Effective Date: January 1, 2026
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
OUR PLEDGE REGARDING HEALTH INFORMATION
I understand that health information about you is personal. I am required by law to maintain the privacy of your Protected Health Information (PHI), provide you with this notice of my legal duties and privacy practices, and notify you promptly following a breach of unsecured PHI.
HOW I MAY USE AND DISCLOSE HEALTH INFORMATION
I may use or disclose your PHI without your written authorization for:
· Treatment: To provide, coordinate, or manage your health care.
· Payment: To bill and receive payment from health plans.
· Healthcare Operations: To run my practice and improve the quality of care.
Uses and disclosures beyond these purposes generally require your written authorization unless otherwise permitted or required by law.
FEDERAL PRIVACY PROTECTIONS & UPDATES (HIPAA / 42 CFR PART 2)
Security of Electronic Information & Technology Safeguards
Electronic records, communications, and telehealth services are protected using reasonable and appropriate administrative, physical, and technical safeguards consistent with HIPAA and professional standards. These safeguards may include encryption, secure platforms, access controls, password-protected devices, and procedures designed to protect the confidentiality, integrity, and availability of your PHI. While no system can guarantee absolute security, reasonable efforts are made to protect your information.
Substance Use Disorder (SUD) Records
Some records related to the treatment of substance use disorders may be subject to heightened confidentiality protections under federal law (42 CFR Part 2). These records generally may not be disclosed without your specific written consent or a court order, except as permitted by federal law.
Fundraising Communications
You have the right to opt out of any fundraising communications. Results Counseling does not engage in fundraising activities.
Reproductive Health Care Privacy
In compliance with federal privacy rules, I will not disclose PHI for the purpose of investigating or imposing liability related to the lawful seeking, obtaining, providing, or facilitating of reproductive health care.
Breach Notification
You have the right to be notified if there is a breach of your unsecured PHI. In the event of a breach, you will be informed promptly by phone, email, or postal mail as required by law.
INTERSTATE PRIVACY CONSIDERATIONS
Licensure & Jurisdictional Scope of Services
Clinicians at Results Counseling are licensed to provide mental health services in Indiana, Illinois, Missouri, Virginia, and Iowa. Services are provided only to clients who are physically located in a state in which the treating clinician is licensed at the time services are rendered. Privacy protections and client rights are governed by applicable federal law and the law of the state in which the client is physically located during services. When state law provides greater privacy protection than federal law, the more protective standard will be followed as required by law.
Privacy protections may otherwise vary depending on your physical location at the time services are provided. The following examples are offered for general informational purposes only and do not create additional rights or obligations beyond those required by applicable law:
· Illinois: Mental health records are protected by the Illinois Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110). Certain disclosures require a court order or a time-limited, Illinois-compliant authorization.
· Indiana: Individuals may have rights under Indiana law to access and request correction of health information, subject to applicable healthcare exemptions.
· Virginia: Virginia law recognizes a right of privacy in health records and establishes timelines for responding to record requests.
· Missouri: Missouri law permits one-party consent for certain communications; however, recording of therapy sessions may be restricted as a condition of treatment to protect privacy and clinical integrity.
· Iowa: Iowa law places strict limits on the re-disclosure of mental health information by recipients of such information.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding your PHI, subject to certain limitations under law:
· Right to Inspect and Copy: You may request access to or copies of your health records in paper or electronic form.
· Right to Request Restrictions: You may ask me to limit how your PHI is used or disclosed. If you pay for a service out-of-pocket in full, you may request that information about that service not be disclosed to your health plan. Requests will be honored except where required by law.
· Right to Request Amendment: You may request corrections to your health record if you believe information is inaccurate or incomplete.
· Right to an Accounting of Disclosures: You may request a list of certain disclosures of your PHI made during the past six years, excluding disclosures made for treatment, payment, or health care operations.
· Right to Confidential Communications: You may request that communications be sent to you by alternative means or at an alternative location.
Right to a Paper Copy: You may request a paper copy of this Notice at any time.
Psychotherapy Notes
Psychotherapy notes are notes recorded by a mental health professional documenting or analyzing the contents of counseling sessions and are kept separate from the medical record. Under federal law, psychotherapy notes receive special protection and are generally not subject to the right of access. Psychotherapy notes will not be used or disclosed without your specific written authorization, except as permitted or required by law. You may request a summary of your treatment in lieu of access to psychotherapy notes.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint without fear of retaliation.
· Privacy Contact: Privacy Officer, Results Counseling
· Contact Information: 812-228-4040
· Mailing Address: 1616 W Main St, Marion, IL 62959
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.