Empowering Individual & Relational Changes

The privacy of your medical information is important to me and I understand that your medical information is personal.  I am committed to protecting it.  I create a record of the care and services you receive to provide you with quality care and to comply with certain legal requirements.  Thisi notice will tell you about the ways I may use and share medical information about you and I also describe your rights and certain duties I have regarding the use and disclosure of medical information.

  1. Uses of Information Obtained From You: The information I obtain from you is used to establish diagnosis, determine your therapy plans and goals, provide the services you request, and establish your ability to pay for these services.
  2. My Legal Responsibility: The law requires us to keep your medical information private, give you this notice describing my legal duties, privacy practices, and your rights regarding your medical information, and follow the terms of the notice that is now in effect.
  3. Patient Rights: Effective April 14, 2003, the 45 CFR Health Insurance Portability and Accountability Act (HIPPA) went into effect, which incules rules on the use of patient information