Notice of Privacy Practices

I. My Commitment to Your Privacy

Your health information is personal, and I am committed to protecting it. I keep a record of the care and services you receive from me so I can provide quality care and meet legal requirements. This notice applies to all records of your care created by Watermark Counseling KC.

I am required by law to:

• Keep your protected health information ("PHI") private and secure
• Give you this notice of my legal duties and privacy practices
• Follow the terms of the notice currently in effect
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information

I may change the terms of this notice, and the changes will apply to all information I have about you. The updated notice will be available on request, in my office, and on my website.

II. How I May Use and Disclose Your Health Information

Treatment. I may use and share your information to provide and coordinate your care. For example, with your permission I may consult with your physician or another licensed provider involved in your care.

Request restrictions when you pay out of pocket. Because I do not bill insurance, I will not share information about your services with a health plan unless you authorize it or the law requires it.

Health Care Operations. I may use your information to run my practice, improve care, and meet professional requirements. For example, I may use a secure electronic health record system or seek clinical consultation to maintain quality care. Business associates who help me run the practice are required by contract to protect your PHI.

Lawsuits and Disputes. If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose information in response to a subpoena or other lawful request, but only after efforts have been made to notify you or to obtain an order protecting the information.

III. Uses and Disclosures That Require Your Written Authorization

1. Psychotherapy Notes. I keep "psychotherapy notes" as defined in 45 CFR § 164.501. Any use or disclosure of these notes requires your written authorization, except when:

1. Used by me to treat you
2. Used in training or supervising mental health practitioners
3. Used to defend myself in legal proceedings you bring against me
4. Required by the Secretary of Health and Human Services to investigate my HIPAA compliance
5. Required by law, limited to what the law requires
6. Required for health oversight activities related to the author of the notes
7. Required by a coroner performing duties authorized by law
8. Needed to prevent a serious threat to the health or safety of others

2. Marketing. I will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. I will not sell your PHI.

4. All Other Uses. Any use or disclosure not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time. Revoking it will stop future disclosures but will not affect disclosures already made while it was in effect.

IV. Uses and Disclosures That Do Not Require Your Authorization

Subject to limits in the law, I may use and disclose your PHI without your authorization:

1. When required by state or federal law, limited to what the law requires
2. For public health activities, including reporting suspected abuse or neglect of a child, elder, or dependent adult, or to prevent or reduce a serious threat to anyone's health or safety
3. For health oversight activities, such as audits and investigations
4. For judicial and administrative proceedings, such as responding to a court order, though I prefer to obtain your authorization first
5. For law enforcement purposes, such as reporting crimes on my premises
6. To coroners or medical examiners performing duties authorized by law
7. For research purposes approved under the law and with appropriate privacy protections
8. For specialized government functions, such as military, national security, or protective services
9. For workers' compensation purposes, as required by those laws, though I prefer to obtain your authorization first
10. To remind you of appointments or tell you about treatment options or services I offer

When Kansas or Missouri law provides stronger privacy protection than federal law, I follow the stronger standard.

V. Disclosures You Have the Opportunity to Object To

Family, friends, or others involved in your care. I may share information with a family member, friend, or other person you identify as involved in your care or payment for your care, unless you object. In an emergency, I may share information if I believe it is in your best interest and ask for your agreement afterward.

VI. Your Rights Regarding Your Health Information

1. Request limits on uses and disclosures. You may ask me not to use or share certain information for treatment, payment, or operations. I am not required to agree, and I may say no if it would affect your care.
2. Request restrictions when you pay out of pocket. If you pay for a service in full yourself, you may ask me not to share information about that service with your health plan, and I will agree unless the law requires the disclosure.
3. Choose how I contact you. You may ask me to contact you in a specific way, such as a certain phone number or address. I will agree to all reasonable requests.
4. See and get a copy of your records. Except for psychotherapy notes, you may request an electronic or paper copy of your records. I will respond within 30 days of your written request and may charge a reasonable, cost-based fee.
5. Get a list of disclosures. You may request a list of times I shared your information for purposes other than treatment, payment, operations, or disclosures you authorized, covering up to six years. I will respond within 60 days. The first list each year is free; additional requests may carry a reasonable, cost-based fee.
6. Request a correction. If you believe information in your record is incorrect or incomplete, you may ask me to correct it. I may say no, but I will explain why in writing within 60 days.
7. Be notified of a breach. You have the right to be notified if your unsecured health information is affected by a breach.
8. Get a copy of this notice. You may request a paper or electronic copy of this notice at any time, even if you agreed to receive it electronically.