Privacy Policy


In mental health care, confidentiality and privacy are central to the success of the therapeutic relationship; therefore, I will do all we can do to protect the privacy of your mental health records. If you have questions regarding matters discussed in this Patient Notification, please do not hesitate to ask.

I. Preamble

Records are kept documenting your care as required by law, professional standards, and other review procedures. HIPAA clearly defines what kind of information is to be included in your “designated medical record” or “case record” as well as some material, known as “Psychotherapy Notes,” which is not accessible to insurance companies and other third-party reviewers. HIPAA provides privacy protections about your personal health information, which is called “protected health information (PHI)” which could personally identify you. PHI consists of three (3) components: treatment, payment, and health care operations. Treatment refers to activities/sessions CIBH provides, coordinates, or manages your mental health care service or other services related to your health care. Examples include a counseling session or communication with your primary care physician about your medication or overall medical condition. Payment is when CIBH obtains reimbursement for your mental health care or other services related to your health care. Health care operations are activities related to the performance such as quality assurance. The use of your protected health information refers to activities CIBH conducts for scheduling appointments, keeping records, and other tasks related to your care. Disclosures refer to activities you authorize such as the sending of your protected health information to other parties (i.e., your insurance company).

II. Uses and Disclosures of Protected Health Information Requiring Authorization

If you request for CIBH to send any of your protected health information of any sort to anyone outside of the CIBH offices, you must first sign a specific authorization to release information to this outside party. A copy of that authorization form is available upon request. In recognition of the importance of the confidentiality of conversations between therapist and patients in treatment settings, HIPAA permits keeping “psychotherapy notes” separate from the overall “designated medical record”. “Psychotherapy notes” are the therapist’s notes “recorded in any medium by a mental health provider documenting and analyzing the contents of a conversation during a private, group, or joint family counseling session and that are separated from the rest of the individual’s medical record.” “Psychotherapy notes” are private and contain information about you and your treatment.

III. Uses and Disclosures Not Requiring Consent or Authorization

By law, protected health information may be released without your consent or authorization under the following conditions:
  • Suspected or known child abuse or neglect
  • Suspected or known sexual abuse of a child
  • Adult and Domestic abuse
  • Judicial or administrative proceedings (i.e., you are ordered here by the court)
  • Serious threat to health or safety (i.e., threats to others or threat to national security)

IV. Patient’s Rights and Our Duties

You have a right to the following:
  • The right to request restrictions on certain uses and disclosures of your protected health information which CIBH may or may not agree to but if so, such restrictions shall apply unless any agreement is changed in writing
  • The right to receive confidential communications by alternative means and at alternative locations. For example, you may not want forms mailed to your home address so CIBH will send them to another location of your choosing.
  • The right to inspect and copy your protected health information in the designated record and any billing records for as long as protected health information is maintained in the record.
  • The right to insert an amendment in your protected health information, although the counselor may deny an improper request and/or respond to any amendment(s) you make to your record of care.
  • The right to an accounting of non-authorized disclosures of your protected health information.
  • The right to a paper copy of notices/information from CIBH, even if you have previously requested electronic transmission of notices/information.
  • The right to revoke your authorization of your protected health information except to the extent that action has already been taken.

V. Complaints

You have the right to have oral or written instructions for filing a complaint. The right to file a HIPAA complaint is not time limited. If you need assistance in filing a HIPAA complaint, you may visit the following Health and Human Services website: grievance or want further information, please contact:

If you prefer, you may also submit a written complaint in your own format by either:

Print and mail the completed complaint and consent forms to:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
Email to