,,hipaa ,,notice ,,of #a ,,privacy ,,practices ,revised ,september #a1 #bjac4 ,,this ,,notice ,,describes ,,how ,,medical ,,information ,,about ,,you ,,may ,,be ,,used ,,and ,,disclosed ,,and ,,how ,,you ,,can ,,get ,,access ,,to ,,this ,,information4 ,,please ,,review ,,it ,,carefully4 ,by law1 the ,counseling ,hut is required to protect the privacy of your personal health information4 ,the ,counseling ,hut is also required to give you this notice to tell you how the ,counseling ,hut may use and give out 78disclose0 or 8release07 your personal health information held by the ,counseling ,hut4 8,personal health information0 includes any record of services you received at the ,counseling ,hut1 including1 and not limited to3 #b - ,dates1 times1 and lengths of your counseling sessions2 - ,information you shared during counseling sessions or at other times2 - ,your counselor's observations of you2 - ,your counselor's assessment of your mental health concerns2 - ,results of psychological tests and diagnostic interviews2 - ,treatment plans and homework suggestions2 - ,medication records2 and--,billing and insurance information4 ,most of your personal health information is in written form4 ,information about you that is not written down1 but is remembered by staff members of the ,counseling ,hut1 is also considered part of your personal health information1 and is #c protected by law the same way written information is protected4 ,information that cannot be traced back to you is not considered part of your personal health information4 ,examples include3 - ,information about an experience you had that many people also had1 and--,information that is changed or made vague so that you cannot be associated with it4 ,the ,counseling ,hut must use and give out your personal health information to provide information3 - ,to you or someone who has the legal right to act for you 7your personal representative71--,to the ,secretary of the ,department of ,health and ,human ,services1 when the degree to which #d your privacy is protected is being examined1 and--,where required by law4 ,the ,counseling ,hut has the right to use and give out your personal health information to be paid for services provided to you1 and to operate the ,counseling ,hut4 ,for example3 - ,insurance companies may ask for your personal health information as a condition for paying for services you received at the ,counseling ,hut4 - ,if your account is referred to a collection agency1 the collection agency may ask for parts of your personal health information relevant to their task1 such as dates of sessions4 - ,the ,counseling ,hut may use your personal health information to make sure you and other clients get quality care1 to #e provide customer services to you1 to resolve any complaints you have1 or to contact you about research studies4 ,the ,counseling ,hut may use or give out your personal health information for the following purposes under limited circumstances3 - ,to ,state and ,federal agencies that have the legal right to obtain such information 7such as a licensing board investigating an ethics complaint72 - ,for public health activities 7such as reporting disease outbreaks72 - ,for government health care oversight activities 7such as insurance fraud investigations72 - ,for judicial and administrative proceedings 7such as in response to a court #f order72 - ,for law enforcement purposes 7such as providing limited information to locate a missing person72 - ,for research studies that meet all privacy law requirements 7such as research on effectiveness of a counseling technique72 - ,to avoid a serious and imminent threat to health or safety2--,for the purpose of supervision1 consultation1 and training2 and--,to create a collection of information that can no longer be traced back to you4 ,by law1 the ,counseling ,hut must have your written permission 7an 8authorization07 to use or give out your personal health information for any purpose that isn't set out in this #g notice1 such as marketing or sale of your personal health information4 ,you may take back 78revoke07 your written permission at any time1 except if the ,counseling ,hut has already acted based on your permission4 ,by law1 you have the right to3 - ,see and get a copy of your personal health information held by the ,counseling ,hut2 - ,have your personal health information amended if you believe that it is wrong or if information is missing1 and the ,counseling ,hut agrees4 ,if the ,counseling ,hut disagrees1 you may have a statement of your disagreement added to your personal health information2 - ,get a listing of those getting your personal health information from the ,counseling ,hut4 ,the listing won't #h cover your personal health information that was given to you or your personal representative1 that was given out to be paid for the services your received or for operating the ,counseling ,hut1 or that was given out for law enforcement purposes2 - ,ask the ,counseling ,hut to communicate with you in a different manner or at a different place 7for example1 by sending materials to a ,p.,o4 ,box instead of your home address72 - ,ask the ,counseling ,hut to limit how your personal health information is used and given out in order to be paid for services you received or to operate the ,counseling ,hut4 ,please note that the ,counseling ,hut may not be able to agree to your request2 and--,get a separate paper #i copy of this notice4 ,if you believe the ,counseling ,hut has violated these privacy rights1 you can file a complaint with3 - ,the ,counseling ,hut ,privacy ,officer4 ,jordan ,j4 ,shin1 ,,ms1 ,,lpc4 #eda-cdb-hadd4 _+jordan@thecounselinghut.org_: . or--,the ,secretary of the ,department of ,health and ,human ,services4 ,contact the ,office for ,civil ,rights4 #a-hff-fbg-ggdh1 #a-hjj-ecg-gfig 7,,tty74 _+http://www.hhs.gov/ocr/_: . ,filing a complaint will not affect the services you receive at the ,counseling ,hut4 ,by law1 the ,counseling ,hut is required to follow the terms in this privacy notice4 #aj ,the ,counseling ,hut has the right to change the way your personal health information is used and given out4 ,if the ,counseling ,hut makes any changes to the way your personal health information is used and given out while you are a current client at the ,counseling ,hut1 you will get a new notice1 directly or by mail1 within #fj days of the change4 ,the ,counseling ,hut1 #acb ,east ,broadway1 ,suite #cah1 ,eugene1 ,,or #igdja4 #eda-cdb-hadd 7,phone_/,,tty71 #eda-cdb-agbd 7,fax74 _+http://www.thecounselinghut.or- g/_: