Privacy Policy

Thank you for entrusting Mindful Mindset Wellness Center with your care. We strive to create a safe and comfortable environment in which we provide clients with empathic, evidenced-based care for a variety of concerns. Information about you is generally held in confidence by law and our policy is to never release information outside of sessions without your consent. We maintain strict privacy policies and procedures, which are detailed in our Notice of Privacy Practices. There are exceptions, and there may be times when the law requires us to disclose your information and break confidentiality. How we use and disclose your information is articulated in our “Notice of Privacy Practices”, which we offer to you prior to our first session, is outlined below, and it will also be available upon your request.

Mindful Mindset Wellness Center, PLLC is committed to protecting your privacy. Mindful Mindset Wellness Center is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. Mindful Mindset Wellness Center is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.

I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
I may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
· “PHI” refers to information in your health record that could identify you.

· “Treatment, Payment and Health Care Operations”
– Treatment is when I provide, coordinate or manage your health care and other services related to your
health care. An example of treatment would be when I consult with another health care provider, such as
your family physician or another psychologist.
- Payment is when I obtain reimbursement for your healthcare. Examples of payment are when I disclose
your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or
coverage.
- Health Care Operations are activities that relate to the performance and operation of my practice.
Examples of health care operations are quality assessment and improvement activities, business-related
matters such as audits and administrative services, and case management and care coordination.

· “Use” applies only to activities within my practice, such as sharing, employing, applying, utilizing,
examining, and analyzing information that identifies you.

· “Disclosure” applies to activities outside of my practice, such as releasing, transferring, or providing access
to information about you to other parties.

II. Uses and Disclosures Requiring Authorization
I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances, when I am asked for information for purposes outside of treatment, payment and health care operations, I will obtain an authorization from you before releasing this information. I will also need to obtain an authorization before releasing your psychotherapy notes.

“Psychotherapy notes” are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

III. Uses and Disclosures with Neither Consent nor Authorization
I may use or disclose PHI without your consent or authorization in the following circumstances:

§ Child Abuse: If I have reasonable cause to believe that a child has suffered abuse or neglect, I am required by law to report it to the proper law enforcement agency or the Illinois Department of Children and Family Services.
§ Adult and Domestic Abuse: If I have reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred, I must immediately report the abuse to the Illinois Department of Family Services. If I have reason to suspect that sexual or physical assault has occurred, I must immediately report to the appropriate law enforcement agency and to the Illinois Department of Family Services.
§ Health Oversight: If the Illinois Examining Board of Psychology subpoenas me as part of its investigations, hearings or proceedings relating to the discipline, issuance or denial of licensure of state licensed psychologists, I must comply with its orders. This could include disclosing your relevant mental health information.
§ Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about the professional services that I have provided to you and the records thereof, such information is privileged under state law, and I will not release information without the written authorization of you or your legal representative, or a subpoena of which you have been properly notified and you have failed to inform me that you are opposing the subpoena, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
§ Serious Threat to Health or Safety: I may disclose your confidential mental health information to any person without authorization if I reasonably believe that disclosure will avoid or minimize imminent danger to your health or safety, or the health or safety of any other individual.
§ Worker’s Compensation: If you file a worker's compensation claim, with certain exceptions, I must make available, at any stage of the proceedings, all mental health information in my possession relevant to that particular injury in the opinion of the Illinois Worker’s Compensation Commission, to your employer, your representative, and the Department of Labor and Industries upon request.

IV. Patient's Rights and Therapist's Duties
Patient’s Rights:
· Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.
· Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me. Upon your request, I will send your bills to another address.)
· Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, I will discuss with you the details of the request and denial process.
· Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. I may deny your request. On your request, I will discuss with you the details of the amendment process.
· Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, I will discuss with you the details of the accounting process.
· Right to a Paper Copy – You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.

Therapist’s Duties:
· I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
· I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.
· If I revise my policies and procedures, I will notify you by mail with a revised version of this document

To file a complaint if you feel your rights are violated.
• You can file a complaint by contacting the practice using the following information:
Mindful Mindset Wellness Center, PLLC
1717 N Naper Blvd Suite 200 Naperville, IL 60563
708-480-2048
• 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
• The Practice will not retaliate against you for filing a complaint.

ELECTRONIC COMMUNICATION

We cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, we will do so. While we may try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

CITY OF CHICAGO INSURANCE AND TELLIGEN

Please note: If you are a City of Chicago employee, your health insurance covers 10 sessions of therapy per calendar year. In order to gain approval for additional sessions to be covered, your therapist will need to contact Telligen, a medical review company contracted with the City of Chicago, and provide them with clinical information about your diagnosis, functioning, and treatment. This clinical information goes beyond the information that you generally agree to have your provider give to the health insurance company when you initially sign up for health insurance, and includes diagnosis, treatment goals, dates of treatment, type of treatment used, and possibly other written records (such as progress notes) that your therapist keeps about your care. If clinical information is not provided to Telligen, Blue Cross/Blue Shield will automatically deny any coverage past the 10th session. If you decide that you agree to have your clinician provide clinical information to Telligen, you will need to complete a release of information for Telligen. Of course, you have the right to review any documentation before we send it to Telligen before we send it. If you decide that you would rather not have your clinician share any clinical information, you can pay for sessions after the 10th session as a self-pay client and then request reimbursement from BCBS afterward. We will be happy to assist you in completing the paperwork to do this.

SUPERVISION AND CONSULTATION

We believe that continuing to grow and develop as therapists requires ongoing consultation and supervision. We may seek professional consultation from other clinicians at Mindful Mindset Wellness Center, PLLC. All discussions among staff and supervisors are held in confidence and are for the purpose of providing the best possible client care. When consulting, clinicians take significant measures to hide the identity of their clients.

INACTIVE CLIENT STATUS

Should you fail to schedule an appointment for 30 days or longer, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued. Your file with Mindful Mindset Wellness Center will be closed and you will no longer be considered an “active client.” You are always welcome to return, however there is no guarantee that your usual therapist will still be available to see you.