Notice of Privacy Practices

A Light for My Path Counseling, LLC

DBA: Jessica Depweg, LPC

7362 W Parks Hwy, Wasilla, AK 99623


This notice went into effect on August 28, 2023

THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION (PHI) MAY BE USED AND DISCLOSED BY JESSICA DEPWEG, LPC, A MENTAL HEALTH CLINICIAN PRACTICING IN THE STATE OF ALASKA. IT ALSO OUTLINES YOUR RIGHTS REGARDING YOUR PHI. PLEASE REVIEW THIS NOTICE CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION:

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 generated 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 am required by law to:

  • Make sure that protected health information (“PHI”) that identifies you is kept private.

  • Give you this notice of my legal duties and privacy practices with respect to health information.

  • Follow the terms of the notice that is currently in effect.

  • I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

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

I may use and disclose your PHI for purposes of treatment, payment, and healthcare operations. These uses and disclosures may include, but are not limited to:

  1. For Treatment: I use and disclose your health information internally in the course of your treatment.  If I wish to provide information outside of my practice for your treatment by another health care provider, I will have you sign an authorization for release of information.

  2. For Payment: I may use and disclose your health information to obtain payment for services provided to you as delineated in the Informed Consent of Policy and Procedures.

  3. For Operations: I may use and disclose your health information as part of our internal operations.  For example, this could mean a review of records to assure quality.  I may also use your information to tell you about services, educational activities, and programs that I feel might be of interest to you.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

Any uses or disclosures of PHI not described in this notice will be made only with your written authorization. You may revoke this authorization at any time by submitting a written request, but this will not affect any actions taken prior to the revocation.

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

Anything said in therapy is confidential and may not be revealed to a third party without written authorization, except for the following limitations:

  1. Self-Harm: Threats, plans or attempts to harm oneself.  I am permitted to take steps to protect the client’s safety, which may include disclosure of confidential information.

  2. Harm to Others: Threats regarding harm to another person.  If you threaten bodily harm or death to another person, I am required by law to report this. This includes communication to a potential victim, the family of a potential victim, law enforcement authorities, or other appropriate authorities concerning a clear and immediate probability of physical harm to the client, other individuals, or society.

  3. Consultation: A case conference or case consultation with other mental health professionals at which the client is not identified.

  4. Investigation of Complaints: Information released to the Board of Professional Counselors during an investigation of a complaint or as part of a disciplinary or other proceeding.

  5. Child Abuse: Child abuse and/or neglect, which include but are not limited to domestic violence in the presence of a child, child on child sexual acting out/abuse, physical abuse, etc.  If you reveal information about child abuse or child neglect, I am required by law to report this to the appropriate authority as required by AS 47.17.

  6. Vulnerable Adult Abuse: Vulnerable adult abuse or neglect.  If information is revealed about vulnerable adult or elder abuse, I am required by law to report this to the appropriate authority as required by AS 47.24.

  7. Funeral Directors/Coroners/State Medical Examiner: I will disclose PHI about you to funeral directors, coroners, and the state medical examiner, consistent with applicable law, to allow them to carry out their duties.

  8. Workers’ Compensation Laws: I will disclose PHI when required by state law and/or when you have made a workers’ compensation claim that provides benefits for work-related injuries or illness.

  9. Correctional Institutions: If you are in jail or prison, I may disclose your PHI in accordance with state law and regulations to the Department of Corrections for your health and the health and safety of others.

  10. Law Enforcement: I may disclose your PHI to law enforcement for certain purposes, such as to report injuries caused by guns or knives, or when it is suspected that criminal conduct occurred at the location of services, or to avert a serious and imminent threat to health and safety, or when legally required to do so, such as when we receive a valid subpoena or court order.

  11. Court Orders & Legal Issued Subpoenas: If I receive a subpoena for your records, I will contact you so you may take whatever steps you deem necessary to prevent the release of your confidential information.  I will contact you twice by phone.  If I cannot get in touch with you by phone, I will send you written correspondence.  If a court of law issues a legitimate court order, I am required by law to provide the information specifically described in the order.  Despite any attempts to contact you and keep your records confidential, I am required to comply with a court order.

  12. Health and Safety Oversight: I will disclose your PHI to a health oversight agency when required by law. These oversight activities include audits, investigations, and medical licensure.

  13. Business Associate Agreements: I may use your PHI and disclose it to individuals and organizations that assist Jessica Depweg, LPC with treatment, payment, and health care operations, including complying with its legal obligations. These business associates must agree in writing to protect the confidentiality of any PHI that they receive or have access to.

  14. Fee Disputes: In the case of a credit card dispute, I reserve the right to provide the necessary documentation (i.e. your signature on the “Informed Consent of Policy and Procedures”) that covers the cancellation policy to your bank or credit card company should a dispute of a charge occur.  If there is a financial balance on account, a bill will be sent to the home address on the intake form unless otherwise noted.

  15. Couples Counseling: When working with couples, all laws of confidentiality exist. However, if one party requests a copy of couples or family therapy records in which they participated, an authorization from each participant (or their representatives and/or guardians) is required in the sessions before the records can be released.

  16. Notification of Family and Others: In emergency cases where you are unavailable or incapacitated, or do not otherwise object, we may also tell your family or friends your location and general condition. If you would like to restrict the information provided to family or friends, please inform me in writing.

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

  1. Right to Access: You have the right to request and obtain a copy of your PHI.

  2. Right to Amend: If you believe your PHI is incorrect or incomplete, you may request an amendment.

  3. Right to Restrict Disclosure: You can request restrictions on certain uses and disclosures of your PHI.

  4. Right to Confidential Communications: You have the right to request that we communicate with you in a specific way or at a certain location.

  5. Right to Accounting of Disclosures: You can request a list of certain disclosures we have made of your PHI.

  6. Right to a Paper Copy: You have the right to obtain a paper copy of this notice, even if you have agreed to receive the notice electronically.

VI. COMPLAINTS

If you believe your rights have been violated you have the right to file a complaint regarding a violation with the U.S. Secretary of the Department of Health and Human Services, Office of Civil Rights (OCR), by mail at 200 Independence Avenue, S. W. Room 509F, HHH Bldg., Washington DC 20201, by email at OCRComplaint@hhs.gov, or online at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf. You may also call the U.S. Department of Health and Human Services, Office for Civil Rights toll-free at: 1-800-368-1019, TDD: 1-800-537-7697

There will be no retaliation for filing a complaint.

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

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.