My responsibility to protect your information

Health information about you and your care is personal. I create and maintain records of the care and services you receive in order to provide treatment and comply with legal and professional requirements.

I am required by law to maintain the privacy and security of protected health information that identifies you, give you notice of my legal duties and privacy practices, and follow the terms of the Notice of Privacy Practices currently in effect.

If I create or maintain records protected by 42 CFR Part 2, additional federal privacy protections apply to those substance use disorder records.

Your rights

You have rights regarding the health information maintained about you. These include the right to:

• Request an electronic or paper copy of your health record.
• Ask that inaccurate or incomplete information be corrected.
• Request confidential communications in a reasonable way.
• Ask for limits on certain uses or disclosures of your information.
• Request certain restrictions when you pay for a service in full out of pocket.
• Request an accounting of certain disclosures of your information.
• Receive a paper or electronic copy of this privacy notice.
• Choose an authorized personal representative to act for you.
• File a complaint if you believe your privacy rights have been violated.

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

How health information may be used or disclosed

Treatment, payment, and health-care operations

Federal privacy rules permit certain uses and disclosures of protected health information for treatment, payment, and health-care operations without a separate written authorization. For example, information may be used to provide and coordinate care, consult with another health-care provider, operate the practice, or bill for services.

If information is protected by 42 CFR Part 2, additional restrictions may apply.

Other uses and disclosures permitted or required by law

Subject to applicable legal requirements, protected health information may also be used or disclosed for purposes including:

• Public-health and safety activities.
• Reporting suspected abuse or neglect when required by law.
• Preventing or reducing a serious threat to health or safety.
• Health oversight activities such as lawful audits or investigations.
• Judicial or administrative proceedings when legally authorized.
• Law-enforcement purposes permitted by law.
• Workers' compensation requirements.
• Coroners or medical examiners performing authorized duties.
• Research when permitted under applicable privacy law.
• Specialized government functions permitted by law.
• Appointment reminders and information about treatment alternatives or services.

Uses that generally require your written authorization

Most uses or disclosures of psychotherapy notes require written authorization, subject to limited exceptions allowed by law.

If I maintain substance use disorder counseling notes protected by 42 CFR Part 2, use or disclosure of those notes may require a separate written authorization and may be subject to additional protections.

I do not sell protected health information in the regular course of business and do not use or disclose your protected health information for marketing purposes without authorization when authorization is required.

Family, friends, and others involved in your care

You may tell me whether you want information shared with a family member, friend, or another person involved in your care or payment for care. In limited circumstances permitted by law — such as certain emergencies — information may be shared when necessary and appropriate.

Substance use disorder records

Certain substance use disorder records may receive additional protections under 42 CFR Part 2. When those rules apply, the records generally may not be used in civil, criminal, administrative, or legislative proceedings against you without the authorization or court process required by federal law.

My responsibilities

• I am required by law to maintain the privacy and security of your protected health information.
• I must provide you with this notice and follow the privacy practices described in the current notice.
• I will notify you as required by law if a breach occurs that may compromise the privacy or security of your information.
• I will not use or disclose your information other than as described in this notice or otherwise permitted by law unless you provide written authorization.
• You may revoke a written authorization as permitted by law, although revocation does not undo actions already taken in reliance on that authorization.

Complaints and questions

If you have questions about this notice or believe your privacy rights have been violated, you may contact:

Kirk Sheppard, LPCC-S
Story & Soul LLC
8118 Corporate Way, Suite 175
Mason, OH 45040
kirk@kirksheppardcounseling.online

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be retaliated against for filing a complaint.

Learn how to file a HIPAA privacy complaint with HHS →

Changes to this notice

The terms of this Notice of Privacy Practices may be changed as permitted by law. Changes may apply to information already maintained by the practice. The current version will be available on this website and upon request.

You may request a paper copy of the current Notice of Privacy Practices at any time.