Empower Within Counseling Services, PLLC
Notice of Privacy Practices
780 West Army Trail Rd., Ste. 302, Carol Stream, IL 60188
(630) 656-9761
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Effective Date: 4/11/26
Our Commitment to Your Privacy
We understand that your health information is private and personal. We are committed to protecting your privacy and the confidentiality of your mental health records. This Notice applies to all records of the care and services you receive at this practice, whether created by this office or received from others.
This Notice is provided to you as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. Parts 160 and 164, and the Illinois Mental Health and Developmental Disabilities Confidentiality Act, 740 ILCS 110/1 et seq. (IMHDDCA). Where Illinois law provides greater protection for your mental health records than HIPAA, Illinois law governs.
How We May Use and Disclose Your Health Information
The following categories describe the ways we may use and disclose your health information. For each category, we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed.
A. Uses and Disclosures for Treatment, Payment, and Health Care Operations
Treatment: We may use and disclose your protected health information (PHI) to provide, coordinate or manage your mental health care. For example, we may share information with other treating healthcare providers such as your psychiatrist or primary care physician, with your knowledge and consent.
Payment: We may use and disclose your PHI so that services you receive may be billed to and payment collected from you, an insurance company, or a third party. For example, we may need to disclose information to your health insurer to obtain prior authorization for treatment.
Health Care Operations: We may use and disclose your PHI for operational purposes, such as quality assessment, staff training, and compliance activities. For example, clinical notes may be reviewed for quality improvement purposes.
B. Uses and Disclosures Requiring Your Written Authorization
Under the Illinois IMHDDCA, your mental health records receive heightened protection. In most circumstances, we may not disclose your mental health records without your written authorization, except as described below. You have the right to revoke any authorization in writing at any time.
Uses requiring your written authorization include: disclosure to family members or significant others (except in emergencies), disclosure to employers, disclosure for legal proceedings (absent a court order), and most disclosures to third parties not involved in your direct care.
C. Disclosures Permitted Without Your Authorization
We may disclose information without your authorization when required or permitted by law, including:
As required by law, including pursuant to a valid court order or subpoena after required legal procedures have been followed.
To report suspected child abuse or neglect to the Illinois Department of Children and Family Services (DCFS), as required by the Abused and Neglected Child Reporting Act.
To report suspected abuse, neglect, or exploitation of an elderly or disabled adult.
When there is a serious and imminent threat to the health or safety of you or another identifiable person ("duty to warn" or "duty to protect"), consistent with the Illinois Mental Health and Developmental Disabilities Code.
To public health authorities for disease reporting, vital statistics, or public health oversight activities as required by law.
To coroners, medical examiners, or funeral directors as permitted or required by law.
To the Secretary of the U.S. Department of Health and Human Services to investigate or determine compliance with HIPAA.
To the Illinois Department of Financial and Professional Regulation (IDFPR) if required for licensure investigation or disciplinary proceedings.
For workers’ compensation or other similar programs, to the extent authorized by law.
Special Protections for Psychotherapy Notes
Psychotherapy notes (also called process notes) are notes recorded by a mental health professional that document or analyze the content of a counseling session and are kept separate from the rest of your medical record. These notes receive heightened privacy protections under HIPAA and may only be used or disclosed:
With your specific written authorization, separate from any general authorization; or
By the originator of the psychotherapy notes for treatment; or
For training programs in which students, trainees, or practitioners in mental health learn under supervision; or
To defend a legal action or other proceeding brought by you; or
As required by the Secretary of HHS for compliance investigations; or
As required by law in specific, limited circumstances (e.g., serious threat of harm).
We will not use or disclose your psychotherapy notes for any other purpose without your written authorization.
Your Rights Regarding Your Health Information
You have the following rights with respect to your protected health information:
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI that is contained in a designated record set used to make decisions about your care, including medical and billing records, for as long as we maintain the PHI. We may charge a reasonable, cost-based fee. Under the IMHDDCA, mental health records may be reviewed in person with a clinician present. We may deny access in limited circumstances; if denied, you may request a review of the denial.
Right to Request an Amendment
If you believe that health information we have about you is incorrect or incomplete, you have the right to request an amendment. You must make your request in writing and provide a reason supporting the request. We may deny the request if the information was not created by us, is not part of the records we maintain, is not part of the information you would be permitted to inspect or copy, or is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an accounting of disclosures of your PHI made during the six years prior to the date of your request, except for disclosures made for treatment, payment, or health care operations; disclosures made with your authorization; disclosures made directly to you; and certain other disclosures. The first accounting in any 12-month period is free; subsequent requests may incur a reasonable fee.
Right to Request Restrictions
You have the right to request restrictions on uses and disclosures of your PHI for treatment, payment, or health care operations, or to persons involved in your care. We are not required to agree to your request except in the following situation: if you pay out of pocket, in full, for a service, you may request that we not disclose information about that service to your health plan and we must comply with that request.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you may ask that we contact you only at a specific phone number or by mail. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically.
Right to Notification of Breach
You have the right to be notified in the event of a breach of unsecured PHI in accordance with applicable law.
Our Duties
We are required by law to:
Maintain the privacy of your protected health information;
Provide you with this Notice of our legal duties and privacy practices with respect to your health information;
Abide by the terms of the Notice currently in effect; and
Notify you if we are unable to agree to a requested restriction.
We reserve the right to change this Notice and to make the revised or changed Notice effective for health information we already have about you, as well as any information we receive in the future. A copy of the current Notice will be available upon request and available on our portal.
Minors and Guardianship
If you are the parent or legal guardian of a minor client, please be aware that your access to your minor child’s mental health records may be limited under the IMHDDCA. In some circumstances, minors in Illinois may consent to their own mental health treatment, and in those circumstances records may be confidential from parents or guardians. We will discuss these situations with you at the outset of treatment.
How to Exercise Your Rights
To exercise any of your rights described in this Notice, you must submit a written request to our Privacy Contact listed below. We will respond within 30 days of receiving your written request (or 60 days if we need to extend the time). If we deny your request, we will provide a written explanation.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our Privacy Contact listed below. You will not be penalized, retaliated against, or denied services for filing a complaint.
Our Privacy Contact
Juli Brown, LCSW
780 Army Trail Rd., #302
Carol Stream, IL 60188
Phone: (630) 656-9761
Email: juli@empowerwithincounseling.com
HHS Office for Civil Rights
U.S. Dept. of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-800-368-1019
Illinois Specific Rights and Information
Illinois residents enjoy additional protections under the IMHDDCA (740 ILCS 110). Key provisions include:
Mental health and developmental disability records may only be disclosed with written consent, except as expressly provided by law.
You may inspect your records and obtain copies upon written request, subject to clinical review.
Your therapist must inform you of the limits of confidentiality at the outset of treatment.
Disclosures made without your authorization must be documented in your record.
You may request that we inform you of disclosures made without your consent within the prior 12 months.
This Notice is provided in compliance with HIPAA (45 C.F.R. §164.520) and the Illinois Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110).