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Notice of Privacy Practices for Protected Health Information

To ensure that you know how your protected Notice of Privacy Practices for Protected Health Informationhealth information (PHI) is used and protected, by law we are required to provide you with a Notice of Privacy Practices for Protected Health Information. This document describes how psychological and medical information about you may be used and disclosed. Additionally, it describes how you can obtain access to this PHI.


With your consent, Cobb Psychotherapy LCSW may use or disclose your protected health information (PHI) for purposes of treatment, payment, and health care operations. Definitions for terms used:

  • "PHI" refers to protected health information in your health record that could identify you.
  • "Treatment, Payment, and Health Care Operations" treatment is when we provide, coordinate, or manage your healthcare and/or other services related to your healthcare. An example of such treatment would be when we consult with another healthcare provider, such as your family physician or another psychotherapist.
  • "Payment" is when we obtain compensation for your healthcare. Examples of payment are when we disclose your PHI to your health insurer in response to a request for information.
  • "Health Care Operations" are activities that relate to the performance and operation of our practice. Examples of healthcare operations are quality assessment and improvement activities; business-related matters such as audits; administrative services; and case management and care coordination.
  • "Use" applies only to activities within our office such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
  • "Disclosure" applies to activities outside our office such as releasing, transferring, or providing access to information about you to other parties.


We may use or disclose PHI for purposes outside of treatment, payment, and health care operations ONLY when your appropriate authorization is obtained. An "authorization" is written permission above and beyond the general consent that permits only specific disclosures. In those instances when we are asked for information for purposes outside of treatment, payment, and health care operations, we will obtain an authorization from you before releasing this information. We will also need to obtain an authorization before releasing your psychotherapy notes. "Psychotherapy notes" are notes we have made about our conversation during a private, group, joint, or family counseling session, which we have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations at any time, provided that you revoke these authorizations in writing. You may not revoke an authorization to the extent that (1) we have already relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.


We may use or disclose PHI without your consent or authorization in the following circumstances:

  • CHILD ABUSE: If, in our professional capacity, we have reasonable cause to suspect a child is abused or maltreated where the parent, guardian, custodian, or other person legally responsible for such child comes before us in our professional or official capacity and states from personal knowledge facts, conditions, or circumstances which, if correct, would render a child abused or maltreated, we must report such abuse or maltreatment to the statewide central register of child abuse and maltreatment and/or the local child protective services agency.
  • HEALTH OVERSIGHT: If there is an inquiry or complaint about our professional conduct to the New York State Board of Social Work, we must furnish to the New York Commissioner of Education your confidential mental health records relevant to this inquiry.
  • JUDICIAL OR ADMINISTRATIVE PROCEEDINGS: If you are involved in a court proceeding and a request is made for information about the professional services that we have provided you and/or the records thereof, such information is privileged under state law, and we must not release this information without your written authorization, or a court order. This privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. We must inform you in advance if these last two situations (evaluation for a third party or court ordered record request) arise.
  • SERIOUS THREAT TO HEALTH OR SAFETY: We may disclose your confidential information if there is good reason to believe you are threatening serious bodily harm to yourself or others. Your therapist may be obligated to seek hospitalization, or to contact family members or others who can help provide protection.
  • WORKERS' COMPENSATION: If you file a workers' compensation claim, and we are treating you for issues involved with that complaint, then we must furnish to the chairman of psychological condition and treatment.


  • RIGHT TO REQUEST RESTRICTIONS: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, we are not required to agree to a restriction you request.
  • RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATION BY ALTERNATIVE MEANS AND AT ALTERNATIVE LOCATION: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing us. Upon request, we will send your bills to another address.)
  • RIGHT TO INSPECT AND COPY: You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but, in some cases, you may have this decision reviewed. On your request, we will discuss with you the details of the request and denial processes.
  • RIGHT TO AMEND: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process.
  • RIGHT TO AN ACCOUNTING: You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). At your request, we will discuss with you the details of the accounting process.
  • RIGHT TO A PAPER COPY: You have the right to obtain a paper copy of the notice from us upon request, even if you have agreed to receive the notice electronically.


  • We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
  • We reserve the right to change the privacy policies and practices described in this notice. However, we are required to abide by the terms currently in effect unless we notify you of such changes to the policies described in this document.
  • If we revise the policies and procedures, you will be provided with a notice of the revised policies and procedures in person during a session or by mail.


If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you may contact us.


We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. If we revise our policies and procedures, we will provide you with a notice of the revised policies and procedures in person, during a session, via email, or via mail.

Effective September 20, 2020