Privacy Policies

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.

I. Our Responsibilities

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us; we need this record to provide you with quality care and to comply with certain legal requirements.

This notice applies to all the records of your care generated by Foundations Counseling and its providers. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Follow the terms of the notice that is currently in effect.

• Give you this notice of our legal duties and privacy practices with respect to health information.

• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 II. Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. You have a right to:

1. Get an electronic or paper copy of your medical record

• Other than psychotherapy notes, you can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

2. Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

• We may say “no” to your request, but we’ll tell you why in writing within 60 days of receiving your request.

3. Request confidential communications

• You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.

• We will say “yes” to all reasonable requests.

4. Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

5. Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why, unless you request a shorter time.

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll respond to your request within 60 days of receipt and we’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

6. Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

7. Choose someone to act for you

• If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

8. File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

• We will not retaliate against you for filing a complaint.

III. Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

1. In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care or payment for your care.

• Share information in a disaster relief situation.

• Include your information in a hospital directory.

If you are not able to tell us your preference (e.g., if you are unconscious), we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. The opportunity to consent may be obtained retroactively in emergency situations such as these.

2. In these cases, we never share your information, unless you give us written permission:

• For marketing purposes

• The sale of your information

• Psychotherapy notes (Unless for the purpose of treating you, for our use in training or supervising mental health practitioners to help them improve their skills, for our use in defending ourselves in legal proceedings instituted by you, for use by the Secretary of Health and Human Services to investigate our compliance with HIPAA, as required by law, as required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes, as required by a coroner who is performing duties authorized by law, and as required to help avert a serious threat to the health and safety of others.)

3. In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

• If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.

IV. Uses and Disclosures

The following categories describe different ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

1. How do we typically use or share your health information?

We typically use or share your health information in the following ways:

A. To treat you

• We can use your health information and share it with other professionals who are treating you.

• Example: A doctor treating you for an injury asks another doctor about your overall health condition.

B. Run our organization (Payment and Healthcare Operations)

• We can use and share your health information to run our practice, improve your care, and contact you when necessary.

• We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

• Example: We use health information about you to manage your treatment and services.

C. Bill for your services

• We can use and share your health information to bill and get payment from health plans or other entities.

• Example: We give information about you to your health insurance plan so it will pay for your services.

2. How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.  

A. Help with public health and safety issues

We can share health information about you for certain situations such as:

• Preventing disease

• Helping with product recalls

• Reporting adverse reactions to medications

• Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing a serious threat to anyone’s health or safety

B. Do research

We can use or share your information for health research.

C. Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. This includes reporting crimes occurring on my premises.

D. Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

E. Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

F. Address workers’ compensation, law enforcement, and other government requests

 We can use or share health information about you:

• For workers’ compensation claims; Although my preference is to obtain an Authorization for Release of Information from you, I may provide your PHI in order to comply with workers’ compensation laws.

• For law enforcement purposes or with a law enforcement official

• With health oversight agencies for activities authorized by law

• For special government functions such as military, national security, and presidential protective services

G. Respond to lawsuits and legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena. Although, my preference is to obtain an Authorization for Release of Information from you before doing so.

• To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

In all cases, including those listed above, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

V. Changes to the Terms of this Notice

We are required to follow the terms of this notice that are currently in effect.  We can change the terms of this notice, and the changes will apply to all information we have about you.  The new notice will be available upon request in our office and on our website.

VI. Notice Effective Date

This notice is effective as of August 15th, 2026.

VII. Other Instructions for Notice

The Foundations Counseling Privacy Official is Caroline Freeman. You may contact the Foundations Counseling Privacy Official at 540-227-4544.

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By agreeing to this form, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.