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Notice of Privacy Practices

HIPAA requires that we give you the following Notice of Privacy Practices, which reads as a legal document. Most of the points were covered in “softer” ways in the Client Services Agreement, above, but please read both parts. After you read the entire document, we will ask you to sign a form showing that you agree to abide by the Client Services Agreement and the Notice of Privacy Practices.

This notice describes how clinical and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Uses and Disclosures for Treatment, Payment, and Health Care Operations

Richmond Creative Counseling (RCC) may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:

“PHI” refers to information in your health record that could identify you.


“Treatment, Payment and Health Care Operations”

is when your provider provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when your therapist or psychiatric provider consults with another health care provider, such as your family physician or another psychotherapist.

Payment is when your provider obtains reimbursement for your healthcare. Examples of payment are when your provider discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.


Health Care Operations are activities that relate to the performance and operation of RCC’s practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

“Use”applies only to activities within RCC’s office such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

applies to activities outside of RCC’s office, such as releasing, transferring, or providing access to information about you to other parties.

Uses and Disclosures Requiring Authorization
RCC may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when your provider is asked for information for purposes outside of treatment, payment or health care operations, your provider will obtain an authorization from you before releasing this information. As a general rule, RCC does not release providers’ personal Psychotherapy Notes. “Psychotherapy Notes” are notes your provider has made about your conversation during a private, group, couple’s, or family counseling session, which your provider has kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You may revoke the authorization for release of your PHI at any time, provided the revocation is in writing. You may not revoke an authorization to the extent that (1) your provider has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage since the law provides the insurer the right to contest the claim under the policy.

Uses and Disclosures with Neither Consent nor Authorization


RCC may use or disclose PHI without your consent or authorization in the following circumstances:

  • Child Abuse – If your provider has reasonable cause to believe that a child has been abused, they must report that belief to the appropriate authority.

  • Adult and Domestic Abuse – If your provider has reasonable cause to believe that a disabled adult or elder person has had a physical injury or injuries inflicted upon such disabled adult or elder person, other than by accidental means, or has been neglected or exploited, they must report that belief to the appropriate authority.

  • Health Oversight Activities – If your provider is the subject of an inquiry by their licensing board, they may be required to disclose protected health information regarding you in proceedings before the Board. Your RCC provider will attempt to inform you and explain what has to be revealed.

  • Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made about the professional services RCC provided you or the records thereof, such information is privileged under state law, and RCC will not release information without your written consent or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.


  • Serious Threat to Health or Safety – If your RCC provider determines, or pursuant to the standards of their profession should determine, that you present a serious danger of violence to yourself or another, your provider may disclose information in order to provide protection against such danger for you or the intended victim.

  • We may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.Worker’s Compensation


Your Rights and Our Duties

  • Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information. However, RCC is not required to agree to a restriction you request.

  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing a provider at RCC. On your request, RCC will not leave messages for you on your home answering machine, as long as your provider has an alternative way of contacting you.)

  • Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. RCC may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, RCC will discuss with you the details of the request and denial process.

  • Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. RCC may deny your request. On your request, your provider will discuss with you the details of the amendment process.

  • Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, RCC will discuss with you the details of the accounting process.

  • Right to obtain a paper copy of the notice from RCC upon request, even if you have agreed to receive the notice electronically.Right to a Paper Copy – You


RCC Provider Duties:

RCC providers are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.

RCC reserves the right to change the privacy policies and practices described in this notice. Unless RCC notifies you of such changes, however, RCC is required to abide by the terms currently in effect.

If RCC revises our policies and procedures, we will provide a copy of these changes to you through our Patient Portal.

If you are concerned that your provider has violated your privacy rights, or you disagree with a decision made about access to your records, you may contact Carrie J. Walker, LPC at (804) 592-6311. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. Your provider can provide you with the appropriate address upon request.

Effective Date, Restrictions, and Changes to Privacy Policy
This notice will go into effect on 11/26/12. It was revised on 4/4/16, 11/28/16, 12/28/17, 12/10/18, 12/1/19, 9/20/20, 12/13/21, and 6/26/23.

RCC reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain. If this should occur, we will provide you a written copy of the revised notice.

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