Privacy Policy

Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES AND CLIENT RIGHTS

Tatiana Duchak, LCPC, tatiana.lcpc@gmail.com, (773) 219-0702

EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on January 18, 2022 and was updated on September 29, 2023.

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

I respect patient/client confidentiality and only release confidential information about you in accordance with Illinois and federal law. This notice describes my policies related to the use of the records of your care generated by this Practice. If you have any questions about this policy or your rights contact Tatiana Duchak at (773) 219-0702.

1. USE AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

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; however, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment: Federal privacy 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 healthcare providers and referrals of a patient for health care from one health care provider to another.

Payment: I may disclose your PHI in order to obtain reimbursement for your healthcare. For example, I may disclose your PHI to your health insurer to obtain reimbursement for your healthcare or to determine eligibility or coverage.

Health Care Operations: I may disclose your PHI to the extent necessary to operate the practice. Such a disclosure might include a quality assessment and improvement measure, business related matters such as audits and administrative services, and case management and care coordination.

2. OTHER USES AND DISCLOSURES REQUIRING AUTHORIZATION

I may use or disclose PHI for purposes outside of treatment, payment, or healthcare operations when your appropriate authorization is obtained. In these instances, I will obtain an authorization from you before releasing this information. I will also need to obtain a separate authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes I have made about our conversations during a private individual, group, joint, or family counseling session, which I have kept separate from the rest of your record. These notes are given a greater degree of protection than PHI.

Please note, I will not use or disclose your PHI for marketing purposes nor will I sell your PHI in the regular course of my business.

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

3. USES AND DISCLOSURES WITHOUT AUTHORIZATION

I may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse or Neglect: If I have reasonable cause to believe a child known to me in my professional capacity may be an abused, dependent, or neglected child, I am required by law to report this belief to the appropriate authorities, together with all the relevant information. In Illinois, this involves making are port to the Department of Child and Family Services (DCFS) Child Abuse Hotline.

Vulnerable Adult/Elder Abuse: If I have reason to believe that an adult (who is protected by state law)has been abused, neglected, or financially exploited, I am required by law to report this belief to the appropriate authorities. In Illinois, this involves making a report to the Department on Aging Adult Protective Services Hotline.

Health Oversight Activities: I may disclose protected health information regarding you to a health oversight agency for oversight activities authorized by law, including licensure, audits, or disciplinary actions.

Judicial and Administrative Proceedings: If you are involved in a lawsuit and/or a court or administrative proceeding, 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.

Serious Threat to Health or Safety: If you communicate to me a specific threat of imminent harm against another individual or if I believe that there is clear, imminent risk of physical or mental injury being inflicted against another individual, I may make disclosures that I believe are necessary to protect that individual from harm. If I believe you present an imminent, serious risk of physical or mental injury or death to yourself, I may make disclosures I consider necessary to protect you from harm.

Workers Compensation: I may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work related injuries or illness without regard to fault.

Law Enforcement Purposes: In certain instances, your protected health information may have to be disclosed to law enforcement officials for law enforcement purposes. For example, (1) your PHI may be the subject of a grand jury subpoena, or (2) I may disclose your PHI if I believe your death was the result of a homicide, and the communication relates directly to the fact or circumstances of the homicide.

4. PATIENT’S RIGHTS AND THERAPIST’S DUTIES

Patient’s Rights:

1. 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.

2. 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.

3. Right to See and Get Copies of Your PHI: You have the right to inspect or obtain a copy (or both) of PHI in the mental health and billing records used to make decisions about your for as long as the PHI is maintained in my records. get an electronic or paper copy of your medical record and other information that I have about you. In lieu of a copy of your PHI, you may also agree to a summary.

4. Right to Amend: You have the right to request an amendment of your PHI for as long as the PHI is maintained in your record. I may deny your request. Requests for amendment must be made inwriting and you must provide a reason for the requested amendment. On your request, I will discuss with you the details of the amendment process.

5. 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.

6. Right to a Paper Copy of this Note: You have the right to get a paper copy of this Notice, even if you have agreed to receive the Notice electronically. You also have the right to get a copy of this notice by email.

Therapist’s Duties:

1. Maintaining Privacy: I am required by law to maintain the privacy of your PHI and to provide you with this Notice of my legal duties and privacy practices with respect to your PHI.

2. Changes in Privacy Policy: I reserve the right to change the privacy policies and practices described in this Notice and to make the new notice provisions effective for all PHI that I maintain. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.

3. Notification of Changes: If I revise my policies and procedures, I will provide a written copy of these changes to you by giving you a copy at your next appointment after the revisions are printed and posted.

5. QUESTIONS AND COMPLAINTS

If you have any questions or concerns about this Notice, disagree with a decision I make about access to your records, or have any other concerns about your privacy rights, you may contact me at (773)219-0702 or via email at tatiana.lcpc@gmail.com.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.

You have specific rights under this Privacy Rule. I will not retaliate against you for exercising your right to file a complaint.

6. Acknowledgement 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.

Mobile SMS Privacy Policy

I utilize a private, HIPAA-secure number, through iPlum, to exchange calls and text messages, and communicate electronically. Please be advised of the following related policy.

As a current or prospective client you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help.
You understand that the messaging frequency may vary. Messaging & data rates may apply.
Your mobile information will not be shared with any third parties/affiliates for marketing/promotional purposes. All policies are followed as per CTIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail.