Privacy Notice

The Collaborative Counseling Center (CCC) Privacy Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. A hardcopy of the Privacy Notice will be provided to you upon request.


Medical information about you and your health is personal. Treating therapists create a record with information provided by you as well as information from assessments, sessions, and information that may be provided by other medical or health care professionals, (for example, your primary care physician or a specialist who is treating you.) We need this information in order to provide you with the best clinical services to meet your needs.


The following categories describe different ways that protected health information may be used and disclosed: for treatment; for health care business operations; as required by law; to avert a serious threat to your health or safety or to the health or safety of another person; for public health risks (for example, to prevent or control disease, injury, or disability, to report reactions to medications, to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition); for health oversight activities, lawsuits and disputes in response to a court order or subpoena, discovery request, or other lawful process; law enforcement in response to a court order, subpoena, warrant, summons, or similar process subject to all applicable legal requirements; coroners, medical examiners, funeral directors; information not personally identifiable.


Certain categories of protected health information have extra protections by law, and therefore require special written authorization for disclosure. For example, most uses and disclosures of psychotherapy notes require special  written authorization.


Your Rights Regarding Protected Health Information:


Right to Inspect and Copy

You have the right, with few exceptions, to inspect and copy protected health information that may be used to make decisions about your care. Typically this does not include psychotherapy notes or information gathered for judicial proceedings.

To inspect and copy your protected health information, submit a request in writing to your treating therapist. Treating therapists may charge a reasonable fee for the cost of copying, mailing, or other supplies associated with your request.


Right to Amend

If you feel that protected health information we may have about you is incorrect or incomplete, you may ask your treating therapist to amend the information. You have the right to request an amendment for as long as the information is kept by your treating therapist. Typically, medical records are kept for ten years by most treating therapists.

Requests for amendment must be done in writing and submitted to your treating therapist.

Requests for amendment may be denied if they are not in writing or if they do not include a reason to support the request. Amendment requests may also be denied if:

  • The information was not created by your treating therapist;
  • The information is not part of the information kept by your treating therapist;
  • The information is not part of the information which you would be permitted to inspect and copy; or
  • The information is accurate and complete.

Treating therapists will respond to your request in writing within sixty (60) calendar days from receipt of written request from you.


Right for an Accounting of Disclosures

You  have the right to ask for a list of the disclosures of your protected health information that your treating therapist has made during the previous six years, but the request cannot include dates before April 14, 2003. This listing will include the dates of each disclosure, who received the disclosed protected health information, a brief description of the protected health information disclosed, and the reason for the disclosure. The listing will not include the following disclosures:

  • Disclosures made for the purpose of treatment, payment, health care services, operations, or disclosures made to family or responsible caregivers;
  • Disclosures made directly to you;
  • Disclosures made based on a valid authorization from you or from your legally authorized representative;
  • Oral or incidental disclosures;
  • Disclosures made for the purpose of national security, or to correctional institutions or law enforcement officers;
  • Disclosures made prior to April 14, 2003.

You must request this listing of disclosures by submitting your request in writing to your treating therapist.

Your treating therapist will provide you with the list within sixty (60) calendar days of receipt of your request, unless you agree to a thirty (30) calendar day extension. There is no charge to you for the list, unless you request such a list more than once a year.


Right to Request Restrictions

You have the right to request restrictions on how your protected health information is used or to whom your information is disclosed, even if the restriction affects the services you receive. However, your treating therapist is not required to agree to your requested restriction and, even if the treating therapist agrees to the restriction, treating therapists are permitted to use your protected health information without complying with the restriction if necessary in an emergency situation.

Restrictions must be requested in writing. In your written request you must tell your treating therapist: (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; (3) to whom you want the limits to apply. Although your treating therapist is generally not required to agree to requested restrictions, treating therapists are required to keep your protected health information confidential if you pay for a health care service “out-of-pocket” in full, and you request that we not disclose protected health information related to that health care service(s).

You must submit requests for restrictions to your treating therapist in writing.


Right to Request Confidential Communication

You have the right to request that your treating therapist communicates with you about protected health information matters in a certain way or at a certain location. For example, you can ask that we only contact you at work, or by mail, or to not leave voicemail messages.

To request confidential communications, you must submit your request in writing to your treating therapist. The treating therapist will not ask you the reason for your request and will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.


Right to a Copy of this Notice

You have the right to a paper copy of this Notice. You may ask CCC and/or your treating therapist to provide you with a paper copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a paper copy of this Notice by contacting the Collaborative Counseling Center or your treating therapist.


Changes to this Notice

The effective date of this Notice is October 10, 2019. It will remain in effect until it is replaced by the Collaborative Counseling Center.



If you believe your privacy rights have been violated, you may file a complaint with your treating therapist or with the Secretary of the Department of Health and Human Services.

To file a complaint with your treating therapist, submit your complaint in writing to your treating therapist. You will not be penalized for filing a complaint.


Other Uses of Protected Health Information

Other uses and disclosures of protected health information not covered by this Notice or by the Collaborative Counseling Center Policy Statement will be made only with your written permission.


Revoking Permissions

If you provide CCC and/or your treating therapist permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time.

If you revoke your permission, CCC and your treating therapist will no longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that CCC and your treating therapist is unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of services we have provided to you.


If you have any questions about this notice

Please contact the Collaborative Counseling Center and/or your treating therapist with any questions you may have.