Your counselor is providing telehealth services using Counsol, which is a secure HIPAA-compliant electronic health management platform for mental health professionals.  Your counselor also employs software and hardware tools that adhere to security best practices and applicable legal standards for the purposes of protecting your privacy, and ensuring that records of your health care services are not compromised, lost, or damaged.

There are potential benefits associated with telehealth, such as:

a.  Being able to receive services at times or places where service may not otherwise be available.

b.  Being able to receive services in a way that may be more convenient and less prone to delays than in-person meetings.

c.  Being able to receive services when you are unable to travel to the counselor's office.

d.  The unique characteristics of telehealth may also help some people make improved progress on goals that may not have been otherwise achievable without telehealth.

There are potential risks associated with telehealth, such as:

a.  Telehealth can be impacted by technical failures, such as interruption of internet connections, sudden failure of computer or smartphone hardware, and/or unexpected loss of power.

b.  Interruptions may disrupt service at important moments, and your counselor may be unable to reach you quickly or using the most effective tools.

c.  Use of telehealth may introduce risks to your privacy that wouldn't otherwise exist using in-person services.

d.  Your counselor will be limited in their ability to respond to emergencies.

Under no circumstances will there be recording of any online sessions by either yourself, or your counselor. All information disclosed within sessions and written records pertaining to those sessions are confidential and may not be disclosed to anyone without written authorization, except where the disclosure is permitted and/or required by law.  The privacy laws that protect the confidentiality of your protected health information (PHI) also apply to telehealth unless an exception to confidentiality applies (i.e. mandatory reporting of child, elder, or vulnerable adult abuse; danger to self or others; you raise mental/emotional health as an issue in a legal proceeding).

You will be responsible for:  a) providing the necessary computer, telecommunications equipment and internet access for your telehealth sessions, b) ensuring security on your device, and c) arranging a location with sufficient lighting and privacy that is free from distractions or intrusions for your telehealth session.  Please use reasonable security protocols to protect the privacy of your own health care information.  

During a telehealth session, technical difficulties resulting in service interruptions can be encountered.  If you are unable to reconnect within 15 minutes, please call your counselor at 210-281-5491 (office) or 210-294-0390 (cell) since your session will have to be rescheduled.

When receiving telehealth services, your counselor will need to know where you are in case of an emergency.  You must agree to inform your counselor of your location at the beginning of each session.  You must also agree to provide an emergency contact that your counselor may call on your behalf in the event of an emergency.

If you are having suicidal or homicidal thoughts, actively experiencing psychotic symptoms, or experiencing a mental health crisis that cannot be resolved remotely, it may be determined that telehealth services are not appropriate and a higher level of care is required.  Counseling via telehealth is not a good fit for every person or situation.  Your counselor will continually assess if working via telehealth is appropriate for your case.  If it is not appropriate, your counselor will either recommend you be seen in-person, or will help you find another counselor with whom to continue services.

Please let your counselor know if you find using telehealth difficult for any reason.  You have the right to stop receiving services by telehealth at any time.  If your counselor is also providing services in-person and you are reasonably able to access the counselor's office, you will not be prevented from accessing those services if you choose to stop using telehealth.

You have the right to withdraw your consent for telehealth at any time without affecting your right to future care, or services to which you would otherwise be entitled.

By signing this form, you are agreeing to allow Joslyn Drzymalla MA LPC-S NCC and Stone Pathways Counseling Services, PLLC to use your PHI and to send it to others for the purposes described above. Your signature below acknowledges you have read or heard of our Notice of Privacy Practices, which explains in more detail what your rights are and how we can use and share your information. In the future, we may change how we use and share your information, and we may change our Notice of Privacy Practices. If we do make changes, you will be notified and asked to sign a new consent form.

If you need more information or have questions about your PHI, please speak to our staff. After you have signed, you have the right to revoke your consent in writing. We will then stop sharing your PHI, but we may already have used or shared some of it and cannot change that.

Privacy is a very important concern for all those who come to this office. It is also complicated, because of many federal and state laws and professional ethics. Because the rules are so complicated, some parts of this notice are very detailed, and you probably will have to read them several times to understand them. For the purposes of this document, "you" means client, parent, or legal guardian; "we" and "our" means Stone Pathways Counseling Services, PLLC and its independently licensed therapists working on behalf of Stone Pathways Counseling Services, PLLC.  The independently licensed therapists at Stone Pathways Counseling Services, PLLC may also provide services outside and separate from Stone Pathways Counseling Services, PLLC. This notice of privacy practices applies only to services provided by these therapists at or on the behalf of Stone Pathways Counseling Services, PLLC and does not apply to any other services these therapists may provide outside and separate from this agency. If you have any questions, we will be happy to help you understand our procedures and your rights.

A. Introduction: This notice will tell you how we handle your medical information. It tells how we use this information here in this office, how we share it with other professionals and organizations, and how you can see it. We want you to know all of this so that you can make the best decisions for yourself and your family. If you have any questions or want to know more about anything in this notice, please ask us for more explanations or more details.

B. Types of Protected Health Information: Each time you visit us or any doctor's office, hospital, clinic, or other health care provider, information is collected about you and your physical and mental health. It may be information about your past, present, or future health or conditions, or the tests and treatment you got from us or from others, or about payment for health care. The information we collect from you is called "PHI," which stands for Protected Health Information. This information goes into your medical or health care records in our office. Your PHI is likely to include these kinds of information:

History: Your personal history, school or work history, and family history.

Diagnoses: The health care terms used to describe your symptoms.

Treatment plan: A list of goals and services to assist with your presenting concerns.

Progress notes: This is what your therapist writes regarding your progress in therapy.

Records: These are documents we get from healthcare professionals who've treated you.

C. Privacy Practices: We are required to tell you about our privacy practices because of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires us to keep your PHI private and to give you this notice about our privacy practices. We will obey the rules described in this notice. If we change our privacy practices, they will apply to all the PHI we keep. We will also post the new Notice of Privacy Practices in our office. You or anyone else can also get a copy from us at any time.

D. Using and Disclosing Protected Health Information: When we use your PHI in this office or disclose it to others, we share only the minimum necessary PHI needed for those other people to do their jobs. The law gives you rights to know about your PHI, to know how it is used, and to have a say in how it is shared. Mainly, we use and disclose your PHI for routine purposes to provide your care, and we will explain more about these purposes below. For other uses, we must tell you about them and ask you to sign a written authorization form. However, the law also says there are some uses and disclosures that don't need your consent or authorization.

After you have read this notice, you will be asked to sign a separate consent form called the Consent to Use Your Protected Health Information to allow us to use and share your PHI. In almost all cases we intend to use your PHI within our office or share it with other organizations or individuals to provide treatment to you, arrange for payment for our services, or some other business functions called "health care operations."  In other words, we need information about you and your condition to provide care to you. You have to agree to let us collect the information, use it, and share it to care for you properly. Therefore, you must sign the consent form before we begin to treat you. If you do not agree and consent, we cannot treat you.

For treatment. We use your PHI to provide you with counseling services. These services might include individual counseling, couples counseling, family counseling, group counseling, and diagnostic evaluations.

For payment. We may use your PHI to bill you, your insurance, or others, so your therapist can be paid for the services they provide to you. We may contact your insurance company to find out exactly what your insurance covers. We may have to tell them about your diagnoses, what services you have received, and the changes we expect in your conditions. We will need to tell them about when you met with your therapist, your progress, and other similar things.

For health care operations. Using or disclosing your PHI for health care operations goes beyond our care and your payment. For example, we may use your PHI to see where we can make improvements in the care and services we provide. We may be required to supply some information to government health agencies, so they can study disorders and treatment and make plans for services that are needed. If we do, your name and personal information will be removed from what we send.

For referrals. We may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of help to you or tell you about health-related benefits or services that may be of interest to you.

For appointment reminders. We may use and disclose your PHI to reschedule or remind you of appointments. If you want us to call or write to you at your home or your work, or you prefer some other way to reach you, we can arrange that.

For business associates. Stone Pathways Counseling Services, PLLC and our independently licensed therapists may hire other businesses or individuals to perform duties on their behalf. They are called "business associates." Examples include a copy service to make copies of your health records or a billing service to process, print, and mail bills. These business associates need to receive some of your PHI to do their jobs properly. To protect your privacy, they have agreed in their contract with us and your therapist to safeguard your information.

If your therapist wants to use your PHI for a purpose not previously listed, we need your written and signed permission on a Release of Information form.  For example, your therapist may share your PHI with other treatment providers, such as your primary care physician, psychiatrist, or other healthcare professionals. In return, other healthcare professionals may share records with your therapist to assist them in creating a treatment plan. We may refer you to other professionals for services we cannot provide. When we do this, we need to provide them with your PHI. When we receive their findings, those documents will go into your records here. If you receive treatment in the future from other professionals, we can also share your PHI with them with your written and signed permission on a Release of Information form.

In addition, we can share PHI with your family with your written and signed permission on a Release of Information form. We will only share information with those involved in your care and anyone else you choose, such as close friends. Our staff will ask you which persons you want us to tell, and what information you want us to tell them.

The law requires us to use and disclose some of your PHI without your consent or authorization in some cases. Here are some examples of when we might do this. There are some federal, state, and local laws that require your therapist to disclose PHI:

Legal proceedings. If you are involved in a lawsuit or legal proceeding, and we receive a subpoena, discovery request, or other lawful process, we may have to release some of your PHI.  We will only do so after trying to tell you about the request, consulting your lawyer, or trying to get a court order to protect the information they requested.

Abuse. If you make statements that give us reasonable cause to believe and/or suspect that a child, elderly, or disabled person has been abused or neglected, we are required to report that information to the appropriate authorities within 48 hours.

Threat to self or others. If you make statements that indicate a probability of imminent physical injury by you to yourself or others (e.g. suicide or homicide).

Professional Misconduct. If you make statements that give us reasonable cause to suspect that another professional has engaged in an inappropriate, sexual, or exploitative relationship with you, we are required to report that information within 3 business days to the appropriate licensing board and prosecuting attorney.

Audits. We have to disclose some information to the government agencies that check on us to see that we are obeying the privacy laws.

Law enforcement. We may release PHI if asked to do so by a law enforcement official to investigate a crime or criminal offense.

Public health. We may disclose some of your PHI to agencies that investigate diseases.

Government functions. We may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment. We may disclose PHI to workers' compensation and disability programs, to correctional facilities if you are an inmate, or to other government agencies for national security reasons.

If you do allow us to use or disclose your PHI, you can cancel that permission in writing at any time. We would then stop using or disclosing your information for that purpose. Of course, we cannot take back any information we have already disclosed or used with your permission.

If it is an emergency, and so we cannot ask if you disagree, we can share information if we believe that it is what you would have wanted and if we believe it will help you if we do share it. If we do share information, in an emergency, we will tell you as soon as we can. If you don't approve, then we will stop.  Again, we cannot take back any information we have already disclosed.

When we disclose your PHI, we may keep records of who we sent it to, when we sent it, and what we sent. You have the right to look at the health information we have about you, such as your clinical and billing records. You can request a copy of these records in writing, but we may charge you. Contact us to arrange how to request your records.

You can ask us to communicate with you about your health and related issues in a particular way or at a certain place that is more private for you. For example, you can ask our staff to call you at home and not at work, to schedule or cancel an appointment.

E. Privacy Rights

Requesting limits. You have the right to ask us to limit what we tell people involved in your care or with payment for your care, such as family members and friends. We don't have to agree to your request, but if we do agree, we will honor it except when it is against the law, or in an emergency, or when the information is necessary to treat you.

Requesting copies. You have the right to a copy of this notice. If we change this notice, we will post the new one and you can always get a copy from us.

Filing complaints. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with us and with the U.S. Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.

Other rights. You may have other rights granted to you by the laws of our state, and these may be the same as or different from the rights described above. Our staff will be happy to discuss these situations with you now or as they arise.

F. Questions: If you need more information or have questions about the Notice of Privacy Practices, please speak to us about them. If you have a problem with how your PHI has been handled, or if you believe your privacy rights have been violated, contact us. As stated above, you have the right to file a complaint with us and with the U.S. Department of Health and Human Services. We will not in any way limit your care or take any actions against you if you complain. If you have any questions or problems about this Notice or Privacy Practices, please contact our privacy officer, Lizette Nale, MA, LPC-S, NCC, at Stone Pathways Counseling Services, PLLC at 210-281-5491.