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.

 

To provide care, Wellness Tree Counseling LCSW, PLLC (“we,” “us,” or “our”) must collect, create, and maintain information about you and your health. This Notice of Privacy Practices (“Notice”) explains how your protected health information may be used and disclosed. Protected health information refers to details about your past, present, or future health care services that can identify you.

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How We Use and Disclose Your Health Information

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We protect your health information from inappropriate use and disclosure. We may use and disclose your health information only for the purposes listed below:

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1. Uses and Disclosures for Treatment, Payment, and Health Care Operations Without Your Consent or Authorization. We may use and disclose your protected health information to provide therapy, obtain payment, and conduct health care operations. Examples include:

• Treatment and Care Management: Your therapist may discuss your diagnosis with other providers involved in your care to better understand your treatment history. If state law requires your consent, we will obtain it.

• Payment: We may use and disclose your health information to get paid for services and help other providers receive payment. This includes checking your insurance eligibility and billing.

• Health Care Operations: We may use and disclose your information for care management, quality improvement, performance evaluation, and resolving complaints. We may also assist other providers with their operations.

 

2. Other Uses and Disclosures Without Your Consent or Authorization. Subject to the limitations set forth in the Consent for Services, we may also use and disclose your health information without your specific written authorization for the following purposes:

• As required by law,  such as to report information regarding abuse of a minor or elderly adult or if we think you may be an imminent threat to yourself or others.

• For public health activities, such as to disclosure information to public health authorities or other agencies and organizations conducting public health activities, such as organizations responding to a pandemic. 

• If you are a victim of abuse, neglect, or domestic violence. We may disclose your health information to an appropriate government agency if we believe you are a victim of abuse, neglect, or domestic violence, and you agree to the disclosure or the disclosure is required or permitted by law. We will let you know if we disclose your health information for this purpose unless we believe that notifying you would place you or another person at risk of serious harm or if we are prohibited by state law from notifying you.

• For health oversight activities, such as to state departments of health, for activities authorized by law, such as audits, investigations, and inspections of us.

• In judicial and administrative proceedings, in response to an appropriate order of a court or other administrative body.

• For law enforcement purposes, such as to the police or law enforcement officials as required or permitted by law, as requested by a court order or a grand jury or administrative subpoena.

• If you pass away, such as to a coroner, medical examiner, or a funeral director as necessary if you pass away and as authorized by law.

• For health or safety purposes to prevent or lessen a threat to your health or safety or that of the general public. We may also disclose your health information to disaster relief organizations such as the Red Cross, or  organizations participating in bioterrorism countermeasures.

• For specialized government functions to provide assistance for certain types of government activities. If you are a member of the armed forces of the United States or a foreign country, we may disclose your health information to appropriate military authority if necessary. We may also disclose your health information to federal officials for lawful intelligence or national security activities.

• For workers’ compensation as permitted by the laws governing the workers’ compensation program or similar programs that provide benefits for work-related injuries or illnesses.

• With business Associates. A business associate is a person or entity that performs certain functions that involve the use or disclosure of your personal health information to a covered entity. Your health information may be used or disclosed to a business associate only as permitted under HIPAA. 

• With individuals involved in your care. Unless prohibited by state law, if you ask us to we may disclose your health information to a family member, relative, or close personal friend assisting you in receiving health care services. 

 

3. Special Treatment of Alcohol and Drug Abuse Records. Records from alcohol and drug treatment programs may have extra protections. We follow any applicable law that is more restrictive than HIPAA.

 

4. Other State Laws. To the extent that you reside in a state that provides additional protections to your information or a subset of treatment information, we will protect your information in accordance with state law. 

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5. We do not perform research or marketing with your health information; we do not sell your health information. 

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6. Obtaining Your Authorization for Other Uses and Disclosures. We will not use or disclose your health information for any purpose not specified in this Notice unless we obtain your express written authorization or the authorization of your legally appointed representative. If you give us your authorization, you may revoke it at any time by providing us with a written notice stating that you wish to revoke your authorization, in which case we will no longer use or disclose your health information for the purpose you authorized, except to the extent that we have relied on your prior authorization to provide your care.

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7. Potential for Redisclosure. When we disclose your information as described in this Notice, either with or without your authorization, it may be redisclosed by the person receiving the information and the information is no longer subject to the protections we’ve described, or protected by the laws with which we comply.  

 

Your Rights Regarding Your Health Information

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You have the following rights regarding your health information:

1. Right to Inspect and Copy. You have the right to inspect or request a copy of health information about you that we maintain. Please let us know what you want and how you'd like to receive it. We’ll usually get it to you within 30 days; however, rare cases we might not be able to share it. If allowed by law, we may charge a fee for copies.

2. Right to Request Amendments. You have the right to request changes to any health information we maintain about you if you tell us why the information is incorrect or incomplete. We don’t have to make the changes, but if we say no, we’ll let you know in writing and explain how you can add your objection to your records. If we do make changes, we won’t delete or rewrite your old records—we’ll just add a note to show the update.

3. Right to an Accounting of Disclosures. You can ask for a list of who we've shared your health information with. This list won’t include sharing done for treatment, payment, or operations, or anything you approved in writing. You’ll need to say what time period you want (up to six years). The first request in a year is free; after that, we may charge a small fee.

4. Right to Request Restrictions. You can ask us not to share your health information for treatment, payment, or operations, or with people helping you or disaster relief groups. We don’t have to agree if it affects your care, but if we do agree, we’ll follow the limits.

5. Right to Request Confidential Communications. You have the right to ask us to send health information to you in a different way or at a different location, which we will do if the request is reasonable. For example, if you are afraid that someone living with you may open your mail, resulting in harm, you may ask us to mail to an alternate address. Your request for an alternate form of communication should also specify where and/or how we should contact you.

6. Right to Paper Copy of Notice. You have the right to receive a paper copy of this Notice at any time. You may obtain a paper copy of this Notice by contacting our Privacy team at info@wellnesstreecounseling.com. You may also print out a copy of this Notice by visiting our website at www.wellnesstreecounseling.com.

 

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by writing to our Privacy Official. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will not penalize or retaliate against you for filing a complaint.

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Changes to This Notice

We may change the terms of this Notice at any time. If the terms of the Notice are changed, the new terms will apply to all of your health information, whether created or received by us before or after the date on which the Notice is changed. Any updates to the Notice will be made available on Therapynotes within 60 days of the date on which they become effective.

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This Notice is effective: 12/01.2021; last updated: 12/01/2025.