This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, collecting payment, or as related to the health care operations of this agency and for other purposes permitted or required by law. It also describes your rights of access and control over your protected health information.

The information referred to in this notice is health information which is protected by federal law. This "protected health information" is information about you that my identify you and that relates to any physical or mental condition and related services.

Family Counseling Service is required to abide by the terms of this Notice. However, Family Counseling Service may change the terms of this Notice at any time. Any revised Notice will then be in effect for any protected health information which Family Counseling Service maintains at that time.

Family Counseling Service will ask you to sign a consent form prior to initiating a counseling relationship. Once you have consented to the use and disclosure of your protected health information for treatment, payment and health care operations by signing the consent form, family Counseling Service may use or disclose your protected health information as described in the following:

1. Obtaining a consult from another mental health professional: This is limited to consultations within Family Counseling Service. Any consultations outside this agency will require your specific written authorization.
2. Providing information to a third-party payer: If your health care provider or employer is paying some or all of the costs of treatment, the necessary information required for purposes of receiving payment will be provided.
3. Health care operations: (a) This includes the disclosure of information necessary to provide or coordinate your services, such as leaving telephone messages for you or sending you information by mail. (b) We may use or disclose your protected health information, as necessary, to contact you to remind you of an appointment, to clarify information or to share additional information with you to aid in providing services. (c) In situations where a counseling "client" includes more than one individual, such as a spouse, partner or other family member who is also participating in treatment, information may be shared among counseling participants as deemed necessary by the counselor to carry out services. (d) We may also disclose information to graduate students in counseling, social work, or psychology who see clients in our office. (e) We may send you a follow up survey to inquire about your satisfaction with our services. (f) Information required for the licensure of staff or certification of the agency will be disclosed as necessary.

Any additional disclosures will require your specific authorization, unless such uses or disclosures are permitted without your consent. You may revoke such an authorization, at any time, in writing, except to the extent that action has already been taken in reliance upon it.

You have the right to request restrictions of your personal health information. Please refer to the section labeled Your Rights.

1. Required by Law: We may use or disclose your protected health information to the extent that

   the use or disclosure is required by law. The use or disclosure will be made in compliance

   with the law and will be limited to the relevant requirements of the law.

2. Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability.
3. Communicable Diseases: We may disclose your protected health information to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease.
4. Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect of children, adults, or elders. In these cases, the disclosure will be made consistent with the requirements of applicable federal and state laws.
5. Legal Proceedings: We may disclose protected health information in the course of any judicial proceeding, in response to an order of a court, in response to a subpoena, discovery or other lawful process.
6. Law Enforcement: We may disclose protected health information for law enforcement purposes. These law enforcement purposes include (1) legal processes required by law, (2) limited information requests for identification and location purposes, (3) information pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the agency, and (6) an emergency where it is likely that a crime has occurred.
7. Criminal Activity: We may disclose your protected health information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
8. Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military, command authorities, (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to a foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities.