THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED IN ACCORDANCE WITH HIPAA COMPLIANCE AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
[Shared Strength Counseling LLC] (the “Practice”) is dedicated to safeguarding your privacy. In compliance with federal law, the Practice is obligated to maintain the privacy of your Protected Health Information (PHI), which includes information that identifies you or could potentially be used to identify you. This Notice of Privacy Practices (this “Notice”) outlines the Practice's legal obligations regarding privacy practices and details your rights under HIPAA regarding the PHI we collect and maintain.
YOUR RIGHTS
Your rights regarding PHI are detailed below. To exercise these rights, please submit a written request to the Practice at the address provided below.
To inspect and copy PHI.
• You can request an electronic or paper copy of your PHI. The Practice may charge you a reasonable fee.
• The Practice may deny your request if it deems that the disclosure could endanger your life or someone else's. You may have the right to have this decision reviewed.
To amend PHI.
• You can request to correct any PHI you believe is inaccurate or incomplete. The Practice may require that you submit your request in writing, along with a reason for the request.
• The Practice may deny your request, in which case a written explanation of the denial will be provided, along with an option for you to submit a written statement of disagreement.
To request confidential communications.
• You may request that the Practice contact you in a specific manner, and the Practice will accommodate all reasonable requests.
To limit what is used or shared.
• You can ask the Practice not to use or disclose PHI for treatment, payment, or business operations. While the Practice is not required to agree if it would affect your care, your request will be considered.
• If you pay for a healthcare item or service out-of-pocket in full, you can request that the Practice not share your PHI with your health insurer.
• You may also ask the Practice not to share your PHI with family members or friends by specifying the requested restriction and to whom it should apply.
To obtain a list of those with whom your PHI has been shared.
• You can request a list, known as an accounting, of instances where your health information has been disclosed. You may receive one accounting every 12 months at no charge, but may incur a reasonable fee for additional requests within that timeframe.
To receive a copy of this Notice.
• You have the right to request a paper copy of this Notice, even if you agreed to receive it electronically.
To choose someone to act for you.
• If you have granted someone medical power of attorney or if a legal guardian is in place, that individual can exercise your rights.
To file a complaint if you believe your rights are violated.
• Complaints can be filed by contacting the Practice directly.
• You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• The Practice will not retaliate against you for filing a complaint.
To opt out of receiving fundraising communications.
• The Practice may reach out to you for fundraising efforts, but you have the option to request not to be contacted again.
To file a complaint or exercise your rights, contact the Practice using the information below:
[Shared Strength Counseling LLC]
[5150 N 90th St Omaha NE 68134]
[402-819-8153]
OUR USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
The Practice is permitted under federal law to use and disclose PHI without your written authorization for certain routine purposes, including treatment, payment, and business operations. The Practice typically utilizes and shares your health information in various ways outlined below:
To treat you.
• The Practice may use and share PHI with other healthcare professionals involved in your treatment.
• Example: As a provisional provider, I have a fully licensed supervisor overseeing my treatment of you.
To run health care operations.
• The Practice can use and share PHI for operational purposes, to enhance your care, and to contact you if needed.
• Example: PHI is used to send appointment reminders should you choose to receive them.
To bill for your services.
• The Practice can use and disclose PHI to bill and obtain payment from health plans or other entities.
• Example: The Practice discloses PHI to your health insurance provider to facilitate payment for services rendered.
2. Uses and Disclosures of PHI Without Your Authorization or Opportunity to Object
The Practice may use or disclose PHI without your prior authorization or opportunity to object, including:
To assist with public health and safety issues
• Public health: For preventing disease spread, product recalls, and reporting adverse medication reactions.
• REQUIRED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES: We may have to disclose your PHI to the Secretary for investigations or compliance determinations as per the final rule on the Privacy Standards for Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections as mandated by government agencies overseeing healthcare or civil rights laws.
• Serious threat to health or safety: To prevent a serious and imminent threat.
• Abuse or Neglect: For reporting suspected cases of abuse, neglect, or domestic violence.
To comply with laws, law enforcement, or requests from government entities
• Required by law: When mandated by federal, state, or local laws.
• Judicial and administrative proceedings: In response to court orders, subpoenas, or discovery requests.
• Law enforcement: For locating and identifying you, or disclosing info about a crime victim.
• Specialized Government Functions: For military or national security matters, including protection services for governmental leaders and determining security clearances.
• National security and intelligence activities: For intelligence, counterintelligence, and protection protocols.
• Workers' Compensation: To comply with applicable workers' compensation laws or claim support.
To comply with other requests
• Coroners and Funeral Directors: For fulfilling their legal duties.
• Organ Donation: For facilitating organ donation or transplantation.
• Research: For research approved by relevant institutional review boards.
• Inmates: PHI created while providing care to inmates may be disclosed.
• Business Associates: To organizations performing functions, activities, or services on our behalf.
3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object
Unless you object, the Practice may disclose PHI to:
• Family, friends, or others if the PHI directly relates to their involvement in your care.
• If disclosure is in your best interest and you are unable to express your preference.
4. Uses and Disclosures of PHI Requiring Your Written Authorization
The Practice must obtain your written consent to use and/or disclose PHI for specific purposes, including:
• Marketing,
• Sale of PHI, or
• Psychotherapy notes.
5. Use and Disclosure of Substance Use Disorder Records Under 42 CFR Part 2:
(A) If applicable, your substance use disorder (SUD) records are protected under federal law (42 C.F.R. Part 2) which offers additional confidentiality and mandates separate patient consent for SUD counseling notes. Every disclosure based on patient consent must include a copy of the consent or a clear scope explanation, along with written notice containing 42 CFR Part 2.32(a) language. Explicit written consent is needed for disclosing these records, except in limited cases such as:
• Medical Emergencies: as needed for treatment,
• Crime Reporting: in connection with incidents occurring on program premises,
• Child Abuse Reporting: to notify appropriate authorities of suspected child abuse or neglect, and
• Fundraising: You will have the opportunity to refuse any fundraising communication before any such outreach.
You may revoke this consent at any time.
(B) Restrictions on Using and Disclosing Part 2 Records:
SUD records from programs under Part 2 cannot be used or disclosed in civil, criminal, administrative, or legislative procedures against you unless it is based on your written consent or a court order following your notice and opportunity to be heard, as provided in Part 2. A court order must accompany a subpoena or legal requirement compelling disclosure before the requested SUD record is shared. If SUD records are disclosed to us or our business associates under your written consent for treatment, payment, and healthcare operations, we or our associates may further use and disclose such health information without additional written consent, consistent with the HIPAA regulations, and in alignment with the other provisions in this Notice regarding PHI.
You can revoke your authorization at any time by contacting the Practice in writing using the information provided above. The Practice will not use or share your PHI in any manner outside of what is described in this Notice unless you provide written permission.
OUR RESPONSIBILITIES
• The Practice is legally required to maintain the privacy and security of your PHI.
• The Practice must adhere to the terms of this Notice currently in effect. If stricter state or federal laws govern PHI, the Practice will comply with the more stringent provisions.
• The Practice reserves the right to amend this Notice. All changes will apply to PHI collected and maintained by the Practice. Should changes occur, you may request a revised Notice by contacting the Practice, or by viewing a version on our website (https://sharedstrengthcounseling.com/).
• You will be notified if your PHI is compromised in a breach.
This Notice is effective as of [6/10/2026].
Shared Strength Counseling
5150 North 90th Street, Omaha, NE, USA
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