Carey Counseling, Stephanie Carey & Cameron Carey, 5301 East State St, St 202, Rockford, IL 61108, 815-703-7542
Notice of Privacy Practices
This notice describes how information about you may be used and disclosed and how you can get access to this information.
Please review this notice carefully.
Stephanie Carey holds an M.A. in Clinical Psychology from Roosevelt University and has practiced since 2005 is committed to maintaining the privacy of your protected health information (PHI) which includes information about your health condition and the therapeutic intervention that you receive. The creation of a record detailing the service you receive helps me to provide you with quality behavioral therapy services. Stephanie Carey is required by law to maintain the privacy of you and your child’s health information and to inform you of the duties and privacy practices. This notice describes some of the ways in which Stephanie Carey may use or disclose you or your child’s PHI and the rights you have concerning you or your child’s health information. Stephanie Carey is the Privacy Officer for Carey Counseling, who will oversee all activities related to implementing and monitoring compliance with the privacy rule.
Disclosure for treatment or payment
Stephanie Carey & Cameron Carey will obtain your consent for most uses and disclosures of your PHI for the purpose of:
treatment-in order to provide you with the optimal therapeutic intervention that you require, Stephanie Carey will provide your PHI to those health care professionals with your consent.
payment-in order to get paid for service provided to you, Stephanie Carey, may also need to tell your insurance plan about treatment you will receive so that it can determine whether or not it will cover the treatment expense. Private payments are $80.00 per session.
when required by law-Stephanie Carey may disclose you or your child’s PHI as required by federal, state, or local laws. For example, Stephanie Carey, may disclose information pursuant to a Federal Grand Jury subpoena.
in an emergency-Stephanie Carey may disclose you or your child’s PHI to medical or law enforcement personnel if the information is needed to prevent immediate harm to you or your child.
Your rights regarding health information
You have the right to: Control the release of your medical information and request restrictions.
-Receive a paper copy of this Privacy Notice from Stephanie Carey
-Receive and inspect a copy of the health information that Stephanie Carey has about you and your child in most situations, including medical and billing records. You must submit your request in writing to Stephanie Carey, and include a time period for which your wish to review your records. Please note that you may be charged a reasonable fee, unless a fee would prevent you from exercising this right.
-Request that Stephanie Carey communicate with you in confidence about you or your child’s PHI in a different means. For example, your may request that Stephanie Carey contact you with confidential information only at work or by mail, or communicate with you in your own language if you are non-english, or a limited-english speaker.
Safe guards to assure privacy
-Stores all records and files containing PHI in a private office in locked file cabinets.
-When such documents containing PHI are in use in the office, they will be kept secured by turning the top page over, or by placing a cover sheet on top of the document to prohibit unauthorized persons from accessing/reading PHI.
-A fax machine located in a private office that is restricted in use by employees only. A confidential cover sheet is used when faxing PHI to an individual outside of the office.
-A printer located in the private office that is restricted for use of employees only.
-Document disposal, whereby Stephanie Carey will shred documents on a needed basis. PHI will be stored in a locked file cabinet until the shredding is complete.
Stephanie Carey & Cameron Carey Requirements
-Is required by federal law to maintain the privacy of your PHI and to provide you with the Privacy Notice detailing our legal duties and privacy practice with respect to your PHI.
-Is required to abide by the terms of the Privacy Notice.
-Reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effect for your entire PHI that it maintains.
-Will distribute any revised Privacy Notice to you prior to implementation.
-Will not retaliate against you for filing a complaint.
Right to file a compaint
Office for Civil Rights
U.S. Department of Health & Human Services
233 N. Michigan Ave.-Suite 240
Chicago, IL 60601
(312)886-2359; (312)353-5693 (TDD)
(312)886-1807 fax
Illinois Department of Financial and Professional
320 West Washington St, 3rd floor
Springfield, IL 62786
(888)473-4858
