Notice of Privacy Practices

Mindful Counseling LLC

11140 S. Towne Square

Suite 200

St. Louis, MO 63123

Effective Date: [6/7/2023]

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

I am required by law to maintain the privacy of protected health information, this information may include: notes from your health care provider, your medical history, your test results, treatment notes and insurance information.

I am also required to provide individuals with notice of my legal duties and privacy practices in regards to protected health information, and to notify affected individuals about breach of unsecured protected health information. This notice describes how I might use and disclose your medical information, particularly those circumstances required by law. It also describes your rights and my legal obligations with respect to your medical information. If you have any questions about this Notice, please contact me directly.

A. How This Practice May Use or Disclose Your Health Information without your permission.

1. Treatment. I use medical information about you to provide you with my services or treatment. Even though privacy laws permit me to share your medical information with other providers involved in your care (e.g. your primary care doctor), I will only share your information with outside providers with your prior permission, except in emergency circumstances where the disclosure is necessary for your treatment and obtaining prior permission is not feasible. To ensure I am providing the best possible care, I may discuss certain details of your case in consultation with other clinicians, but without revealing any identifying information about you.

2. Payment. I may need to use information about you to secure payment for my services. If you are using health insurance, I must submit certain information (name, diagnoses, etc.) to them to obtain payment, and must comply with any requests they make for information about your treatment, including details about our sessions. I must share necessary information, such as your name and billing address, with my credit card processing service in order to complete credit card payments.

 3. Health Care Operations. I may need to use medical information about you to operate this practice. For example, I may use and disclose this information to get your health plan to authorize services or referrals. I may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs as required by law or contract. Your information may also be seen by certain identified “business associates”, such as the company that manages my electronic health records, in order to complete necessary administrative services. I have a written contract with each of these business associates that contains terms requiring them to protect the confidentiality and security of your protected health information.

4. Appointment Reminders. Reminders of appointment times may be sent by email or by text. You have the chance to opt out of certain types of electronic communication in your consent forms, or you can notify me verbally at any point if you do not wish to receive appointment reminders. It is important to consider that text messages and unencrypted email are not considered to be secure means of communication.

 5. Discussions in Office. While speaking with me in common areas of the office (e.g. waiting area), it is possible that other people may be able to hear the discussion. This can be avoided by only talking to me while in the counseling room with the door closed.

6. Required by Law. As required by law, I will use and disclose your health information, but I will limit my use or disclosure to the relevant requirements of the law. When the law requires me to report abuse or neglect, or respond to judicial or administrative proceedings, or to law enforcement officials, it is my practice to reveal the minimum amount of information necessary.

7. Public Health. I may, as required by law, disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

8. Health Oversight Activities. I may, when required by law, disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.

9. Judicial and Administrative Proceedings. I may disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. I may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.

10. Public Safety. I may disclose relevant information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

11. Specialized Government Functions. I may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.

12. Workers’ Compensation. I may disclose your health information as necessary to comply with workers’ compensation laws. For example, to the extent your care is covered by workers’ compensation, I will make periodic reports to your employer about your condition. I am also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.

13. Change of Ownership. In the event that this practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to practice or provider.

14. Breach Notification. In the case of a breach of unsecured protected health information, I will notify you as required by law. If you have provided me with a current e-mail address, we may use e-mail to communicate information related to the breach. In some circumstances my business associate may provide the notification. I may also provide notification by other methods as appropriate.

15. Psychotherapy Notes. I will not use or disclose your psychotherapy notes without your prior written authorization except for the following: 1) use by the originator of the notes for your treatment, 2) to defend myself if you sue me or bring some other legal proceeding, 3) if the law requires me to disclose the information to you or the Secretary of HHS or for some other reason, 4) in response to health oversight activities concerning your psychotherapist, 5) to avert a serious and imminent threat to health or safety, or 6) to the coroner or medical examiner after you die.

16.Supervision. If you’re working with a PLPC, your treatment will be monitored by a fully licensed supervisor. The supervisor will cosign all documentation in your health record including notes detailing the contents of what was discussed in sessions. The PLPC meets weekly with the supervisor to discuss client cases and receive guidance on how to approach treatment.

17.Group. In a group counseling setting, your counselor may bring up relevant information you’ve previously shared with the group. They will not bring up private information shared between you and the counselor without your permission. It is assumed that if you choose to share information openly with the group, the counselor is not violating your privacy by bringing it up again. Mindful Counseling LLC cannot control other group members; therefore, there is always a risk that information you share with other members will be redisclosed by other group members.

B. Your Rights: You have the right to:

1. Right to Request Special Privacy Protections. : You can request me not to use or share your information for treatment, payment, or health care operations. You can also ask me not to share information with individuals involved in your care, e.g. family members or friends. You must make these requests in writing. I must share information when required by law. I reserve the right to accept or reject any other request, and will notify you of my decision.

2. Right to Request Confidential Communications. You can request that you receive your health information in a specific way or at a specific location. For example, you may ask that I send information to a particular e-mail account or to your work address. You must make these requests in writing.

3. Right to Inspect and Copy. You have the right to see your health information and request a copy of that information with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format.

4. Right to Amend or Supplement. You have a right to request that I amend or change your health information that you believe is incorrect or incomplete. You must make such requests in writing and provide a reason for the change. If I disagree with the request, I will provide you with information about this practice’s denial and how you can disagree with the denial. I may deny your request if I do not have the information, if I did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if I would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If I deny your request, you may submit a written statement of your disagreement with that decision, and I may, in turn, prepare a written rebuttal. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.

5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by this practice. You must make such request in writing. This practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in above paragraphs : (treatment), (payment), (health care operations), (notification and communication with family) and (specialized government functions) of Section A of this Notice of Privacy Practices or disclosures for purposes of research or public health

6. Right to a Paper or Electronic Copy of this Notice. You have a right to notice of my legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.

C. Changes to this Notice of Privacy Practices

I reserve the right to change this Notice of Privacy Practices at any time in the future. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that I maintain, regardless of when it was created or received. I will keep a copy of the current notice posted in our practice location, and a copy will be available at each appointment.

D. File Complaints

You can file a complaint with me or with the government if you think that your information was used or shared in a way that is not allowed. You can also complaint when you were not allowed to view a copy of your information. You can also file a complaint directly to me by contacting me via phone or email. You can file a complaint with your regional office of the United States Office of Civil Rights. You will not be penalized in any way for filing a complaint.