Notice to Website Browsers:
This website is provided for information and education purposes only. No doctor/patient relationship has
been established by the use of this site. No diagnosis or treatment is being provided. The information
contained here should be used in consultation with a medical/health professional of your choice. No
guarantees or warranties are made regarding any of the information contained within this website. This
website is not intended to offer specific medical advice to anyone. NORTHWEST COUNSELING &
PSYCHOTHERAPY CENTER is licensed to practice in Michigan, and this website is not intended to solicit
patients from other states. Further, this website takes no responsibility for web sites hyper-linked to this site
and such hyper-linking does not imply any relationships or endorsements of the linked sites.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ CAREFULLY.
This notice of Privacy Practices is being provided to you as a requirement of the Health Insurance
Portability and Accountability Act (HIPAA). This notice describes how we may use and disclose your
protected health information to carry out treatment, payment, or health care operations and for other
purposes that are permitted by law. It also describes your rights to access and control your protected health
information in some cases. Your protected health information means any of your written and oral health
information, including demographic data that can be used to identify you. This is health information that is
created or received by your health care provider, and that relates to your past, present, and future physical
or mental health condition.
I. Uses and Disclosures of Protected health Information
The practice may use your protected health information for purposes of providing treatment, obtaining
payment for treatment, and conducting health care operations. Your protected health information may be
used or disclosed only for these purposes unless the practice has obtained your authorization or the use
and disclosure is otherwise permitted by the HIPAA Privacy Regulations or State law. Disclosures of your
protected health information for the purposes described in this Notice may be in writing, orally, or by
facsimile.
A. Treatment. We will use and disclose your protected health information to provide, coordinate, or manage
your health care and related services. This includes the coordination or management of your health care
with a third party for treatment purposes. For example, we may disclose your protected health information to
a referring physician to coordinate and approve your plan of care, or to an OBGYN professional to provide
updates on your progress in preparation for your return to work. We may also disclose protected health
information to other physicians who may be treating you or consulting with your physician with respect to
your care. In some cases, we may also disclose your protected health information to another OBGYN
provider for purposes of continuing your care with that provider.
B. Payment. Your protected health information will be used, as needed, to obtain payment for the services
that we provide. This may include certain communications to your health insurer to get approval for the
treatment that your referring physician and we recommend. We may also disclose protected health
information to your insurance company to determine whether you are eligible for benefits or whether a
particular service is covered under your health plan. In order to get payment for our services, we may also
need to disclose your protected health information to your insurance company to demonstrate the medical
necessity of the services or, as required by your insurance company, for utilization review or auditing. We
may also disclose patient information to another provider involved in your care for the other provider's
payment activities.
C. Operations. We may use or disclose your protected health information, as necessary, for our own health
care operations in order to facilitate the function of the practice and to provide quality care to all patients.
health care operations include such activities as:
• Quality assessment and improvement activities
• Employee review activities
• Training programs including those in which students, trainees, or practitioners in health care
learn under supervision
• Accreditation, certification, licensing or credentialing activities
• Review and auditing, including compliance reviews, peer reviews, legal services and maintaining
compliance programs
• Business management and general administrative activities.
In certain situations, we may also disclose patient information to another provider or health plan for their
health care operations.
D. Other Uses and Disclosures. As part of treatment, payment and healthcare operations, we may also use
or disclose your protected health information for the following purposes:
• To remind you of an appointment
• To inform you of potential treatment alternatives or options
• To inform you of health-related benefits or services that may be of interest to you.
II. Uses and Disclosures beyond Treatment, Payment, and Health Care Operations Permitted Without
Authorization or Opportunity to Object.
Federal privacy rules allow us to use or disclose your protected health information without your permission
or authorization for a number of reasons including the following:
A. When Legally Required. We will disclose your protected health information when we are required to do
so by any Federal, State, or local law.
B. When there are Risks to Public Health. We may disclose your protected health information for the
following public activities and purposes:
• To prevent, control, or report disease, injury or disability as permitted by law
• To report vital events such as birth or death as permitted or required by law
• To conduct public health surveillance, investigations and interventions as permitted or required by law
• To collect or report adverse events and product defects, track FDA regulated products, enable
product recalls, repairs or replacements to the FDA and to conduct post marketing surveillance
• To notify a person who has been exposed to a communicable disease or who may be at risk of
contracting or spreading a disease as authorized by law. To report to an employer information about
an individual who is a member of the workforce as legally permitted or required.
C. To Report Abuse, Neglect, or Domestic Violence. We may notify government authorities if we believe that
a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when
specifically required or authorized by law or when the patient agrees to the disclosure.
D. To Conduct health Oversight Activities. We may disclose your protected health information to a health
oversight agency for activities including audits; civil, administrative, or criminal investigations, proceeding, or
actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight
as authorized by law. We will not disclose your health information if you are the subject of an investigation
and your health information is not directly related to your receipt of health care or public benefits.
E. In Connection With Judicial and Administrative Proceedings. We may disclose your protected health
information in the course of any judicial or administrative proceeding in response to an order of a court or
administrative tribunal as expressly authorized by such order or in response to a signed authorization (in a
format approved by the Michigan Court Administrator).
F. For Law Enforcement Purposes. We may disclose your protected health information to a law enforcement
official for law enforcement purposes as follows:
• As required by law for reporting of certain types of wounds or other physical injuries
• Pursuant to court order, court-ordered warrant, subpoena, summons or similar process
• For the purposes of identifying or locating a suspect, fugitive, material witness or missing person
• Under certain limited circumstances, when you are the victim of a crime
• To a law enforcement official if the practice has a suspicion that your death was the result of a criminal
conduct
• In an emergency in order to report a crime.
G. For Research Purposes. We may disclose your protected health information for research when the use
or disclosure for research has been approved by an institutional review board or privacy board that has
reviewed the research proposal and research protocols to address the privacy of your protected health
information.
H. In the Event of a Serious Threat to health or Safety. We may, consistent with applicable law and ethical
standards of conduct, use or disclose your protected health information if we believe, in good faith, that such
a disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to
the health and safety of the public.
I. For Specified Government Functions. In certain circumstances, the Federal regulations authorize the
practice to use or disclose your protected health information to facilitate specified government functions
relating to military and veterans activities, national security and intelligence activities, protective services for
the President and others, medical suitability determinations, correctional institutions and law enforcement
custodial situations.
J. For Worker's Compensation. The practice may release your protected health information to comply with
worker's compensation laws or similar programs.
III. Uses and Disclosures Permitted Without Authorization but With Opportunity to Object
We may disclose your protected health information to your family member or a close personal friend if it is
directly relevant to the person's involvement in your care or payment related to your care. We can also
disclose your information in connection with trying to locate or notify family members or others involved in
your care concerning your location, condition or death.
You may object to these disclosures. If you do not object to these disclosures or we can infer from the
circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is
in your best interests for us to make disclosure of information that is directly relevant to the person's
involvement with your care, we may disclose your protected health information as described.
IV. Uses and Disclosures Which You Authorize
Other than as stated above, we will not disclose your health information other than with your written
authorization. You may revoke your authorization in writing at any time except to the extent that we have
taken action in reliance upon the authorization.
V. Your Rights
You have the following rights regarding your health information:
A. The right to inspect and copy your protected health information. You may inspect and obtain a copy of
your protected health information that is contained in a designated record set for as long as we maintain the
protected health information. A 'designated record set' contains medical and billing records and any other
records that your therapist and the practice uses for making decisions about you.
Under Federal law, however, you may not inspect or copy the following records: psychotherapy notes;
information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or
proceeding; and protected health information that is subject to a law that prohibits access to protected
health information. Depending on the circumstances, you may have the right to have a decision to deny
access reviewed.
We may deny your request to inspect or copy your protected health information if, in our professional
judgment, we determine that the access requested is likely to endanger your life or safety or that of another
person referenced within the information. You have the right to request a review of this decision.
To inspect and copy your medical information, you may be asked to submit a written request to the Privacy
Officer whose contact information is listed at the end of the Notice. If you request a copy of your information,
we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with
your request. Please contact our Privacy Officer if you have questions about access to your medical record.
B. The Right to Request a Restriction on Uses and Disclosures of Your Protected health Information. You
may ask us not to disclose certain parts of your protected health information for the purposes of treatment,
payment or health care operations. You may also request that we not disclose your health information to
family members or friends who may be involved in your care or for notification purposes as described in this
document. Your request must state the specific restriction requested and to whom you want the restriction to
apply.
The practice is not required to agree to a restriction that you may request. We will notify you if we deny your
request to a restriction. If the practice does agree to the requested restriction, we may not use or disclose
your protected health information in violation of the restriction unless it is needed to provide emergency
treatment. You may request a restriction by contacting the Privacy Officer.
C. The right to Request to Receive Confidential Communications from us by Alternative Means or at an
Alternative Location. You have the right to request that we communicate with you in certain ways. We will
accommodate reasonable requests. We may condition this accommodation by asking you for information as
to how payment will be handled or specification of an alternative address or other method of contact. We will
not require you to provide an explanation of your request which must be made in writing to the Privacy
Officer.
D. The Right to Have Your Physician Amend Your Protected health Information. You may request an
amendment of protected health information about you in a designated record set for as long as we maintain
this information. In certain cases, we may deny your request for an amendment. If we deny your request for
amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to
your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in
writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to
support the requested amendments.
E. The Right to Receive an Accounting. You have the right to request an accounting of certain disclosures
of your protected health information made by the practice. This right applies to disclosures for purposes
other than treatment, payment or health care operations as described in this document. We are also not
required to account for disclosures that you requested, disclosures that you agreed to by signing an
authorization form, disclosures for a facility directory, to friends or family members involved in your care, or
certain other disclosures we are permitted to make without your authorization. The request for an accounting
must be made in writing to our Privacy Officer. The request should specify the time period sought for the
accounting. We are not required to provide an accounting of the disclosures that take place prior to April 14,
2003. Accounting requests may not be made for periods of time in excess of six years. We will provide the
first accounting you request during any 12-month period without charge. Subsequent accounting requests
may be subject to a reasonable cost-based fee.
F. The Right to Obtain a Paper Copy of this Notice. Upon request, we will provide a separate paper copy of
this notice even if you have already received a copy of the notice or have agreed to this notice electronically.
VI. Our Duties
The practice is required by law to maintain the privacy of your protected health information and to provide
you with this Notice of our duties and privacy practices. We are required to abide by terms of this Notice as
may be amended from time to time. We reserve the right to change the terms of this Notice and to make the
new Notice provisions effective for all protected health information that we maintain. If the practice changes
this Notice, we will provide a copy of the revised Notice.
VII. Complaints
You have the right to express complaints to the practice and to the Secretary of health and Human services
if you believe that your privacy rights have been violated. You may complain to the practice by contacting
the practice's Privacy Officer verbally or in writing, using the contact information below. You will not be
retaliated against in any way for filing a complaint.
VIII. Contact Person
The practice's contact person for all issues regarding patient privacy and you rights under the Federal
privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be
requested by contacting the Recipient’s Rights Officer. Complaints against the practice can be mailed to the
Recipient’s Rights Officer by sending it to:
Northwest Counseling & Psychotherapy Center
30375 Northwestern Highway, Suite 200
Farmington Hills, MI 48334
(248) 254-3332
northwestcounseling@yahoo.com
The Recipient's Rights Officer, Hillary Turk, can be contacted by telephone at (248) 254-3332.
IX. Effective Date
This Notice is effective February 1, 2010.
This website is provided for information and education purposes only. No doctor/patient relationship has
been established by the use of this site. No diagnosis or treatment is being provided. The information
contained here should be used in consultation with a medical/health professional of your choice. No
guarantees or warranties are made regarding any of the information contained within this website. This
website is not intended to offer specific medical advice to anyone. NORTHWEST COUNSELING &
PSYCHOTHERAPY CENTER is licensed to practice in Michigan, and this website is not intended to solicit
patients from other states. Further, this website takes no responsibility for web sites hyper-linked to this site
and such hyper-linking does not imply any relationships or endorsements of the linked sites.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ CAREFULLY.
This notice of Privacy Practices is being provided to you as a requirement of the Health Insurance
Portability and Accountability Act (HIPAA). This notice describes how we may use and disclose your
protected health information to carry out treatment, payment, or health care operations and for other
purposes that are permitted by law. It also describes your rights to access and control your protected health
information in some cases. Your protected health information means any of your written and oral health
information, including demographic data that can be used to identify you. This is health information that is
created or received by your health care provider, and that relates to your past, present, and future physical
or mental health condition.
I. Uses and Disclosures of Protected health Information
The practice may use your protected health information for purposes of providing treatment, obtaining
payment for treatment, and conducting health care operations. Your protected health information may be
used or disclosed only for these purposes unless the practice has obtained your authorization or the use
and disclosure is otherwise permitted by the HIPAA Privacy Regulations or State law. Disclosures of your
protected health information for the purposes described in this Notice may be in writing, orally, or by
facsimile.
A. Treatment. We will use and disclose your protected health information to provide, coordinate, or manage
your health care and related services. This includes the coordination or management of your health care
with a third party for treatment purposes. For example, we may disclose your protected health information to
a referring physician to coordinate and approve your plan of care, or to an OBGYN professional to provide
updates on your progress in preparation for your return to work. We may also disclose protected health
information to other physicians who may be treating you or consulting with your physician with respect to
your care. In some cases, we may also disclose your protected health information to another OBGYN
provider for purposes of continuing your care with that provider.
B. Payment. Your protected health information will be used, as needed, to obtain payment for the services
that we provide. This may include certain communications to your health insurer to get approval for the
treatment that your referring physician and we recommend. We may also disclose protected health
information to your insurance company to determine whether you are eligible for benefits or whether a
particular service is covered under your health plan. In order to get payment for our services, we may also
need to disclose your protected health information to your insurance company to demonstrate the medical
necessity of the services or, as required by your insurance company, for utilization review or auditing. We
may also disclose patient information to another provider involved in your care for the other provider's
payment activities.
C. Operations. We may use or disclose your protected health information, as necessary, for our own health
care operations in order to facilitate the function of the practice and to provide quality care to all patients.
health care operations include such activities as:
• Quality assessment and improvement activities
• Employee review activities
• Training programs including those in which students, trainees, or practitioners in health care
learn under supervision
• Accreditation, certification, licensing or credentialing activities
• Review and auditing, including compliance reviews, peer reviews, legal services and maintaining
compliance programs
• Business management and general administrative activities.
In certain situations, we may also disclose patient information to another provider or health plan for their
health care operations.
D. Other Uses and Disclosures. As part of treatment, payment and healthcare operations, we may also use
or disclose your protected health information for the following purposes:
• To remind you of an appointment
• To inform you of potential treatment alternatives or options
• To inform you of health-related benefits or services that may be of interest to you.
II. Uses and Disclosures beyond Treatment, Payment, and Health Care Operations Permitted Without
Authorization or Opportunity to Object.
Federal privacy rules allow us to use or disclose your protected health information without your permission
or authorization for a number of reasons including the following:
A. When Legally Required. We will disclose your protected health information when we are required to do
so by any Federal, State, or local law.
B. When there are Risks to Public Health. We may disclose your protected health information for the
following public activities and purposes:
• To prevent, control, or report disease, injury or disability as permitted by law
• To report vital events such as birth or death as permitted or required by law
• To conduct public health surveillance, investigations and interventions as permitted or required by law
• To collect or report adverse events and product defects, track FDA regulated products, enable
product recalls, repairs or replacements to the FDA and to conduct post marketing surveillance
• To notify a person who has been exposed to a communicable disease or who may be at risk of
contracting or spreading a disease as authorized by law. To report to an employer information about
an individual who is a member of the workforce as legally permitted or required.
C. To Report Abuse, Neglect, or Domestic Violence. We may notify government authorities if we believe that
a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when
specifically required or authorized by law or when the patient agrees to the disclosure.
D. To Conduct health Oversight Activities. We may disclose your protected health information to a health
oversight agency for activities including audits; civil, administrative, or criminal investigations, proceeding, or
actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight
as authorized by law. We will not disclose your health information if you are the subject of an investigation
and your health information is not directly related to your receipt of health care or public benefits.
E. In Connection With Judicial and Administrative Proceedings. We may disclose your protected health
information in the course of any judicial or administrative proceeding in response to an order of a court or
administrative tribunal as expressly authorized by such order or in response to a signed authorization (in a
format approved by the Michigan Court Administrator).
F. For Law Enforcement Purposes. We may disclose your protected health information to a law enforcement
official for law enforcement purposes as follows:
• As required by law for reporting of certain types of wounds or other physical injuries
• Pursuant to court order, court-ordered warrant, subpoena, summons or similar process
• For the purposes of identifying or locating a suspect, fugitive, material witness or missing person
• Under certain limited circumstances, when you are the victim of a crime
• To a law enforcement official if the practice has a suspicion that your death was the result of a criminal
conduct
• In an emergency in order to report a crime.
G. For Research Purposes. We may disclose your protected health information for research when the use
or disclosure for research has been approved by an institutional review board or privacy board that has
reviewed the research proposal and research protocols to address the privacy of your protected health
information.
H. In the Event of a Serious Threat to health or Safety. We may, consistent with applicable law and ethical
standards of conduct, use or disclose your protected health information if we believe, in good faith, that such
a disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to
the health and safety of the public.
I. For Specified Government Functions. In certain circumstances, the Federal regulations authorize the
practice to use or disclose your protected health information to facilitate specified government functions
relating to military and veterans activities, national security and intelligence activities, protective services for
the President and others, medical suitability determinations, correctional institutions and law enforcement
custodial situations.
J. For Worker's Compensation. The practice may release your protected health information to comply with
worker's compensation laws or similar programs.
III. Uses and Disclosures Permitted Without Authorization but With Opportunity to Object
We may disclose your protected health information to your family member or a close personal friend if it is
directly relevant to the person's involvement in your care or payment related to your care. We can also
disclose your information in connection with trying to locate or notify family members or others involved in
your care concerning your location, condition or death.
You may object to these disclosures. If you do not object to these disclosures or we can infer from the
circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is
in your best interests for us to make disclosure of information that is directly relevant to the person's
involvement with your care, we may disclose your protected health information as described.
IV. Uses and Disclosures Which You Authorize
Other than as stated above, we will not disclose your health information other than with your written
authorization. You may revoke your authorization in writing at any time except to the extent that we have
taken action in reliance upon the authorization.
V. Your Rights
You have the following rights regarding your health information:
A. The right to inspect and copy your protected health information. You may inspect and obtain a copy of
your protected health information that is contained in a designated record set for as long as we maintain the
protected health information. A 'designated record set' contains medical and billing records and any other
records that your therapist and the practice uses for making decisions about you.
Under Federal law, however, you may not inspect or copy the following records: psychotherapy notes;
information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or
proceeding; and protected health information that is subject to a law that prohibits access to protected
health information. Depending on the circumstances, you may have the right to have a decision to deny
access reviewed.
We may deny your request to inspect or copy your protected health information if, in our professional
judgment, we determine that the access requested is likely to endanger your life or safety or that of another
person referenced within the information. You have the right to request a review of this decision.
To inspect and copy your medical information, you may be asked to submit a written request to the Privacy
Officer whose contact information is listed at the end of the Notice. If you request a copy of your information,
we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with
your request. Please contact our Privacy Officer if you have questions about access to your medical record.
B. The Right to Request a Restriction on Uses and Disclosures of Your Protected health Information. You
may ask us not to disclose certain parts of your protected health information for the purposes of treatment,
payment or health care operations. You may also request that we not disclose your health information to
family members or friends who may be involved in your care or for notification purposes as described in this
document. Your request must state the specific restriction requested and to whom you want the restriction to
apply.
The practice is not required to agree to a restriction that you may request. We will notify you if we deny your
request to a restriction. If the practice does agree to the requested restriction, we may not use or disclose
your protected health information in violation of the restriction unless it is needed to provide emergency
treatment. You may request a restriction by contacting the Privacy Officer.
C. The right to Request to Receive Confidential Communications from us by Alternative Means or at an
Alternative Location. You have the right to request that we communicate with you in certain ways. We will
accommodate reasonable requests. We may condition this accommodation by asking you for information as
to how payment will be handled or specification of an alternative address or other method of contact. We will
not require you to provide an explanation of your request which must be made in writing to the Privacy
Officer.
D. The Right to Have Your Physician Amend Your Protected health Information. You may request an
amendment of protected health information about you in a designated record set for as long as we maintain
this information. In certain cases, we may deny your request for an amendment. If we deny your request for
amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to
your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in
writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to
support the requested amendments.
E. The Right to Receive an Accounting. You have the right to request an accounting of certain disclosures
of your protected health information made by the practice. This right applies to disclosures for purposes
other than treatment, payment or health care operations as described in this document. We are also not
required to account for disclosures that you requested, disclosures that you agreed to by signing an
authorization form, disclosures for a facility directory, to friends or family members involved in your care, or
certain other disclosures we are permitted to make without your authorization. The request for an accounting
must be made in writing to our Privacy Officer. The request should specify the time period sought for the
accounting. We are not required to provide an accounting of the disclosures that take place prior to April 14,
2003. Accounting requests may not be made for periods of time in excess of six years. We will provide the
first accounting you request during any 12-month period without charge. Subsequent accounting requests
may be subject to a reasonable cost-based fee.
F. The Right to Obtain a Paper Copy of this Notice. Upon request, we will provide a separate paper copy of
this notice even if you have already received a copy of the notice or have agreed to this notice electronically.
VI. Our Duties
The practice is required by law to maintain the privacy of your protected health information and to provide
you with this Notice of our duties and privacy practices. We are required to abide by terms of this Notice as
may be amended from time to time. We reserve the right to change the terms of this Notice and to make the
new Notice provisions effective for all protected health information that we maintain. If the practice changes
this Notice, we will provide a copy of the revised Notice.
VII. Complaints
You have the right to express complaints to the practice and to the Secretary of health and Human services
if you believe that your privacy rights have been violated. You may complain to the practice by contacting
the practice's Privacy Officer verbally or in writing, using the contact information below. You will not be
retaliated against in any way for filing a complaint.
VIII. Contact Person
The practice's contact person for all issues regarding patient privacy and you rights under the Federal
privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be
requested by contacting the Recipient’s Rights Officer. Complaints against the practice can be mailed to the
Recipient’s Rights Officer by sending it to:
Northwest Counseling & Psychotherapy Center
30375 Northwestern Highway, Suite 200
Farmington Hills, MI 48334
(248) 254-3332
northwestcounseling@yahoo.com
The Recipient's Rights Officer, Hillary Turk, can be contacted by telephone at (248) 254-3332.
IX. Effective Date
This Notice is effective February 1, 2010.
