Notice of Privacy Practices
Effective Date: June 30, 2026
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED, YOUR RIGHTS REGARDING THAT INFORMATION, AND HOW YOU CAN ACCESS IT. PLEASE REVIEW IT CAREFULLY.
Counseling & Mediation Solutions LLC is committed to protecting the privacy and confidentiality of your Protected Health Information (PHI). Federal law requires us to maintain the privacy of your health information, provide you with this Notice of Privacy Practices, notify you following certain breaches of unsecured PHI, and follow the terms of this Notice.
This Notice applies to all services provided by Counseling & Mediation Solutions LLC.
Our Responsibilities
We are required by law to:
Protect the privacy and security of your Protected Health Information (PHI).
Provide you with this Notice of Privacy Practices.
Notify you if a breach occurs that may compromise the privacy or security of your information.
Follow the privacy practices described in this Notice.
Obtain your written authorization whenever required by law before using or disclosing your information.
How We May Use and Disclose Your Health Information
Treatment
We may use and disclose your health information to provide, coordinate, or manage your treatment.
Examples include:
Coordinating care with another healthcare provider.
Consulting with specialists.
Referring you to another provider when appropriate.
Payment
We may use your health information to bill and receive payment for services.
Examples include:
Verifying insurance eligibility.
Submitting claims.
Collecting payment for services rendered.
Health Care Operations
We may use your information for activities necessary to operate our practice, including:
Quality improvement
Staff training
Licensing requirements
Accreditation
Legal compliance
Business management
Whenever possible, only the minimum necessary information will be used.
Other Situations Where We May Share Information
Federal or state law may require or permit us to disclose your information for reasons including:
Public health reporting
Abuse or neglect reporting
Court orders or subpoenas
Law enforcement requests when legally required
Health oversight activities
Medical emergencies
Preventing a serious threat to health or safety
Workers’ compensation claims
Whenever legally possible, we will limit disclosures to only the information necessary.
Uses That Require Your Written Authorization
Except where permitted or required by law, we will obtain your written authorization before:
Releasing records to employers.
Sharing information with family members when not otherwise permitted.
Using your information for marketing purposes.
Selling your Protected Health Information.
Releasing psychotherapy notes except where HIPAA specifically permits.
You may revoke your authorization at any time in writing unless we have already acted upon it.
Your Rights
You have the right to:
Obtain a Copy of Your Records
You may request access to your health records in paper or electronic form.
Request Corrections
If you believe information in your record is inaccurate or incomplete, you may request an amendment.
Request Confidential Communications
You may ask us to contact you in a specific way or at a specific location.
Examples include:
Calling only your cell phone
Sending mail to a different address
Using a secure email address
Request Restrictions
You may request limits on how we use or disclose your information. While we are not always required to agree, we will comply when required by law.
Receive an Accounting of Disclosures
You may request a list of certain disclosures we have made of your health information.
Receive a Paper Copy
You have the right to receive a paper copy of this Notice at any time.
Psychotherapy Notes
Psychotherapy notes receive additional protection under HIPAA.
These notes are maintained separately from your general medical record and generally cannot be disclosed without your written authorization except in limited circumstances permitted by law.
Electronic Communication
Counseling & Mediation Solutions LLC utilizes secure technology to support patient care.
Appointment requests, intake forms, client documentation, secure messaging, and the client portal are provided through SimplePractice, a HIPAA-compliant practice management platform.
If you communicate with us through standard email or leave voicemail messages, there may be privacy risks beyond our control. We encourage clients to use the secure SimplePractice Client Portal whenever possible for sensitive communications.
Website Privacy
Our public website is intended to provide information about our services.
The website:
Uses Google Analytics to understand website usage.
Does not store client health records.
Does not store submitted counseling forms on the website itself.
Sends secure online forms directly through SimplePractice.
Our Legal Duties
We will never sell your Protected Health Information.
We limit access to your information to those who need it to perform their job responsibilities or provide your care.
We maintain administrative, technical, and physical safeguards designed to protect your information.
Changes to This Notice
We reserve the right to revise this Notice at any time. Updated versions will be available in our office and on our website. The revised Notice will apply to all Protected Health Information we maintain.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, please contact us.
Counseling & Mediation Solutions LLC
Phone: (651) 307-4993
Website: https://counselingsolutionsmn.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Filing a complaint will not affect your care or your right to receive services.
Acknowledgment of Receipt
Patients may be asked to acknowledge that they have received a copy of this Notice of Privacy Practices. Signing the acknowledgment does not mean you agree with every provision, only that you have received the Notice.