Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. HEART COUNSELING, LLC‘S PLEDGE REGARDING HEALTH INFORMATION:

HEART Counseling, LLC understands that health information about you and your health care is personal. We are committed to protecting this information. Your privacy is already protected under Wisconsin law.

HEART Counseling, LLC creates a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice of Privacy Practices (“Notice”) applies to all of the records of your care generated by HEART Counseling, LLC. This Notice will tell you about the ways in which we may use and disclose health information about you. It also describes your rights to the health information we keep about you and describes certain obligations we have regarding the use and disclosure of your health information.

HEART Counseling, LLC is required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of our legal duties and privacy practices with respect to PHI. 
• Notify you in the event a breach of unsecured PHI occurs.
• Follow the terms of the Notice that is currently in effect.
• Send you a new notice if our privacy policies change.

HEART Counseling, LLC can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in the HEART Counseling, LLC office and on our website.

II. HOW HEART COUNSELING, LLC MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU FOR YOUR TREATMENT, PAYMENT, OR HEALTHCARE OPERATIONS:

The following categories describe different ways that we may use and disclose health information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways in which we are permitted to use and disclose information for treatment, payment or operations are as follows:

1. For Treatment: HEART Counseling, LLC may use or disclose your PHI to provide, coordinate, or manage your health care. For example: If we were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, to assist the clinician in diagnosis and treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard because therapists and other health care providers need access to the full record and/or full and complete information to provide quality care.
2. To Obtain Payment for Treatment: HEART Counseling, LLC may use or disclose your health care information to obtain payment for your health care services. In order for an insurance company to pay for your treatment, a claim must be submitted that identifies you, your diagnosis, and the treatment provided to you.
3. For Health Care Operations: HEART Counseling, LLC may use or disclose your health care information for activities relating to the evaluation of patient care, evaluating the performance of healthcare providers, business planning, and compliance with law. For example: in order to improve the quality or cost of care delivered.
4. Employees and Business Associates:  There may be instances where services are provided to HEART Counseling, LLC by an employee or through contracts with third-party “business associates.” Whenever an employee or business associate arrangement involves the use or disclosure of your PHI, HEART Counseling, LLC will have a written contract that requires the employee or business associate to maintain the same high standards of safeguarding your privacy that is required of HEART Counseling, LLC.

III. PSYCHOTHERAPY NOTES: HEART Counseling, LLC keeps “Psychotherapy Notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes and records requires your authorization unless the use or disclosure is:

1. 1. For HEART Counseling, LLC’s use in treating you.
   2. For HEART Counseling, LLC’s use in training or supervising mental health practitioners to help them improve their skills in group, joint, couples, family, or individual counseling or therapy.
   3. For HEART Counseling, LLC’s use in defending ourselves in legal proceedings instituted by you.
   4. For use by the Secretary of Health and Human Services to investigate HEART Counseling, LLC’s compliance with HIPAA.
   5. Required by law and the use or disclosure is limited to the requirements of such law.
   6. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
   7. Required by a coroner who is performing duties authorized by law.
   8. Required to help avert a serious threat to the health and safety of others.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, HEART Counseling, LLC can use and disclose your PHI without your authorization for the following reasons:

1. 1. Treatment, payment, or health care operations as stated above in Section II.
   2. Required by Law: When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law. For example: HEART Counseling, LLC may disclose PHI in response to a court or administrative order. We may also disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
   3. For Judicial and Administrative Proceedings, Court, or Other Hearings: Your information may be disclosed to respond to, or comply with, a court or administrative order. Under some limited circumstances, HEART Counseling, LLC will request your authorization prior to permitting disclosure.
   4. For Public Health Activities: Information may be reported to a public health authority authorized by law to collect or receive information to help prevent or control disease, injury, disability, or infection exposure, and child abuse and family violence, such as suspected child, elder, or dependent adult abuse.
   5. For Public Safety: Your information may be disclosed to prevent, lessen, or reduce a serious threat to anyone’s health or safety – including yourself, another person, or the general public.
   6. For Health Oversight Activities: Information may be shared with government agencies to provide oversight of the healthcare system. This may include licensing and inspections, audits, investigations, or other proceedings relating to the oversight of the healthcare system or government benefit programs.
   7. For Law Enforcement Purposes: Your information may be disclosed to fulfill a requirement by law or law enforcement agencies. This may include reporting crimes occurring on our premises, complying with a court order, or identifying or locating a suspect, fugitive, or missing person.
   8. To Coroners, Medical Examiners, or Funeral Directors: Your information may be released to a coroner, medical examiner, and/or funeral director as needed when such individuals are performing duties authorized by law.
   9. For Research Purposes: Under certain circumstances, and only after a special approval process, we may use and disclose your medical information to help conduct research. For example: Studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
   10. For Specialized Government Functions: Your information may be used or disclosed to the government for specialized government functions. This may include: ensuring the proper execution of military missions; protecting the President of the United States; conducting national security intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
   11. For Workers’ Compensation Purposes: Your health information may be disclosed to the appropriate persons to comply with laws related to workers’ compensation or other similar programs/laws which may provide benefits for work-related injuries or illness. Under some limited circumstances, HEART Counseling, LLC will request your authorization prior to permitting disclosure.
   12. For Organ Donations: If you are an organ donor, information may be given to the organization that finds or transplants organs for the purpose of an organ transplantation or donation.
   13. Disclosures to Plan Sponsors: We may disclose health information to the sponsor of your group health plan for purposes of administering benefits under the plan. If you have a group health plan, your employer is the plan sponsor.
   14. Marketing: Appointment reminders and health related benefits or services: HEART Counseling, LLC may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health-related services or benefits that we offer.
   15. As Required or Permitted by Law: In addition to the ways listed above, HEART Counseling, LLC may use or disclose your health information when that use is required or permitted by law. For example: HEART Counseling, LLC may be required to report some of your health information to legal authorities such as law enforcement officials, court officials, or government agencies.
   16. Applicability of More Stringent State Law: Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that are more stringent than federal laws, including disclosures related to mental health and substance abuse, developmental disability, alcohol and other drug abuse (AODA), and HIV testing.
   17. Minors: If you are a minor (under 18 years of age), HEART Counseling, LLC may be compelled to release certain types of information to your parent(s) or guardian in accordance with applicable law. Here are the ways this information would be released, in accordance with Wisconsin law and HEART Counseling, LLC’s policies:
       1. For Minor Clients Age 13 & Under:
          1. Minor Clients Age 13 & Under: You have a right to view your records, however, you must view your records in the presence of a parent/guardian, attorney, judge, or HEART Counseling, LLC staff member. 
          2. Parents of Minor Clients Age 13 & Under: Except in unusual circumstances that involve danger to yourself or others, parents have the right to a copy of their child’s records.
       2. For Minor Clients Age 14-17:
          1. Minor Clients Age 14-17: You have a right to view your records. You can consent to release your own mental health treatment records to others. HEART Counseling, LLC requires you to consent to release your treatment records to your parents if you are ages 14-17. 
          2. Parents of Minor Clients Age 14-17: HEART Counseling, LLC requires clients ages 14-17 to consent in order to release their treatment records to parents.

NOTE: Regardless of your age, HEART Counseling, LLC may limit how much you may see of your records; they will give you reasons for any limits.

Except for the situations listed above in Sections II, III, and IV, HEART Counseling will not use or disclose your health care information without your written authorization. 

If you sign an authorization form, you may withdraw your authorization at any time as long as your withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to HEART Counseling, LLC. If you revoke your authorization, HEART Counseling will no longer be able to use or disclose your health information for the reasons covered by your written authorization, though HEART Counseling, LLC will not be able to take back any disclosures it has already made with your consent.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. 1. Disclosures to family, friends, or others. HEART Counseling, LLC may provide your PHI to a family member, friend, or other person that you indicate is involved in your care, or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. 1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask HEART Counseling, LLC not to use or disclose certain PHI for treatment, payment, or health care operations purposes. HEART Counseling, LLC is not required to agree to your request, and may say “no” if we believe it would affect your health care. To request a restriction, you must make your request in writing to: Erin Neill, HEART Counseling, LLC, 7633 Ganser Way, Suite 200, Madison, WI 53719.
   2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. To request a restriction, you must make your request in writing to: Erin Neill, HEART Counseling, LLC, 7633 Ganser Way, Suite 200, Madison, WI 53719.
   3. The Right to Choose How We Send PHI to You. You have the right to ask HEART Counseling, LLC to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests. To request confidential communications be sent to you in a specific way, you must make your request in writing to: Erin Neill, HEART Counseling, LLC, 7633 Ganser Way, Suite 200, Madison, WI 53719.
   4. The Right to See and Get Copies of Your PHI. Other than “Psychotherapy Notes” or information gathered for judicial proceedings, you have the right to get an electronic or paper copy of your medical record and other information that HEART Counseling, LLC has about you. If the form and format is not readily available, then HEART Counseling, LLC will work with you to provide it in a reasonable electronic format. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so. Your right to inspection or access must be submitted in writing to: Erin Neill, HEART Counseling, LLC, 7633 Ganser Way, Suite 200, Madison, WI 53719.
   5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which HEART Counseling, LLC has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. HEART Counseling, LLC will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost-based fee for each additional request. To request an accounting of disclosures, you must make your request in writing to: Erin Neill, HEART Counseling, LLC, 7633 Ganser Way, Suite 200, Madison, WI 53719.
   6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that HEART Counseling, LLC correct the existing information or add the missing information. You may be asked to make such requests in writing and to give a reason as to why your health information should be changed. However, if HEART Counseling, LLC did not create the health information that you believe is incorrect or if we disagree with you and believe your health information is correct, we may say “no” to your request. If we say no to your request, we will tell you why in writing within 60 days of receiving your request. To request an amendment, you must make your request in writing to: Erin Neill, HEART Counseling, LLC, 7633 Ganser Way, Suite 200, Madison, WI 53719.
   7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it. To receive a paper or electronic copy of this Notice, you must make your request in writing to: Erin Neill, HEART Counseling, LLC, 7633 Ganser Way, Suite 200, Madison, WI 53719.
   8. Notification of a Breach. HEART Counseling, LLC is required by law to maintain the privacy of your PHI and provide you with a notice of its legal duties and privacy practices with respect to PHI and to notify you following a breach of unsecured PHI.
   9. Complaints. If you believe your privacy rights have been violated, you may file a complaint with HEART Counseling, LLC and with the federal Department of Health and Human Services. There will be no retaliation against you in any way for filing a complaint.

If you have any questions or concerns regarding your privacy rights or the information in this notice, please contact: 

Erin L. Neill, PhD, LCSW 
Owner/President, Security Officer, & Privacy Official
HEART Counseling, LLC
7633 Ganser Way, Suite 200, Madison, WI 53719
Phone: 608-688-3200
EFFECTIVE DATE OF THIS NOTICE: This revised notice went into effect on May 18, 2026.