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Heart & Hope Counseling, LLC – Notice of Privacy Practices (NPP)

1. Purpose of This Notice

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.

This Notice of Privacy Practices explains how your protected health information (PHI) may be used or disclosed, your rights regarding your health information, and my legal obligations under the Health Insurance Portability and Accountability Act (HIPAA) and applicable Ohio law.

Protected Health Information (PHI) includes individually identifiable information related to:

  • Your mental or physical health

  • Health care services you receive

  • Payment for health care services

PHI may exist in written, electronic, or verbal form.

 

2. My Responsibilities Regarding Your PHI

I am committed to protecting the privacy and security of your health information.

I am required by law to:

  • Maintain the privacy and security of your PHI.

  • Provide you with this Notice describing my legal duties and privacy practices.

  • Follow the terms of the Notice currently in effect.

  • Notify affected individuals when required by law if a breach of unsecured PHI occurs.

  • Provide you with a copy of this Notice upon request.

I may change the terms of this Notice. Any revised Notice will apply to the PHI I maintain as permitted by law. The current Notice will be available upon request and will be posted on the Heart & Hope Counseling, LLC website.

 

3. How PHI May Be Used and Disclosed Without Your Written Authorization

HIPAA permits me to use or disclose your PHI without your written authorization for certain purposes, including:

Treatment

I may use or disclose PHI to provide, coordinate, or manage your health care and related services.

For example, I may consult with another health care professional involved in your care when permitted by law.

Payment

I may use or disclose PHI as necessary to obtain or process payment for services.

Because Heart & Hope Counseling, LLC is a self-pay practice and does not bill insurance directly, PHI is generally not disclosed to health plans for payment purposes unless otherwise authorized or required by law.

PHI may be used or disclosed for payment processing, including when you request a superbill or other documentation for potential insurance reimbursement.

Health Care Operations

I may use or disclose PHI for health care operations, such as administrative activities, quality improvement, professional consultation, supervision, and other activities necessary to operate the practice and provide quality care.

Clinical Supervision and Consultation

As a Marriage & Family Therapist practicing under clinical supervision, information may be shared with my clinical supervisor as reasonably necessary for supervision, consultation, treatment planning, and quality of care.

Information shared for these purposes will be limited to what is reasonably necessary and handled in accordance with applicable privacy laws and professional standards.

Appointment Reminders and Scheduling

I may use PHI to contact you regarding appointments, scheduling, or other administrative matters related to your care.

As Required by Law

I may use or disclose PHI when required to do so by federal, state, or local law.

Public Health and Safety

I may use or disclose PHI when permitted or required by law for certain public health and safety purposes, including reporting abuse or neglect, preventing or controlling disease, or addressing serious threats to health or safety.

Judicial and Administrative Proceedings

I may disclose PHI in response to a court order, subpoena, discovery request, or other lawful process when permitted or required by applicable law.

Law Enforcement

I may disclose PHI to law enforcement when permitted or required by applicable law.

 

4. Uses and Disclosures Requiring Your Written Authorization

I will obtain your written authorization before using or disclosing your PHI when an authorization is required by law.

This may include:

  • Certain disclosures to individuals or organizations not involved in your treatment

  • Marketing communications when authorization is required

  • Sale of PHI

  • Most uses or disclosures of psychotherapy notes

You may revoke a written authorization at any time by submitting a written revocation, except to the extent that action has already been taken in reliance on the authorization.

 

5. Uses and Disclosures Where You May Object

I may share relevant PHI with a family member, close friend, or another person involved in your care or payment for your care when permitted by law.

When appropriate, I will provide you with an opportunity to agree or object to such disclosures.

In emergency situations, information may be disclosed when permitted or required by law.

 

6. Your Rights Regarding PHI

You have the following rights regarding your health information:

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your PHI.

I am not required to agree to every requested restriction, except where applicable law requires a restriction.

If you pay for a service or health care item completely out of pocket, you may request that PHI related to that service not be disclosed to your health plan for payment or health care operations purposes. I will agree to such a request unless disclosure is otherwise required by law.

Right to Confidential Communications

You have the right to request that I communicate with you about your health information by a specific method or at a specific location.

I will accommodate reasonable requests for confidential communications as required by applicable law.

Right to Access Your PHI

You generally have the right to inspect and obtain a copy of your PHI maintained in your designated record set, subject to certain legal exceptions.

Psychotherapy notes maintained separately from the medical record are generally not included in this right of access.

Requests for access should be submitted in writing. Any applicable fees will be limited as permitted by law.

Right to Request an Amendment

You have the right to request that your PHI be amended if you believe the information is inaccurate or incomplete.

Requests must be made in writing and should explain why you believe the information should be amended.

I may deny an amendment request when permitted by law. If a request is denied, you will receive a written explanation and information about your right to submit a statement of disagreement when applicable.

Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your PHI made by Heart & Hope Counseling, LLC during the six years preceding your request.

The accounting does not include certain disclosures, including disclosures made for treatment, payment, and health care operations, disclosures made pursuant to your authorization, and other disclosures excluded by law.

Right to Receive a Paper Copy of This Notice

You have the right to request a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically.

A paper copy will be provided upon request.

Right to Choose a Personal Representative

You may have the right to designate or have a legally authorized personal representative exercise certain rights on your behalf regarding your PHI.

A personal representative is generally a person authorized under applicable law to make health care decisions for you. The extent of a personal representative's authority depends on applicable law and the circumstances.

 

7. Special Protections for Certain Information

Certain types of health information may receive additional protection under federal or state law.

This may include information related to:

  • Substance use disorder treatment records

  • Psychotherapy notes

  • HIV/AIDS or other specially protected health information

  • Genetic information

  • Other information subject to additional federal or Ohio protections

Where additional legal protections apply, Heart & Hope Counseling, LLC will comply with those requirements.

Substance Use Disorder Records

If Heart & Hope Counseling, LLC creates or maintains records that are subject to the federal 42 CFR Part 2 protections for substance use disorder patient records, those records will be handled in accordance with the applicable Part 2 requirements in addition to HIPAA.

Part 2 protections may provide additional restrictions on the use and disclosure of certain substance use disorder records. Where applicable, Heart & Hope Counseling, LLC will provide the rights and protections required for Part 2 records.

 

8. Safeguards and Security

Heart & Hope Counseling, LLC uses reasonable administrative, physical, and technical safeguards designed to protect the privacy and security of your PHI as required by applicable federal and state law.

No method of electronic communication or storage can be guaranteed to be completely secure. Appropriate safeguards are used to reduce privacy and security risks.

 

9. Complaints and Privacy Questions

If you have questions about this Notice, your privacy rights, or how your PHI is handled, you may contact:

Heart & Hope Counseling, LLC
Haley Pottkotter, MA, MFT
Phone: (567) 621-1177
Email: info@hearthopecounseling.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) if you believe your privacy rights have been violated.

You will not be retaliated against for filing a privacy complaint.

 

10. Changes to This Notice

I may revise this Notice of Privacy Practices when necessary.

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