PRIVACY POLICY (Updated and amended 1-16-2023)
Connected Thoughts Counseling PLLC dba Connected Thoughts Counseling (CTC) and Website are owned and managed by Connected Thoughts Counseling PLLC. Connected Thoughts Counseling PLLC makes every reasonable effort to keep your personal information protected and private. We do not share personal information collected unless prior authorization is given.
This Privacy Policy (the “Policy”) applies to our websites available at: https://connectedthoughtscounseling.com and https://www.therapynotes.com/app/login/Connectedthoughts2024 and/or any other website or mobile application to which this Policy applies to (collectively the “Sites”). This Policy will not apply to any of your interaction with CTC offline.
This Privacy Policy describes how we collect, use, process and distribute your information, including Personal Data (as defined below) used to access this Website. We will not use or share your information with anyone except as described in this Privacy Policy. The use of information collected through our Website shall be limited to the purposes under this Privacy Policy and our Terms of Use for clients.
Please read this Privacy Policy carefully. We reserve the right to change this Privacy Policy on the Website at any time without notice. In the event of a material change, we will update the notice on our Website.
Use of any personal information or contribution that you provide to us, or which is collected by us on or through our Website or its content is governed by this Privacy Policy. By using our Website or its content, you consent to this Privacy Policy, whether or not you have read it.
BY USING ANY OF OUR SITES YOU CONSENT TO THE TERMS OF THIS POLICY AND TO TPOT’S COLLECTION AND PROCESSING OF YOUR PERSONAL INFORMATION FOR THE PURPOSES STATED BELOW. IF YOU DO NOT AGREE TO THE TERMS OF THIS POLICY PLEASE DO NOT USE THE SITES.
Information Collected
We generally collect two types of information from users of the CTC sites: 1) Personal Information ( your name, email address, payment information); and, 2) Non-Personal Information (e.g. cookies or IP address). Additional information may be requested if services are being requested. Currently we are redirecting clients to Alma at https://secure.helloalma.com/providers-landing/ who handles administrative tasks, working with insurance and other administrative supportive tasks. The Electronic Healthcare System that CTC utilizes is a HIPAA compliant Telehealth Platform through Therapy Notes https://www.therapynotes.com/app/login/Connectedthoughts2024 where additional information will be requested if services are requested and agreed on.
Personal Information
“Personal Information” is defined as information that identifies you personally, such as your name, address, phone numbers, or email address. CTC collects and stores the Personal Information that you have provided to us. Here are some examples of manners in which we may collect your Personal Information on the Sites:
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A name and an email address so we can deliver our newsletter to you – you would be affirmatively consenting to this by providing this to us in our contact forms. At this time, no newletters are being sent out.
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Billing information including name, address and credit card information so that we can process payment to deliver our products or services to you under our contractual obligation.
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A name and an email address if you complete our contact form with a question. We may send you marketing emails with either your consent or if we believe we have a legitimate interest to contact you based on your contact or question.
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Information from you from a co-branded offer. In this case, we will make clear as to who is collecting the information and whose privacy policy applies. If both / all parties are retaining the information you provide, this will also be made clear as will links to all privacy policies.
Please note that the information above (“Personal Data”) that you are giving to us is voluntarily, and by you providing this information to us you are giving consent for us to use, collect and process this Personal Data. You are welcome to opt-out or request for us to delete your Personal Data at any point by contacting us.
If you choose not to provide us with certain Personal Data, you may not be able to participate in certain aspects of our Website or content.
Retention and Deletion
We retain your Personal Data for the minimum amount of time necessary to provide you with the information and/or services that you requested from us. We may include certain Personal Data for longer periods of time if necessary for legal, contractual and accounting obligations.
Sensitive Information
We ask that you not send us, and you do not share any sensitive Personal Information (e.g., Social Security numbers)
Anonymous Data Collection and Use
To maintain our Website’s high quality, we may use your IP address to help diagnose problems with our server and to administer the Website by identifying which areas of the Website are most heavily used, and to display content according to your preferences. Your IP address is the number assigned to computers connected to the Internet. This is essentially “traffic data” which cannot personally identify you, but is helpful to us for marketing purposes and for improving our services. Traffic data collection does not follow a user’s activities on any other websites in any way. Anonymous traffic data may also be shared with business partners and advertisers on an aggregate basis.
Non-Personal Information
“Non-Personal Information” can be technical information or it can be demographic information, such as your age, gender, ZIP code or other geolocation data, or interests. Non-Personal Information does NOT identify you personally. Here are some examples of the Non-Personal Information that is collected via the Sites and a description of how this information is used:
Internet Protocol (IP) address — Your IP address is a number that lets computers attached to the Internet know where to send you data — such as the webpages you view. We use this information to deliver our webpages to you upon request, to tailor our Sites to the interests of our users and to measure traffic within our Sites.
Cookies — our Sites use “cookies” to improve functionality and usability. We use this information for planning, tracking and to improve the technical functions of our Sites and products. By using our products and agreeing to this Policy, you consent to our use of cookies in accordance with the terms of this Policy.
About Cookies
Cookies are text files sent by Web servers to Web browsers and are stored on the user’s computer or mobile device. If the browser is loading a page and the server requests the information stored in the cookie, the cookie is sent back to the server.
Cookies contain data about the user’s activities on the website, and can be used by Web servers to identify and track users as they navigate different pages on a website, and to identify users returning to a website.
Cookies may be either “persistent” or “session” cookies. A persistent cookie will remain valid until its set expiration date (unless deleted by the user). A session cookie will expire at the end of the user session, when the Web browser is closed.
Blocking cookies
Most browsers allow users to refuse to accept cookies.
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In Google Chrome, you can adjust your cookie permissions by clicking “Options,” “Under the hood” and Content Settings in the “Privacy” section. Click on the Cookies tab in the Content Settings.
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In Safari, you can block cookies by clicking “Preferences,” selecting the “Privacy” tab and “Block cookies.”
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In Internet Explorer, you can refuse all cookies by clicking “Tools,” “Internet Options,” “Privacy,” and selecting “Block all cookies” using the sliding selector.
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In Firefox, you can block all cookies by clicking “Tools,” “Options,” and un-checking “Accept cookies from sites” in the “Privacy” box.
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Blocking all cookies will, however, have a negative impact upon the usability of many websites. If you block cookies, you may not be able to log on, access content or use search functions, for example.
Deleting cookies
Users can also delete cookies already stored on their computers:
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In Google Chrome, you can adjust your cookie permissions by clicking “Options,” “Under the hood,” and Content Settings in the “Privacy” section. Click on the Cookies tab in the Content Settings.
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In Safari, you can delete cookies by clicking “Preferences,” selecting the “Privacy” tab and selecting “Remove All Website Data.”
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In Internet Explorer, you must manually delete cookie files.
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In Firefox, you can delete cookies by first ensuring that cookies are to be deleted when you “clear private data” (this setting can be changed by clicking “Tools,” “Options” and “Settings” in the “Private Data” box) and then clicking “Clear private data” in the “Tools” menu.
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Doing this may have a negative impact on the usability of many websites.
Use of Information Collected Via the Sites
Personal Information
We use your Personal Information that we collect on the Sites primarily for the following purposes:
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To deliver services, such as educational programs, information or newsletters you request or purchase;
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To let you know about updated information and other new services from CTC or other third parties or to forward promotional materials;
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To process your order and, if necessary, to contact you regarding the status of your order;
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To fulfill the terms of a promotion;
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To ensure the Sites are relevant to your needs;
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To help us create and publish content most relevant to you;
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To contact you regarding additional services and features;
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To request your feedback about your experience with CTC;
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To notify you about a material change to this Policy, if necessary; and
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To allow you access to limited-entry areas of the Sites.
Non-Personal Information
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Non-Personal Information is used as described above and in other ways as permitted by applicable laws, including combining Non-Personal Information with Personal Information.
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Release of Information to Third Parties
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By using the Sites you grant CTC the right to use your Non-Personal Information for marketing and to improve the Sites. This use may involve the disclosure of your Non-Personal Information to third parties. CTC will not share or disclose your Personal Information with third parties.
Third Party Websites and Advertisers
The Sites may provide you with links to other websites, although we do not necessarily advise that you link to another website. In the event that you choose to access such websites, CTC is not responsible for any actions or policies of those sites. Further, please note that the third party’s privacy policies and security practices may differ from CTC standards. CTC neither assumes responsibility for, nor does it control, endorse or guarantee any aspect of your use of any linked sites. We recommend that you check the privacy policy of such a party before providing Personal Information to it.
The CTC may also permit advertisers, third party ad networks or other advertising companies to serve advertisements on the Sites. Please be advised that such advertising companies may gather information about your visit to the Sites or other sites (such as through cookies, Web beacons and other technologies) to enable such advertising companies to market products or services to you, to monitor which ads have been served to your browser and which Web pages you were viewing when such ads were delivered. PLEASE NOTE THAT THIS POLICY DOES NOT COVER THE COLLECTION AND USE OF INFORMATION BY SUCH ADVERTISING COMPANIES.
Opt-Out
We communicate with our members on a regular basis via email. For example, we may use your email address to confirm your request, to send you notice of payments, to send you information about changes to our products and services, and to send notices and other disclosures as required by law. Generally, members cannot opt-out of these communications, but they will be primarily informational in nature rather than promotional.
However, we provide you the opportunity to exercise an opt-out choice if you do not want to receive other types of communications from us, such as messages or updates from us regarding new services and products offered on the Sites. For emails, you may opt-out by clicking on the “unsubscribe” link within the text of an email. We will process your request to unsubscribe as soon as possible, but please be aware that in some circumstances you may receive a few more messages until the unsubscribe is processed. Please note that electing to opt-out of our promotional emails does not mean that we will delete or remove your email address from our systems.
Changes in Our Privacy Policy
CTC reserves the right to make changes to this Policy at any time and for any reason without prior notice. Any changes to this Policy will be posted on this page so that you are always aware of our current policies. We may also contact you by email with changes. Additionally, we will update the “last updated” date below.
Website Security
No data transmissions over the Internet can be guaranteed to be 100 percent secure. Consequently, we cannot ensure or warrant the security of any information you transmit to us and you understand that any information that you transfer to CTC is done at your own risk. However, CTC uses website security measures consistent with current best practices to protect the Sites, email and mailing lists. These measures include technical, procedural, monitoring and tracking steps intended to safeguard data from misuse, unauthorized access or disclosure, loss, alteration or destruction.
PLEASE NOTE THAT THE SITES DO NOT USE SSL ENCRYPTION. THE SITES DO NOT PROCESS PURCHASES. THE SITES USE THIRD PARTY VENDORS (such as, PayPal, Square, etc.) TO PROCESS PURCHASES. User and purchaser information is a high priority and we use our own protective measures, as well as the capabilities of our software and hardware vendors.
We realize there can be incidents of misuse or unauthorized program incursions, as almost every website, service and user encounters. In those instances, our goals are to move quickly to isolate the problem, ensure or restore proper functionality and minimize any inconvenience to our users. As appropriate and necessary, CTC will notify the relevant authorities of these incidents of misuse or unauthorized program incursions of the CTC Sites.
Assignment
In the event that all or part of CTC’s assets are sold or acquired by another party, or in the event of a merger, you grant CTC the right to assign the Personal and Non-Personal Information collected via the Sites.
Addendum (2/6/2023)
What We Do With Information We Collect
Contact You
We may contact you with information that you provide to us based on these lawful grounds for processing:
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Consent. We may contact you if you give us your clear, unambiguous, affirmative consent to contact you.
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Contract. We will contact you under our contractual obligation to deliver goods or services you purchase from us.
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Legitimate Interest. We may contact you if we feel you have a legitimate interest in hearing from us. For example, if you sign up for a webinar, we may send you marketing emails based on the content of that webinar. You will always have the option to opt out of any of our emails.
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Process Payments
We will use the Personal Data you give to us in order to process your payment for the purchase of goods or services under a contract. We only use third party payment processors that take the utmost care in securing data and comply with the GDPR.
Targeted Social Media Advertisements
We may use the data you provide to us to run social media advertisements and/or create look-alike audiences for advertisements.
Share with Third Parties
We may share your information with trusted third parties such as our newsletter provider in order to contact you via email, our merchant accounts to process payments, and Google / social media accounts in order to run advertisements and our affiliates.
Viewing by Others
Note that whenever you voluntarily make your Personal Data available for viewing by others online through this Website or its content, it may be seen, collected and used by others, and therefore, we cannot be responsible for any unauthorized or improper use of the information that you voluntarily share (i.e., sharing a comment on a blog post, posting in a Facebook group that we manage, sharing details on a group coaching call, etc.).
Submission, Storage, Sharing and Transferring of Personal Data
Personal Data that you provide to us is stored internally or through a data management system. Your Personal Data will only be accessed by those who help to obtain, manage or store that information, or who have a legitimate need to know such Personal Data (i.e., our hosting provider, newsletter provider, payment processors or team members).
It is important to note that we may transfer data internationally. For users in the European Union, please be aware that we transfer Personal Data outside of the European Union. By using our Website and providing us with your Personal Data, you consent to these transfers in accordance with this Privacy Policy.
Data Retention
We retain your Personal Data for the minimum amount of time necessary to provide you with the information and / or services that you requested from us. We may include certain Personal Data for longer periods of time if necessary for legal, contractual and accounting obligations.
Confidentiality
We aim to keep the Personal Data that you share with us confidential. Please note that we may disclose such information if required to do so by law or in the good-faith belief that: (1) such action is necessary to protect and defend our rights or property or those of our users or licensees, (2) to act as immediately necessary in order to protect the personal safety or rights of our users or the public, or (3) to investigate or respond to any real or perceived violation of this Privacy Policy or of our Disclaimer, Terms and Conditions, or any other terms of use or agreement with us.
Passwords
To use certain features of the Website or its content, you may need a username and password. You are responsible for maintaining the confidentiality of the username and password, and you are responsible for all activities, whether by you or by others, that occur under your username or password and within your account. We cannot and will not be liable for any loss or damage arising from your failure to protect your username, password or account information. If you share your username or password with others, they may be able to obtain access to your Personal Data at your own risk.
You agree to notify us immediately of any unauthorized or improper use of your username or password or any other breach of security. To help protect against unauthorized or improper use, make sure that you log out at the end of each session requiring your username and password.
We will use our best efforts to keep your username and password(s) private and will not otherwise share your password(s) without your consent, except as necessary when the law requires it or in the good faith belief that such action is necessary, particularly when disclosure is necessary to identify, contact or bring legal action against someone who may be causing injury to others or interfering with our rights or property.
How You Can Access, Update or Delete Your Personal Data
You have the right to:
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Request information about how your Personal Data is being used and request a copy of what Personal Data we use.
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Restrict processing if you think the Personal Data is not accurate, unlawful, or no longer needed.
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Rectify or erase Personal Data and receive confirmation of the rectification or erasure. (You have the “right to be forgotten”).
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Withdraw your consent at any time to the processing of your Personal Data.
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Lodge a complaint with a supervisory authority if you feel we are using your Personal Data unlawfully.
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Receive Personal Data portability and transference to another controller without our hinderance.
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Object to our use of your Personal Data.
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Not be subject to an automated decision based solely on automatic processing, including profiling, which legally or significantly affects you.
Unsubscribe
You may unsubscribe from our e-newsletters or updates at any time through the unsubscribe link at the footer of all email communications. If you have questions or are experiencing problems unsubscribing, please contact us at [help@Private Practice Workshop.com].
Security
We take commercially reasonable steps to protect the Personal Data you provide to us from misuse, disclosure or unauthorized access. We only share your Personal Data with trusted third parties who use the same level of care in processing your Personal Data. That being said, we cannot guarantee that your Personal Data will always be secure due to technology or security breaches. Should there be a data breach of which we are aware, we will inform you immediately.
Anti-Spam Policy
We have a no spam policy and provide you with the ability to opt-out of our communications by selecting the unsubscribe link at the footer of all e-mails. We have taken the necessary steps to ensure that we are compliant with the CAN-SPAM Act of 2003 by never sending out misleading information. We will not sell, rent or share your email address.
Third Party Websites
We may link to other websites on our Website. We have no responsibility or liability for the content and activities of any other individual, company or entity whose website or materials may be linked to our Website or its content, and thus we cannot be held liable for the privacy of the information on their website or that you voluntarily share with their website. Please review their privacy policies for guidelines as to how they respectively store, use and protect the privacy of your Personal Data.
Children’s Online Privacy Protection Act Compliance
We do not collect any information from anyone under 18 years of age in compliance with COPPA (Children’s Online Privacy Protection Act) and the GDPR (General Data Protection Regulation of the EU). Our Website and its content is directed to individuals who are at least 18 years old or older.
Notification of Changes
We may use your Personal Data, such as your contact information, to inform you of changes to the Website or its content, or, if requested, to send you additional information about us. We reserve the right, at our sole discretion, to change, modify or otherwise alter our Website, its content and this Privacy Policy at any time. Such changes and/or modifications shall become effective immediately upon posting our updated Privacy Policy. Please review this Privacy Policy periodically. Continued use of any of information obtained through or on the Website or its content following the posting of changes and/or modifications constituted acceptance of the revised Privacy Policy. Should there be a material change to our Privacy Policy, we will contact you via email or by a prominent note on our Website.
Data Controller and Processors
We are the data controllers as we are collecting and using your Personal Data. We use trusted third parties as our data processors for technical and organizational purposes, including for payments and email marketing. We use reasonable efforts to make sure our data processors are GDPR- compliant.
Contacting Connected Thoughts Counseling PLLC
You may contact us by mail at 732 Thimble Shoals Blvd. Ste 302 A 1005 Newport News, VA 23606 with any questions. Email any questions or concerns regarding this Privacy Policy to admin@connectedthoughtscounseling.com. While we may not be able to respond to every report, we take each report seriously and will investigate it thoroughly.
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Connected Thoughts Counseling, PLLC dba Connected Thoughts Counseling will be referred to in this Notice of Privacy Practices (“Notice”) as “Agency.” This Notice is given to you by the Agency to describe the ways in which Agency may use and disclose your medical information (called “protected health information” or “PHI”) and to notify you of your rights with respect to PHI in the possession of Agency. Agency protects the privacy of PHI, which also is protected from disclosure by state and federal law. In certain circumstances, pursuant to this Notice, patient authorization or applicable laws and regulations, PHI can be used by Agency or disclosed to other parties. Below are categories describing these uses and disclosures, along with some examples to help you better understand each category.
Uses and Disclosures for Treatment, Payment and Health Care Operations
Agency may use or disclose your PHI for the purposes of treatment, payment and health care operations, described in more detail below, without obtaining written authorization from you.
FOR TREATMENT: Agency may use and disclose PHI in the course of providing, coordinating, or managing your medical treatment, including the disclosure of PHI for treatment activities at another healthcare Agency. These types of uses and disclosures may take place between physicians, nurses, technicians, students, and other health care professionals who provide you health care services or are otherwise involved in your care. For example, if you are being treated by a primary care physician, that physician may need to use/disclose PHI to a specialist physician whom he or she consults regarding your condition, or to a nurse who is assisting in your care.
FOR PAYMENT: Agency may use and disclose PHI in order to collect payment for the health care services provided to you. For example, Agency may need to give PHI to your health plan in order to be reimbursed for the services provided to you. Agency may also disclose PHI to their business associates, such as billing companies, claims processing companies, and others that assist in processing health claims. Agency may also disclose PHI to other health care providers and health plans for the payment activities of such providers or health plans.
FOR HEALTH CARE OPERATIONS: Agency may use and disclose PHI as part of their operations, including for quality assessment and improvement, such as evaluating the treatment and services you receive and the performance of our staff in caring for you. Other activities include hospital training, underwriting activities, compliance and risk management activities, planning and development, and management and administration. Agency may disclose PHI to doctors, nurses, technicians, students, attorneys, consultants, accountants, and others for review and learning purposes. These disclosures help make sure that Agency is complying with all applicable laws, and are continuing to provide health care to patients at a high level of quality. Agency may also disclose PHI to other health care facilities plans for certain of their operations, including their quality assessment and improvement activities, credentialing and peer review activities, and health care fraud and abuse detection or compliance, provided that those other facilities and plans have, or have had in the past, a relationship with the patient who is the subject of the information.
FOR SHARING PHI AMONG AGENCY AND PROFESSIONAL STAFF: Agency works together with physicians and other care providers on their professional staff to provide medical services to you when you are a patient at an Acadia Healthcare Agency. Agency and members of their respective professional staff will share PHI with each other as needed to perform their treatment, payment and health care operations activities.
OTHER USES AND DISCLOSURES FOR WHICH AUTHORIZATION IS NOT REQUIRED: In addition to using or disclosing PHI for treatment, payment and health care operations, Agency may use and disclose PHI without your written authorization under the following circumstances:
AS REQUIRED BY LAW AND LAW ENFORCEMENT: Agency may use or disclose PHI when required by law, Agency also may disclose PHI when ordered to in a judicial or administrative proceeding, in response to subpoenas or discovery requests, to identify or locate a suspect, fugitive, material witness, or missing person, when dealing with gunshot and other wounds, about criminal conduct, to report a crime, its location or victims, or the identify, description or location of a person who committed a crime, or for other law enforcement purposes.
FOR PUBLIC HEALTH ACTIVITIES AND PUBLIC HEALTH RISKS: Agency may disclose PHI to government officials in charge of collecting information about births and deaths, preventing and controlling disease, reports of child abuse or neglect and of other victims of abuse, neglect, or domestic violence, reactions to medications or product defects or problems, or to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.
FOR HEALTH OVERSIGHT ACTIVITIES: Agency may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws.
CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS: Agency may disclose PHI to coroners, medical examiners, and funeral directors for the purpose of identifying a decedent, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law.
ORGAN, EYE, AND TISSUE DONATION: Agency may release PHI to organ procurement organizations to facilitate organ, eye, and tissue donation and transplantation.
RESEARCH: Under certain circumstances, Agency may use and disclose PHI for medical research purposes.
TO AVOID A SERIOUS THREAT TO HEALTH OR SAFETY: Agency may use and disclose PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, Agency may disclose health information about you in response to a court or administrative order.
SPECIALIZED GOVERNMENT FUNCTIONS: Agency may use and disclose PHI of military personnel and veterans under certain circumstances, and may also disclose PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities, and for the provision of protective services to the President or other authorized persons or foreign heads of state or to conduct special investigations.
WORKERS’ COMPENSATION: Agency may disclose PHI to comply with workers’ compensation or other similar laws that provide benefits for work-related injuries or illnesses.
HEALTH-RELATED BENEFITS AND SERVICES; LIMITED MARKETING ACTIVITES: Agency may use and disclose PHI to inform you of treatment alternatives or other health-related benefits and services that may be of interest to you, such as disease management programs.
Disaster Relief: Agency may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
DISCLOSURES TO YOU OR FOR HIPAA COMPLIANCE INVESTIGATIONS: Agency may disclose your PHI to you or to your personal representative, and are required to do so in certain circumstances described below in connection with your rights of access to your PHI and to an accounting of certain disclosures of your PHI. Agency must disclose your PHI to the Secretary of the U.S. Department of Health and Human Services (the “Secretary”) when requested by the Secretary in order to investigate compliance with privacy regulations issued under the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)
Uses and Disclosures to Which You May Object:
You may object to the following uses and disclosures of PHI that Agency may make:
PATIENT DIRECTORIES: Your information may be included in a patient directory that is available only to those individuals whom you have identified as contacts during your hospital stay. You will receive a unique patient code that can be provided to these contacts.
Other Uses and Disclosures of PHI for Which Authorization Is Required:
Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which you have the limited right to revoke in writing.
REGULATORY REQUIREMENTS: Agency is required by law to maintain the privacy of your PHI, to provide individuals with notice of their legal duties and privacy practices with respect to PHI, and to abide by the terms described in this Notice. Agency reserves the right to change the terms of this Notice and of its privacy policies, and to make the new terms applicable to all of the PHI it maintains. Before Agency makes an important change to its privacy policies, they will promptly revise this Notice and post a new Notice in registration and admitting areas. You have the following rights regarding your PHI:
You may request the Agency restrict the use and disclosure of your PHI. Agency is not required to agree to any restrictions you request, but if the entity does so it will be bound by the restrictions to which it agrees except in emergency situations.
You have the right to request that communications of PHI to you from Agency be made by particular means or at particular locations. For instance, you might request that communications be made at your work address, or by e-mail rather than regular mail. Your requests must be in writing and sent to the Privacy Officer. Agency will accommodate your reasonable requests without requiring you to provide a reason.
Generally, you have the right to inspect and copy your PHI in the possession of Agency if you make a request in writing to the Agency’s Medical Records Department. Within thirty (30) days of receiving your request (unless extended by an additional thirty (30) days), Agency will inform you of the extent to which your request has or has not been granted. In some cases, Agency may provide you a summary of the PHI you request if you agree in advance to such a summary and any associated fees. If you request copies of your PHI or agree to a summary of your PHI, Agency may impose a reasonable fee to cover copying, postage, and related costs. If Agency denies access to your PHI, it will explain the basis for denial and your opportunity to have the denial reviewed by a licensed health care professional (not involved in the initial denial decision) designated as a reviewing official. If Agency does not maintain the PHI you request, if it knows where that PHI is located it will tell you how to redirect your request.
If you believe that your PHI maintained by Agency contains an error or needs to be updated, you have the right to request that the entity correct or supplement your PHI. Your request must be made in writing to the local Medical Records Department and it must explain why you are requesting an amendment to your PHI. Within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Agency will inform you of the extent to which your request has or has not been granted. Agency generally can deny your request if your request relates to PHI: (i) not created by Agency; (ii) that is not part of the records Agency maintains; (iii) that is not subject to being inspected by you; or (iv) that is accurate and complete. If your request is denied, Agency will give you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) submit a request that any future disclosures of the relevant PHI be made with a copy of your request and Agency’s denial attached, if you do not file a statement of disagreement; and (iii) complain about the denial.
You generally have the right to request and receive a list of disclosures of your PHI Agency has made during the six (6) years prior to your request (but not before April 14, 2003). The list will not include disclosures (i) for which you have provided a written authorization; (ii) for treatment, payment, and health care operations; (iii) made to you; (iv) for an Agency patient directory or to persons involved in your health care; (v) for national security or intelligence purposes; (vi) to correctional institutions or law enforcement officials; or (vii) of a limited data set. You should submit any such request to the Privacy Officer, and within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Agency will respond to you regarding the status of your request. The entity will provide the list to you at no charge, but if you make more than one request in a year you will be charged $25.00 for each additional request.
You have the right to receive PHI in an electronic format, if electronic medical records are in use in the Agency.
You have the right to receive a paper copy of this notice upon request even if you have agreed to receive this notice electronically. To obtain a paper copy of this notice, please contact the Privacy Officer (Contact information below).
You have the right to receive notice in the event of a breach of confidentiality.
You have the right to opt out of all communications from our company including fundraising.
You have the right to restrict disclosures of PHI to health plans if you have paid for services out of pocket in full.
CHANGES TO THIS NOTICE: We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. We will post a copy of the new notice on our website. The notice will contain the effective date on the second page, in the bottom right-hand corner.
You may complain to Agency if you believe your privacy rights with respect to your PHI have been violated by contacting Agency’s Privacy Officer and submitting a written complaint. To reach the Agency for any reason associated with this Notice, please write or call:
Privacy Officer
Connected Thoughts Counseling
732 Thimble Shoals Blvd.
Ste 302 A 1005
Newport News, VA 23606
(757)794-4476
Agency will not penalize you or retaliate against you for filing a complaint regarding their privacy practices. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services at 200 Independence Avenue, S.E., Washington, DC
Effective 1/16/2024
Client Service Agreement and Consent Form
Dr. Steven Majdecki with Connected Thoughts Counseling is proud to provide you with personalized support and care. Please read and sign the following agreement: it lists our billing, scheduling and cancellation policies and procedures. If you have any questions, please ask for clarification.
A. Scheduling Services.
All services can be scheduled [by using Alma’s website, visiting https://connectedthoughtscounseling.com by phone at (757) 703-3777 or emailing connectedthoughtscounseling@gmail.com. If you schedule an appointment or communicate with Provider via email, you are consenting for Provider to respond to your email utilizing the same method, even if you have not completed the email and text consent you will receive in conjunction with this Agreement.
B. Cost of Services.
Provider’s full self-pay rate for a 60 minute session of telehealth therapy is $140. A sliding fee scale is available for client’s in need of financial assistance. (Medium fee: $100 to $120) (Low fee: $80 to $100).
C. Services.
You agree to receive counseling and therapy services through remote telehealth. You understand the risks, benefits and alternatives of receiving these Services and have had the opportunity to ask questions. The potential benefits of counseling are many and include improved personal functioning, stress management, reduction in anxiety and depressive symptoms, improvement in relationships, self---image, mood, and the attainment of personal goals. However, in some cases persons have reported feeling worse after counseling. Clients understand that healing and growth is difficult, and some discomfort will likely be a part of the counseling process.
D. Payment Methods.
You understand and agree that payment for services shall be made prior to the time of service by using Alma’s billing platform. Provider accepts payment in the form of cash or check [or credit card]. [If you will be using insurance to cover some or all of the cost of your appointment, you should call Provider ahead of your appointment to ensure your insurance is accepted and bring your insurance
card with you to your appointment. You should be prepared to pay any co-payments at the time of the appointment with either cash or check [or credit card]. If Provider is out of network for your insurance, Provider will submit an out-of-network claim on your behalf, but you must be prepared to pay in full for your appointment at the time of service, with either cash, check or credit card. Unfortunately, we cannot
extend credit or provide services unless payment is made in conjunction with those Page 2 of 2 services. Clients understand they are fully responsible for all fees if insurance or other vendor does not pay for any reason.
E. Cancellation Policy.
Scheduling an appointment is a commitment that both counselors and clients honor. Appointments can be cancelled or rescheduled if 24 hour notice is provided. If sessions are cancelled or rescheduled with less than the required notice, or if a client misses a session, the client agrees to pay $60 for that session (insurance will not pay for missed appointments). Please know that exceptions to this policy may be made in the instance of a serious medical emergency, or serious family emergency. Additionally, if there are three late
cancellations (being done within 24 hours of appointment time or no-shows) or more within a 6 month period, the client may be discharged from treatment services or referred out to another provider who can better accommodate your availability.
F. Confidentiality and Compliance.
Provider will take appropriate precautions to keep your health information confidential and to not disclose it without your consent. You are also protected under the provisions of the federal Health Insurance Portability and Accountability Act (HIPAA) and any other applicable federal and state laws related to protection of patient information, including but not limited to Public Health Law § 18. There are certain exceptions to when your confidential information would not be protected—for instance, if Provider believes that you will
harm yourself or another person or are neglecting or abusing a child or a vulnerable adult, then mandated reporting would apply. All communications and records with your counselor are held in strict confidence. Information may be released, in accordance with state law, when (1) The client signs a written release indicating consent to release; (2) The client expresses serious intent to harm self or someone else; (3) There is reasonable suspicion of abuse against a minor, elderly person, or dependent adult; (4) To acquire payment for services or for billing purposes, or (5) A subpoena or court order is received directing the disclosure of information. To protect your privacy to the greatest extent of the law, it is our policy to assert either (a) privileged communication in the event of #5 or (b) The right to consult with clients, if at all possible, before mandated disclosure in the event of #2 or #3.
G. Electronic Communication
Electronic communications, both telephone and Internet (including email, text, instant messaging), are not secure methods of communication, and there is some risk that one’s confidentiality could be compromised with their use. Counselors
sometimes communicate with clients using these mediums. If you would prefer to not be contacted by telephone, email, text, or other messaging, please inform your counselor and we will honor this request.
H. Client Follow Up
Your counselor may “follow-up” with you after counseling has ended. 1 month, 3month, or 6 Month follow-up calls may be made to check in with clients and see if gains made in counseling have been maintained. In addition, someone you may receive solicitation for feedback on your counseling experience. If you would prefer to not be contacted, simply inform your counselor and your preferences will be
respected.
I. Emergency Contacts
Your counselor will establish emergency contacts for you, such as the phone number and location of a family member. Your counselor will also obtain alternative methods for contacting you, such as a mobile phone, or work phone number. These emergency contacts may be used if the counselor perceives a need. If you are in crisis and cannot reach your counselor, please contact emergency services (911), Behavioral Health Response’ 24/7 mental health crisis line at 988, or go to your nearest emergency room.
J. Work Agreement
It is agreed that the client shall engage in the counseling process as an important priority in his or her life. Suspension, termination, or referral shall be discussed between counselor and client for a pattern of behavior showing disinterest, lack of
commitment, or for any unresolved conflict or impasse between counselor and client.
K. Conflict Resolution
We work hard to make sure that you have a positive counseling experience. However, if a conflict occurs, it is agreed that any disputes shall be negotiated directly between the parties. If these negotiations are not satisfactory, then the parties agree to mediate any differences with a mutually acceptable third--‐party mediator. If these are unsatisfactory, then the parties shall move to arbitration, and then binding arbitration, choosing an arbitrator mutually agreeable to both. Litigation shall be considered only if and after all of these methods of resolution are given a
good faith effort and are unsatisfactory.
L. Court Action / Legal Fees
NOTE: There may be a time when your therapist is subpoenaed to testify or produce records on your behalf. If that case should arise, the below fees would be assessed and charged. Although, responsible for the fees described herein, it is important to note that your therapist is required to testify to the facts and that such facts may not necessarily or solely be in your favor.
• • Retainer Fee: $2500 due at least 7 days prior to any court appearances
• • Preparation (including Records Review and Preparation) time: $250/hour
• • Phone calls (outside of initial inquiry/cause for subpoena): $250/hour
• • Depositions: $250/hour
• • Time required in giving testimony: $250/hour
• • Mileage: $0.57/mile
• • Time away from office due to depositions or testimony: $250/hour
• • All attorney fees and costs incurred by the therapist as a result of the legal action.
• • Filing a document with the court: $150
• • Court presence requested, but canceled/rescheduled within 72 hours: $500 in addition to the $2500 retainer already provided
• • Records Search and Retrieval: $26.85
• • Copying of Records: $0.57/per page
M. Waiver of Liability. By signing this Agreement, you agree to waive, release and discharge Provider from any and all liability, including, without limitation, any injuries that may occur during the provision of services under this Agreement.
Our website address is: https://www.connectedthoughtscounseling.com