, preventing or reducing serious health threats).
  • For health oversight activities, including audits and investigations.
  • For judicial and administrative proceedings.
  • For law enforcement purposes.
  • To coroners or medical examiners.
  • For research purposes.
  • For specialized government functions (e.g., military missions, protection of the President, intelligence activities).
  • For workers’ compensation purposes.
  • For appointment reminders and health-related benefits or services.

V. 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 person involved in your care or payment, unless you object in whole or in part. In emergencies, consent may be obtained retroactively.

VI. Your Rights with Respect to Your PHI

  • Right to Request Limits: You may ask me not to use or disclose PHI for treatment, payment, or health care operations. I may refuse if it affects your care.
  • Right to Restrict Disclosures for Out-of-Pocket Expenses: You can request restrictions on disclosures to health plans for items/services you paid for in full out-of-pocket.
  • Right to Choose How I Contact You: You may request specific communication methods (e.g., mail to a different address).
  • Right to See and Get Copies: You may request a paper or electronic copy of your medical record (excluding psychotherapy notes). I will provide it within 30 days, possibly with a reasonable fee.
  • Right to Get a List of Disclosures: You may request a list of disclosures made in the last six years (other than for treatment, payment, or health care operations).
  • Right to Correct or Update PHI: You may request corrections or additions to your record. I may refuse, but will respond in writing within 60 days.
  • Right to Get a Copy of This Notice: You can request a paper or electronic copy at any time.

Effective Date of This Notice

This notice went into effect on September 20, 2013.