Interactions Therapy Center
Dr. Gail Gabbert, D. Min., LMFT, CRADC

Notice of Privacy Practices

This notice includes a description of how medical information may be used and disclosed
and how this information is accessed. Please review it carefully.

Confidentiality
Federal and Illinois law and regulations protect the confidentiality of your records.
The principal purpose of maintaining information about you is to document your assessment, treatment, and follow up activities. The highest professional standards will be adhered to in maintaining your record.

The two federal laws that protect your health information are the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Confidentiality Law 42 C.F.R part 2. Under these laws, Interactions Therapy Center may not inform others that you attend counseling or disclose any other protected information except as permitted by federal law.

Disclosures of Information
Interactions may disclose your Protected Health Information (PHI) for many different reasons. For some of these uses of disclosures, prior authorization is required; for others, it is not. Below are the different categories of uses and disclosures:

PHI can be used without consent for the following reasons:

1. Coordination of treatment with other licensed health care providers.
2. To obtain payment for treatment. Interactions can use and disclose PHI to bill and collect
   payment for the treatment and services provided from billing companies, claims    processing companies, and others that process health care claims.
3. For health care operations within the normal course of business operation such as   accountants, attorneys and consultants.

Under federal and state regulations, certain disclosures of information may be made:

1. When the client consents in writing. Any such written consent may be revoked in writing.
2. Pursuant to an agreement with a qualified service organization/business associate.
3. When the disclosure is allowed by a valid court order.
4. In case of an emergency, and if you are not able to give or refuse permission, we will share
   only the information that is directly necessary for obtaining emergency care for you,
   according to our professional judgement.
5. If there is a situation of danger to self or others or where the safety of the public or an    individual is concerned, Interactions Therapy Center may be required to notify the intended    victim and/or law enforcement officials.
6. When there is suspected child or elder abuse and neglect.
7. When a crime is committed by a client at Interactions Therapy Center, or against any person    who works for Interactions, or when there is a threat to commit such a crime.

No more protected health information (PHI) may be used than is necessary to accomplish the purpose for which the use or disclosure is made.

YOUR RIGHTS Under HIPAA
You have the right to request restrictions on certain uses and disclosures your information. Interactions is not required to agree to any restrictions you request, but if we do agree then we are bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.

You have the right to request that we communicate with you by alternative means alternative location. Interactions will accommodate such requests that are reasonable.

Under HIPAA you also have the right to inspect and copy your own health information maintained by Interactions except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances. Such requests are to be made in writing. A reasonable fee for copying may be imposed.

Under HIPAA you also have the right, with some exceptions, to amend health care Information maintained in your records. Your request must be in writing, and it must explain why the information should be amended. We may deny your request, but if we do, we will provide
a written explanation. If we accept your request to amend the information, we will make
reasonable efforts to include the changes in any future disclosures of that information.

You have the right to request and receive an accounting of disclosures of your health related information made by Interactions during the six years prior to your request. You also have a
right to receive a paper copy of this notice.

Violation of the federal and state law and regulations by Interactions is a crime. Suspected violations may be reported to appropriate authorities. You may complain to your counselor
and the Secretary of the U.S. Department of Health and Human Services at 200 Independence Ave. SW, Washington, D.C., 20201 or call 1-977-696-6775 if you believe that your privacy
rights have been violated under HIPAA. You will not be retaliated against for filing such a complaint.

Interactions reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. Your signature below
means have read this document, understand it, have been given the opportunity to ask
questions for clarification. You may print this notice.

This notice became effective on April 14, 2003.