Notice of Privacy Practices Clearview Counseling Group
Effective Date: May 5, 2018 THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY
Your Personal Health Information (PHI) is information about you created and received by Clearview
Counseling Group, including demographic information, that may reasonably identify you and that relates
to your past, present, or future physical or mental health condition, or payment for the provision of your
health care. Clearview Counseling Group is required by law to maintain the privacy of your PHI, and
adheres to the strictest privacy standards. You have the right to be informed and will receive notification
from Clearview Counseling Group in the event of any breach of the security of your PHI.
Clearview Counseling Group is also required by law to provide you with this notice of our legal duties
and privacy practices with respect to your PHI, as well as abide by the terms of the notice that is
currently in effect. However, Clearview Counseling Group reserves the right to revise our privacy
practices at any time, and in such an event, you will be provided with a revised copy of this privacy
notice. In such an event, the new revised notice of privacy practices will apply to all of your PHI
maintained by Clearview Counseling Group.
Clearview Counseling Group will ask you to sign a consent form that allows Clearview Counseling Group
to use and/or disclose your PHI for treatment, payment, and healthcare operations. You will also be
asked to sign a form acknowledging receipt of this privacy practices notice.
The following categories describe some of the ways Clearview Counseling Group may use and/or disclose
your PHI. Clearview Counseling Group believes protecting client confidentiality and responsibly
maintaining your individually identifiable health information and PHI are of the utmost importance,
therefore, we will make all reasonable efforts to limit access to your PHI to those persons or classes of
persons, as appropriate, in our workforce who need access to carry out their duties.
How We May Use or Disclose your Protected Health Information (PHI):
For treatment: Clearview Counseling Group may use and/or disclose your PHI to provide you with
medical treatment and related services. With your written consent your PHI may be used to refer you to
other providers or to send your records to another treating health care professional. If we are permitted
to do so, Clearview Counseling Group may also disclose your PHI to individuals or facilities that will be
involved with your care after you end treatment with Clearview Counseling Group, or for other
treatment-related reasons. Clearview Counseling Group may also use and/or disclose your PHI in an
-For payment: Clearview Counseling Group may use and/or disclose your PHI to accurately bill and
receive payment for the treatment and related services you receive. For billing and payment purposes,
we may disclose your PHI to your payment source, including an insurance or managed care company, 2
Medicare, Medicaid, or another third-party payer. This information may include diagnosis, dates of
attendance, and treatment plans.
-For health care operations: Clearview Counseling Group may use and/or disclose your PHI as necessary
for operations of the practice, such as quality assurance, medical review, legal services, auditing
functions, and general administrative activities of Clearview Counseling Group.
-Business associates: Clearview Counseling Group may use some services provided by business
associates; such as billing, accounting, or legal consultants. We may disclose your PHI so that they can
perform the duties required of them by Clearview Counseling Group.
-Appointment reminders: Clearview Counseling Group may use and/or disclose your PHI to contact you
as a reminder for your appointments with Clearview Counseling Group.
-Individuals involved in your care or payment for your care: Unless you object, Clearview Counseling
Group may disclose your PHI to a family member, relative, close friend, or any other person you identify,
if the information relates to the person’s involvement in your healthcare, to notify the person of your
location or general condition or payment related to your health care. In addition, Clearview Counseling
Group may disclose your PHI to a public or private entity authorized by law to assist in a disaster relief
effort. If you are unable to agree or object to such a disclosure, Clearview Counseling Group may disclose
such information if we determine that it is in your best interest based on professional judgment, or if we
reasonably infer that you would not object.
-Public health activities: Clearview Counseling Group may disclose your PHI to a public health authority
that is authorized by law to collect or receive such information, such as: for the purpose of preventing or
controlling disease, injury, or disability, reporting births, deaths, or other vital statistics, reporting child
abuse or neglect, notifying a person who may have been exposed to a disease or may be at risk of
contracting or spreading a disease or condition.
-Health oversight activities: Clearview Counseling Group may disclose your PHI to a health oversight
agency for activities authorized by law, such as audits, investigations, inspections, licensure and
-Judicial and administrative proceedings: If you are involved in a lawsuit or dispute, Clearview
Counseling Group may disclose your PHI in response to your signed Release of Information or a court or
administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or
other lawful process if such disclosure is permitted by law.
-Law enforcement: Clearview Counseling Group may disclose your PHI for certain law enforcement
purposes if permitted or required by law. For example, to report gunshot wounds, emergencies or
suspicious deaths, to comply with a court order, warrant, or similar legal process, or to answer certain
requests for information concerning crimes.
-To avert a serious threat to health or safety: Clearview Counseling Group may use and disclose your PHI
when necessary to prevent a serious threat to your health or safety, or the health or safety of the public
or another person. Any disclosure, however, would be to someone to be able to help prevent the threat.
-Coroners, medical examiners, funeral directors, organ procurement organizations: Clearview Counseling
Group may release your PHI to a coroner, medical examiner, funeral director, or, if you are an organ
donor, to an organization involved in the donation of organs and tissues.
-Military and National security: If required by law, if you are a member of the armed forces, Clearview
Counseling Group may use and disclose your PHI as required by military command authorities or the
Department of Veterans Affairs. If required by law, we may disclose your PHI to authorized federal
officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities
authorized by law. If required by law, we may disclose your PHI to authorized federal officials so they may
provide protection to the President, other authorized persons, or foreign heads of state or conduct
-Workers’ compensation: Clearview Counseling Group may disclose your PHI as permitted by laws
relating to workers’ compensation or related programs.
Special Rules Regarding Disclosure of Behavioral Health, Substance Abuse, and HIV-Related
For disclosures concerning PHI relating to care for psychiatric conditions, substance abuse, or HIV related
testing and treatment, special restrictions may apply. For example, we generally may not disclose this
specially protected information in response to a subpoena, warrant, or other legal process unless you
sign a Release of Information or a court orders that disclosure.
- Behavioral health information: Certain behavioral health information may be disclosed for treatment,
payment, and health care operations as permitted or required by law. Otherwise, Clearview Counseling
Group will only disclose such information pursuant to an authorization, court order, or as otherwise
required by law. For example, all communications between you and a psychologist, psychiatrist, social
worker, and certain therapists and counselors will be privileged and confidential in accordance with State
and Federal law.
- Substance abuse treatment information: If you are treated in a specialized substance abuse program,
the confidentiality of alcohol and drug abuse related patient records is protected by Federal law and
regulations. Generally, Clearview Counseling Group may not say to a person outside the practice that you
are in treatment, or disclose any information identifying you as an individual being treated for drug and
alcohol abuse unless you:
1. You consent in writing
2. This disclosure is allowed by a court order
3. This disclosure is made to medical personnel in a medical emergency or to qualified personnel for
research or audit.
Violation of these Federal laws and regulations by Clearview Counseling Group is a crime. Suspected
violations may be reported to appropriate authorities in accordance with Federal regulation. * Federal
laws do not protect any information about a crime committed by a client at a substance abuse program,
or against any person who works for the program, or about any threat to commit such a crime. Federal
laws and regulations do not protect any information about suspected child abuse or neglect from being
reported under State law to appropriate State or local authorities.
- HIV-related information: Clearview Counseling Group may disclose HIV-related information as
permitted or required by State law.
Minors: Clearview Counseling Group will comply with State law when using or disclosing PHI of minors.
Clearview Counseling Group may not use or disclose your protected health information:
Except as described in this notice, or as permitted by State or Federal law, we will not use or disclose
your protected health information (PHI) without your written authorization indicated on a signed
Release of Information Form provided to you by your therapist.
Your Release of Information will specify particular uses or disclosures that you choose to allow. If you do
authorize Clearview Counseling Group to use or disclose your PHI for reasons other than treatment,
payment, or health care operations, you may revoke your Release of Information in writing at any time
by contacting Clearview Counseling Group. If you revoke your Release of Information, we will no longer
use or disclose your PHI for the purposes covered by the authorization, except where Clearview
Counseling Group has already relied on the authorization.
Examples of uses and disclosures that require your authorization:
- Psychotherapy notes: A signed Release of Information is required for the use or disclosure of
psychotherapy notes except for our own use to treat you, for training programs, and to defend Clearview
Counseling Group in a legal action or other proceedings.
- Sale of protected health information: Clearview Counseling Group will not sell your PHI unless we
receive a signed authorization from you.
- Uses and disclosures not described in this notice: Unless otherwise permitted by Federal or State law,
other uses and disclosures of your protected health information (PHI) that are not described in this
notice will be made only with your signed authorization.