Your Privacy Information. Your Privacy Rights. Our Privacy Responsibilities.

Your Rights

You have the right to:

• Access a copy of your paper or electronic mental health records

• Request corrections to your records

• Ask for confidential communication methods

• Limit what information we share

• Get a list of who has accessed your information

• Receive a copy of this privacy notice

• Designate someone to act on your behalf

• File a complaint if your privacy rights are violated

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Your Choices

You can make decisions about how we share your information, including:

• We may not disclose any mental health records or information except as provided under HIPAA, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, state and federal alcohol and substance abuse privacy laws and the exceptions provided therein.

• We may not tell any third-party family and friends about your condition except as provided for in the above identified laws. For example: only pursuant to a valid subpoena, release of information, pursuant to the Abused and Neglected Child Reporting Act, and under certain other circumstances of immanent risk of harm.

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How We Use and Disclose Your Information

How do we typically use or share your health information?

Subject to HIPAA, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, state and federal alcohol and substance abuse privacy laws and the exceptions provided therein, we typically use or share your health information in the following ways.

• Treat you

• Run our organization

• Bill for your services

• We can use and share your health information to bill and get payment from health plans or other entities.

• We may contract with business associates to do work directly for us related to your treatment; this may include billing, consultation, legal, and related business practices. In such circumstances, the business associate will be subject to a Business Associates Agreement which obligates any such associate to maintain privacy consistent with the state and federal requirements outlined herein.

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Subject to certain exceptions, we can share health information about you for certain situations such as:

• Reporting adverse reactions to medications

• Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing a serious threat to anyone’s health or safety

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Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the 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.

• For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

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Changes to This Notice

We may update this notice and will make it available upon request or on our website.

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Contact Information: Kristen Christensen, LCSW
Serenity Counseling and Wellness
Email: kristen@serenitycounselinglkn.com
Phone: (847) 364-0163
Fax: (847) 589-5835

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We do not sell or market personal information.