Cook Counseling Service, LLC (CCS) Notice of Privacy Practices

This notice describes how psychological and medical information about you may be used and/or disclosed and how you can access to this information.


  1. Uses and disclosures for Treatment, Payment, and Health Care Operations.CCS may use or disclose your protected health information (PHI) for treatment, payment, and health care operations purposes with your consent.  To help clarify these terms, here are some definitions:
    • “PHI” refers to information in your health care record that could identify you.
    • “Treatment, Payment and Health Care Operations”
      Treatment  is when we provide, coordinate, or manage your health care or other services related to your health care. An example of this would be when your therapist would consult with another health care provider, such as your family physician or another mental health professional.
      Payment   is when we obtain reimbursement for your health care.  Examples of payment when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
      Health Care Operations  are activities that are related to the performance and operation of our practice.  Examples of health care operations are: quality assessment and improvement activities, business-related matters, such as audits and administrative services, and case management and care coordination.
    • “Use”  applies only to activities within the practice, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
    • “Disclosure”  applies only to activities outside of our clinic, such as releasing, transferring, or providing access to information about you to other parties.
  2. Uses and Disclosures Requiring Authorization
    CCS may use or disclose PHI for purposes outside of treatment, payment, or health care operations when appropriate authorization is obtained. An “authorization” is written permission over and beyond the general consent that permits only specific disclosures.  In those instances when we are asked for information for the purposes outside of treatment, payment, or health care operations, we will obtain an authorization from you before releasing this information.You may revoke all such information at any time, provided each revocation is in writing.  You may not revoke an authorization to the extent that the therapist has relied on the 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
  3. Uses and Disclosures with Neither Consent nor AuthorizationCCS may use or disclose PHI without your consent or authorization in the following circumstances:
    • Child Abuse: if the mental health professional knows or has reason to believe a child is being neglected or physically or sexually abused, or has been neglected or physically or sexually abused within the preceding three years, he/she must immediately report the information to the local welfare agency, police or sheriff’s department.
    • Adult and Domestic Abuse: If the mental health professional has reason to believe that a vulnerable adult is being or has been maltreated, or has knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained, he/she must immediately report the information to the appropriate agency in the designated county.  This information may also be reported to a law enforcement agency.
      “Vulnerable Adult”  means a person who, regardless of residence, or whether any type of service is received, possesses a physical or mental infirmity or other physical, mental or emotional dysfunction: 

      1. That impairs the individual’s ability to provide adequately for the individual’s own care without assistance, including the provision of food, shelter, clothing, health care, or supervision; and
      2. Because of the dysfunction or infirmity and the need for assistance, the individual has an impaired ability to protect the individual from maltreatment.