Privacy Policy

Counseling Services of Hawaii, LLC

NOTICE OF PRIVACY PRACTICES

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

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care created, received, or maintained by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information.

I. MY PLEDGE & RESPONSIBILITIES

I am required by law to maintain the privacy and security of your protected health information (PHI).

• Notification of Privacy Practices: I must give you this notice of my legal duties and privacy practices with respect to health information.

• Legal Duties: I must follow the duties and privacy practices described in this notice.

• Breach Notification: I will let you know promptly (and no later than 60 days) if a breach occurs that may have compromised the privacy or security of your information.

• Changes to Terms: I can change the terms of this notice; changes will apply to all information I have about you. The new notice will be available in my office and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order 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 in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit or dispute, I may disclose your Protected Health Information (PHI) in response to a court or administrative order. I may also disclose PHI in response to a subpoena or discovery request, but only after making a good-faith effort to notify you.

As an LCSW in Hawaii, my policy is to assert therapist-client privilege (HRS § 467E-15 and HRE 504.1) on your behalf upon receipt of a subpoena. This protects your privacy until you provide written authorization or a judge directs otherwise.

Special Note (SUD Records): If your records contain substance use disorder (SUD) information protected by 42 CFR Part 2, I am a lawful holder of that information, and it will not be disclosed in legal proceedings against you without your specific written consent or a specialized court order and subpoena, as required by federal law.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

Psychotherapy Notes: I may keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

• For my use in treating you.

• For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

• For my use in defending myself in legal proceedings instituted by you.

• For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

• Required by law and the use or disclosure is limited to the requirements of such law.

• Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

• Required by a coroner who is performing duties authorized by law.

• Required to help avert a serious threat to the health and safety of others.

Marketing Purposes: I will not use or disclose your PHI for marketing purposes without your written authorization.

Fundraising: I do not use or disclose your health information for fundraising purposes. Should this practice engage in fundraising in the future, you will be provided with a clear opportunity to opt out of receiving such communications.

Sale of PHI: As a psychotherapist, I will not sell your PHI.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

• 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 public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to the health and safety to yourself or others.

• For health oversight activities, including audits and investigations.

• For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

• For law enforcement purposes, including reporting crimes occurring on my premises.

• To coroners or medical examiners, when such individuals are performing duties authorized by law.

• For research purposes, including 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.

• Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

• For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.

• Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

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

Disclosures to family, friends, or others: I 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. Note: If you are unable to tell me your preference (e.g., unconscious), I may share your information if I believe it is in your best interest.

VI. YOUR RIGHTS

• The Right to See and Get Copies of Your PHI: You can ask to see or get a copy of your record. I will provide a copy or a summary, within 30 days of your request. I may charge a reasonable, cost-based fee for doing so. Psychotherapy notes are not part of the legal health record and you do not have a right to inspect or copy them.

• The Right to Correct or Update Your PHI: You can ask me to correct information you think is incorrect or incomplete. I may say “no,” but I will tell you why in writing within 60 days.

• The Right to Choose How I Send PHI to You: You can ask me to contact you in a specific way (home/office phone) or at a different address. I will agree to all reasonable requests.

• The Right to Request Limits on Uses and Disclosures of Your PHI: You can ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your care.

• The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You can ask me to restrict 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. I will agree to your request not to share that information with your health insurer for payment or operations unless a law requires me to share it.

• The Right to Get a Paper or Electronic Copy of this Notice: You have the right to a paper copy of this notice at any time, even if you agreed to receive it electronically.

• The Right to An Accounting of Disclosures: You may request a list of the times I have shared your health information for the six years prior to your request. This list will not include disclosures made for treatment, payment, health care operations, or those you specifically authorized.

• The Right to Choose someone to Act For You: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. I will verify their legal authority before taking any action.

VII. SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER (SUD) RECORDS

Some of the records I receive or maintain may be protected by federal law under 42 C.F.R. Part 2. These records are subject to stricter confidentiality than standard health records.

Explicit Consent Required: Disclosure of these records requires your explicit written consent, except in limited circumstances such as:

• Medical Emergencies: To the extent necessary to treat a condition that poses an immediate threat to your health.

• Reporting Crimes: To report a crime committed against me or on my office premises.

• Child Abuse Reporting: To report suspected child abuse or neglect to the appropriate state or local authorities as mandated by state law.

• Legal Proceedings: For information on how SUD records are protected in court or lawsuits, please see the "Lawsuits and Disputes" section in Section II of this notice.

Single Consent & Redisclosure:

• If you provide a single consent for treatment, payment, and healthcare operations, I may further use or share those records as permitted by HIPAA.

• This single consent does not apply to "SUD Counseling Notes," which always require a separate, specific authorization.

• Right to Accounting: If you provide this single consent, you have the right to request an accounting of any disclosures of your SUD records made by me (or my business associates) for the 3 years prior to your request.

• Legal Protection: Even if these records are redisclosed for treatment or billing, they remain protected against use in legal proceedings against you without a specialized court order. You may revoke your consent at any time.

Requirements for Disclosure: Each disclosure made with your written consent must be accompanied by a copy of the consent or a clear explanation of its scope. It must also include a written notice stating that "42 CFR part 2 prohibits unauthorized disclosure of these records."

VIII. QUESTIONS AND COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with me or with the Secretary of the U.S. Department of Health and Human Services. I will not retaliate against you for filing a complaint.

To file a complaint with this practice, contact: Erin Rose, LCSW, Privacy Officer

Phone: 808-865-5050

Mail: PO Box 10870, Hilo, HI 96721

Email: erin@counselingservicesofhawaii.com

Please note: Standard email may not be secure. By choosing to communicate via email, you acknowledge and accept the risk that your communication could be intercepted by unauthorized third parties.

To file a complaint with the U.S. Department of Health and Human Services:

• Online: OCR Complaint Portal

• Email: OCRComplaint@hhs.gov

• Mail: Office for Civil Rights – Region IX, U.S. Dept. of Health & Human Services, 90 7th Street, Suite 4-100, San Francisco, CA 94103

• Customer Response Center: (800) 368-1019 | TDD: (800) 537-7697

EFFECTIVE DATE: March 19, 2026

ACKNOWLEDGEMENT OF RECEIPT

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.  By signing below (or electronically agreeing), you acknowledge that you have received a copy of this Notice of Privacy Practices from Counseling Services of Hawaii, LLC.