Comprehensive Counseling & Psychiatric Services

Providing Quality Behavioral Health Services since 1963

Lisbon Office: (330) 424-9573
East Liverpool Office: (330) 386-9004
Salem Office: (330) 332-1514

Notice of Privacy Practices

This notice describeshow medical information about you may be used and disclosed andhow you can get access to this information. Please review it carefully.

This notice has been prepared by The Counseling Center. It tells you how Protected Health Information about you can be created, shared, protected and maintained.

What is my Protected Health Information (PHI)?

  • Anything from the past, present or future;
  • About your medical or physical health or condition;
  • That is spoken, written, or electronically recorded; and is
  • Created by or given to anyone providing care to you: a health plan; a public health authority; your employer, your insurance company; your school or university; or anyone who processes health information for you.
Understanding Your Health Record/Information

Each time you visit The Counseling Center, a record of your visit is made. This information in your record serves as a:

  • Basis for planning your care and treatment
  • Means of communication among health professionals who contribute to your care
  • Legal document describing the care you received
  • Means by which you or a third-party payer can verify that services billed actually were provided
  • Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
  • Ensure its accuracy
  • Better understand who, what, when,where, and why others may access your health information
  • Make more informed decisions when authorizing disclosure to others
What rights do I have regarding my Protected Health Information (PHI)?
  • Although your record is the physical property of The Counseling Center, the information belongs to you.
  • You have the right to consent to the use and disclosure of your PHI for the limited purpose of diagnosing you and administering and paying for your treatment.
  • You have the right to see and copy your PHI except for information prepared for certain legal proceedings.
  • You have the right to request that we amend your PHI.
  • You have the right to be informed about and to share your PHI in a confidential manner chosen by you. The manner you choose must be possible and feasible for us to do.
  • You have the right to restrict how we use and disclose your PHI. We do not have to agree to your restrictions under certain circumstances; however, if we do agree, we must follow your restrictions.
  • You have the right to obtain a copy of a record of disclosures of your PHI that we make.
  • You have the right to have a copy of this Privacy Notice.
Our Responsibilities The Counseling Center is required to:
  • Maintain the privacy of your health information as required by law
  • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
  • Abide by the terms of the Privacy Notice currently in effect
  • Notify you if we are unable to agree to a requested restriction
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

* We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will provide you with a copy of the revised Notice of Privacy Practices when you visit The Counseling Center, or when your community service provider meets with you.


What can be done with my information if I consent to disclose it for my diagnosis or to administer and pay for my treatment?

  • We will use your health information for treatment. For example: Information obtained by doctor, nurse, case manager, counselor or other member of your healthcare team will be recorded in your record and used to assist in determining the course of treatment that should work best for you.
  • We will use your health information for payment. For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, and treatment provided.
  • We will use your health information for regular health operations. For example: Members of the quality improvement team may use information in your record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continue improving the quality and effectiveness of the healthcare and service we provide.
Can I revoke my consent?
  • Yes. You can revoke your consent. You must do so in writing and bring it to us so that we can stop using and disclosing your PHI. We are permitted to use and disclose your PHI based on the consent until we receive your revocation in writing. However, if you revoke your consent, we reserve the right to refuse to provide further treatment to you, on the basis of your refusal to allow us to share your information for purposes of treatment, payment, and healthcare operations.
Other Uses or Disclosures

Business associates: Some services in our organization are provided through agreements with business associates.
When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we have asked them to do. We require the business associate to safeguard your information appropriately.

Notification: We may use or disclose information to notify or assist in notifying a family member,personal representative, or another person responsible for your care,location, and general condition.

Communication with family: Health professionals, using their best judgment, may disclose to a family member,other relative, close personal friend, or any other person you identify,health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral directors: We may disclose to funeral directors health information consistent with applicable law so they can carry out their duties.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you if you have given us permission to do so.

Workers’ compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.

Public health: As required by law,we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to an order of the court.

* Federal law makes provision for your health information to be released to an appropriate health oversight agency,public health authority, or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.


What can be done with my information if I authorize its disclosure for other purposes?

  • With your permission, we can share your PHI for reasons other than to diagnose you and to administer pay for your treatment.

Can I revoke my authorization?

  • Yes. You can revoke your authorization. You must do so in writing and bring it to us so that we can stop using your PHI. We are permitted to share your PHI based on your authorization until we receive your revocation in writing.

Are there any circumstances when my information can be shared without my consent or authorization?

  • Yes. Your PHI can be shared without your prior consent or authorization:
  1. In an emergency as long as consent is obtained as soon as possible;
  2. When required by law;
  3. When there are substantial communication barriers and it is reasonable to believe that you are giving your consent or authorization;
  4. When required to do so toad minister payment for your treatment.

What about any other uses of my medical information?

  • Other uses and disclosures of medical information not covered by this notice, or the laws that apply to us,will be made only with your written permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain records of the care that we provided you.

What can I do if I have questions or want to complain about the use and disclosure of my Protected Health Information (PHI)?

  • All questions and complaints about the use and disclosure of your PHI may be directed to Jerry Semivan, Director of Corporate Compliance at The Counseling Center, 330-424-9573, Extension 485.
  • We may not retaliate against you for complaining about the use and disclosure of your Protected Health Information.

All questions and complaints about the use and disclosure of your PHI may be directed to:

  • Jerry Semivan, Director of Corporate Compliance at The Counseling Center 330-424-9573, Extension 485

Health Information Privacy Complaints may also be made in writing to the Department of Health and Human Services as follows:

  • OR
  • Mail to:
    • Office of Civil Rights, DHHS
      233 North Michigan Avenue, Suite 240
      Chicago, Illinois 60601
      (312) 886-2359
      (312) 353-5693 (TDD)
      (312) 886-1807 FAX

The Counseling Center

40722 State Route 154

Post Office Box 429

Lisbon, Ohio 44432-0429

Phone: 330-424-9573

Fax: 330-424-7140