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Notice of Privacy: Regen Counseling Center, PLLC 

Policies and Practices to Protect the Privacy of Your Health Information

THIS NOTICE DESCRIBES HOW PRIVATE HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Right to OPT IN or OPT OUT of Telecommunications: 

Regen Counseling Center obtain express end-user consent (opt-in) and respect the end-user’s right to revoke consent (opt-out):

OPT IN: Upon completion of submitting your contact information to Regen Counseling Center on  www.regenthero.com, you acknowledge and agree to receive, telephone call,  messaging(SMS), as well as voice mail messaging at our office phone number (224)-634-4447. This phone number utilizes HIPPA COMPLIANT text (SMS), calling and voice mail messaging application called IPLUM. Additionally, your contact information will be stored in an electronic health record (EHR) called Therapy Notes, a HIPPA Compliant practice management system .

OPT OUT: Additionally, we respect your right to opt out from receiving any phone call, messaging(SMS), and voice mail by contacting us at: crocha@regenthero.com. 

I.  Uses and Disclosures for Treatment, Payment, and Health Care Operations Regen Counseling Center, PLLC may use or disclose your protected health information (PHI), for treatment, payment, contact information and health care operations purposes. To help clarify these terms, here are some definitions: 

• “PHI” refers to information in your health record that could identify you. 

• “Treatment, Payment, and Health Care Operations”

– Treatment is when Regen Counseling Center PLLC, provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when a Compass Counseling LLC Therapist consults with another health care provider, such as your family physician or another mental health professional.

- Payment is when Regen Counseling Center PLLC obtains reimbursement for your healthcare.  Examples of payment are when Compass Counseling LLC discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

- Health Care Operations are activities that relate to the performance and operation of my practice.  Examples of health care operations are quality assessment and improvement activities, business-related matters, such as audits and administrative services, and case management and care coordination.

• “Use” applies only to activities within Regen Counseling Center, PLLC [office, clinic, practice group, etc.], such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

• “Disclosure” applies to activities outside of Regen Counseling Center, PLLC [office, clinic, practice group, etc.], such as releasing, transferring, or providing access to information about you to other parties. 

II.  Uses and Disclosures Requiring Authorization 

Regen Counseling Center, PLLC may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained.  An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when Regen Counseling Center, PLLC is asked for information for purposes outside of treatment, payment or health care operations, Regen Counseling Center, PLLC will obtain an authorization from you before releasing this information.  Regen Counseling Center, PLLC will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes your therapist has made about your conversation during a private, group, joint, or family counseling session, which your therapist has kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing.  You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

III.  Uses and Disclosures with Neither Consent nor Authorization

Regen Counseling Center, PLLC may use or disclose PHI without your consent or authorization in the following circumstances: 

• Child Abuse: If Regen Counseling Center, PLLC has reasonable cause to believe that a child is dependent, neglected or abused, your Regen Counseling Center, PLLC therapist must report this belief to the appropriate authorities, which may include the D.C.F.S or its designated representative; the commonwealth's attorney or the county attorney; or local law enforcement agency or the Illinois state police.

"Dependent child" means any child, other than an abused or neglected child, who is under improper care, custody, control, or guardianship that is not due to an intentional act of the parent, guardian, or person exercising custodial control or supervision of the child.

• Adult and Domestic Abuse: If Regen Counseling Center, PLLC has reasonable cause to believe that an adult has suffered abuse, neglect, or exploitation, your Regen Counseling Center, PLLC therapist must report this belief to the DCFS.

• Health Oversight Activities: IDFPR  may subpoena records from your Regen Counseling Center, PLLC therapist relevant to its disciplinary proceedings and investigations. 

• Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and records thereof, such information is privileged under state law, and Regen Counseling Center, PLLC will not release information without the written authorization of you or your personal or legally- appointed representative, or a court order.  The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case. 

• Serious Threat to Health or Safety: If you communicate to your Regen Counseling Center, PLLC therapist an actual threat of physical violence against a clearly identified or reasonably identifiable victim or an actual threat of some specific violent act, all Regen Counseling Center, PLLC therapists have a duty to notify the victim and law enforcement authorities.

• Workers’ Compensation: If you file a claim for workers’ compensation, you waive the psychotherapist-patient privilege and consent to disclosure of your health information reasonably related to your injury or disease to your employer, workers’ compensation insurer, special fund, uninsured employers’ fund or the administrative law judge.  

IV.  Client's Rights and Therapist's Duties

Client's Rights:

• Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information.  However, Regen Counseling Center, PLLC is not required to agree to a restriction you request. 

• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing a therapist at Regen Counseling Center, PLLC.  On your request, Regen Counseling Center, PLLC will send your bills to another address.) 

• Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in Regen Counseling Center, PLLC’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Regen Counseling Center, PLLC may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, Regen Counseling Center, PLLC will discuss with you the details of the request and denial process.   

• Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Regen Counseling Center, PLLC may deny your request.  On your request, your Regen Counseling Center, PLLC therapist will discuss with you the details of the amendment process. 

• Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI.  On your request, Regen Counseling Center, PLLC will discuss with you the details of the accounting process. 

• Right to a Paper Copy – You have the right to obtain a paper copy of the notice from Regen Counseling Center, PLLC upon request, even if you have agreed to receive the notice electronically.

Therapist’s Duties:

• Regen Counseling Center, PLLC therapists are required by law to maintain the privacy of PHI and to provide you with a notice of therapist’s legal duties and privacy practices with respect to PHI.

• Regen Counseling Center, PLLC reserves the right to change the privacy policies and practices described in this notice. Unless Regen Counseling Center, PLLC notifies you of such changes, however, Regen Counseling Center, PLLC is required to abide by the terms currently in effect. 

• If Regen Counseling Center, PLLC revises policies and procedures, Regen Counseling Center, PLLC will provide you with a revised notice so that you will become aware of any changes.

V.  Complaints. If you are concerned that a Regen Counseling Center, PLLC therapist has violated your privacy rights, or you disagree with a decision made about access to your records, you may contact the IDFPR at www.IDFPR.com

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.  The Administrator listed above can provide you with the appropriate address upon request.

VI. Effective Date, Restrictions, and Changes to Privacy Policy. This notice will go into effect on May 1, 2013.  Regen Counseling Center, PLLC reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that Regen Counseling Center, PLLC maintains.  Regen Counseling Center, PLLC will provide you with a revised notice so that you will become aware of any changes.