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EFFECTIVE DATE OF THIS NOTICE This notice went into effect on July 15, 2022

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Introduction to Shades of Resilience Counseling, PLLC

Privacy is a very important concern for all those who come to my practice. The laws and standards of our profession require that Shades of Resilience Counseling keep Protected Health Information “PHI” about you in your Clinical Record.

What Shades of Resilience Counseling, PLLC means by your Clinical Record

Your Clinical Record is likely to include these kinds of information:

• Your history: Things you experienced as a child; your school and work experiences; your marriage and other personal histories.

• Reasons you came for treatment: Your problems, complaints, symptoms, or needs.

• Diagnoses: These are the medical terms for your problems or symptoms.

• A treatment plan: This is a list of the goals that we set for treatment.

• Progress notes: Each time you come in, I write down some things about how you are doing, your progress towards those goals, and what you tell me.

• Records: Medical and social history, your treatment history, any past treatment records that I receive from other providers, reports of any professional consultations, and any reports that have been sent to anyone.

• Billing and insurance information.

You may examine and/or receive a copy of your Clinical Record if you request it in writing. Because these are professional records, they can be misinterpreted by and/or be upsetting to untrained readers. For this reason, I recommend that you initially review them or have them forwarded to another mental health professional so you can discuss the contents. In most circumstances, Shades of Resilience Counseling is allowed to charge a copying fee of $25 (and for certain other expenses).