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Behavioral Wellness Clinic


Therapists at BWC Adhere to the Following Practices

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

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services is referred to as Protected Health Information (PHI). This Notice of Privacy Practices describes how your therapist may use and disclose your PHI in accordance with applicable law and Health Insurance Portability and Accountability Act (HIPAA). It also describes your rights regarding how you may gain access to and control of your PHI.

Your therapist is required by law to maintain the privacy of PHI and to provide you with notice of legal duties and privacy practices with respect to PHI. Your therapist is required to abide by the terms of this Notice of Privacy Practices. Your therapist reserves the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that your therapist maintains at that time. Your therapist will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on the BWC website, sending a copy to you in the mail upon request, or providing one to you at your next appointment.

How Your Therapist May Use and Disclose Health Information About You

For Treatment: Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your heath care treatment and related services. This includes consultation with clinical supervisors or other treatment team members; however, your therapist may disclose PHI to any other consultant only with your authorization. Your therapist may also contact you to remind you of your appointments or to provide information to you about treatment alternatives or other health-related benefits and services that may be of interest to you.

For Payment: Your therapist may use and disclose PHI to receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, your therapist will only disclose a minimum amount of PHI necessary for purposes of collection.

For Health Care Operations: Your therapist may use or disclose, as needed, your PHI in order to support business activities including, but not limited to, quality assessment activities, licensing, and conducting or arranging for other business activities. For example, your therapist may share your PHI with third parties that perform various business activities (e.g. billing or typing services), provided your therapist has a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes, PHI will be disclosed only with your authorization.

As Required by Law: Under the law, your therapist must disclose your PHI to you upon your request. In addition, your therapist may be required make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining compliance with requirements of the Privacy Rule.

Research: PHI may only be disclosed for use in research activities ONLY after a special approval process which includes your Written Informed Consent to participate in research activities.

Without Authorization: Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permit your therapist to disclose information about you without your authorization only in a limited number of situations.

It is your therapist's practice to adhere to more stringent privacy requirements for disclosures without an authorization. The following addresses these categories to the extent consistent with the your therapist's professional organization's code of ethics and HIPAA.

  • Child Abuse or Neglect: Your therapist may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect in the event that you tell your therapist about a case of known or suspected child abuse or neglect or, if in an assessment, your therapist has a reason to suspect that you are abusing or neglecting a child. In the event that your therapist must make a report to Child Protective Services, every effort will made to notify you in advance, except where to do so could present a risk of further injury or harm to a child.
  • You Intend to Harm Yourself or Others: In the event that you give your therapist reason to believe that you present an imminent danger to yourself or others, your therapist will take immediate steps to prevent that from occurring.
  • Judicial and Administrative Hearings: Your therapist may disclose your PHI pursuant to a subpoena (with your consent) or if court ordered to produce your records. In the event that your therapist receives a subpoena, your therapist will use the following guidelines to protect the safety and privacy of your PHI:
    • Notify you of the disclosure
    • Discuss possible consequences of the release
    • Discuss your wishes regarding authorizing the release
    • Review legal options, including (if necessary) filing a Motion to Quash, requesting only a Limited Review of Records, etc.
  • Medical Emergencies: Your therapist may use or disclose PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. Your therapist will try to provide information to you about this as soon as reasonably practicable after the resolution of the emergency.
  • Family Involvement in Care: Your therapist may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.
  • Health Oversight: If required, your therapist may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payers based on your prior consent) and peer review organizations performing utilization and quality control.
  • Public Health: Your therapist may disclose your PHI as required or authorized by law relating to public health activities, health oversight activities, serious threats to health or safety, or relating to contagious disease,
  • Court-Ordered Evaluation: When examination and evaluation of an individual are undertaken pursuant to judicial or administrative law order, but only to the extent as required by such order.
  • Law Enforcement: Your therapist may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
  • Guardian ad Litem: To the attorney and/or guardian ad litem of a minor who represents such minor in any judicial or administrative proceeding, if the court or administrative hearing officer has entered an order granting the attorney or guardian ad litem this right and such attorney or guardian ad litem presents evidence to the health care entity of such order;
  • Court-Appointed Special Advocate (CASA) Representative: Inspection and copying of records by advocate; confidentiality of records. Upon presentation by the advocate of the order of his appointment and upon specific court order, your therapist is required by law to permit the advocate to inspect and copy, without the consent of the child or his parents, any records relating to the child involved in the case or, in lieu of the advocate inspecting and copying any related records of the child, your therapist will be available within seventy-two hours to conduct for the advocate a review and an interpretation of the child's treatment records which are specifically related to the investigation. An advocate shall not disclose the contents of any document or record to which he becomes privy, which is otherwise confidential, except upon order of a court of competent jurisdiction
  • Other: Your therapist may disclose your PHI in situations where disclosure is reasonably necessary to establish or collect a fee or to defend a health care entity or the health care entity's employees or staff against any accusation of wrongful conduct; also as required in the course of an investigation, audit, review or proceedings regarding a health care entity's conduct by a duly authorized law-enforcement, licensure, accreditation, or professional review entity.

Verbal Permission: Your therapist may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your previous written authorization, which you have the right to revoke at any time

Special Consideration of Minors: The PHI of minors who are treated in this practice will only be released with the prior written authorization of custodial parents or a legal guardian, except as provided by law. An exception to this rule is when a minor independently and voluntarily seeks out mental health treatment on his own accord, in which case a guardian does not have access to the minor's records (except as provided by law) without the express written authorization of the minor.

Your Rights Regarding Your PHI

You have the following rights regarding PHI your therapist maintains about you. To exercise any of these rights, please submit your request in writing to your therapist:

  • Right of Access to Inspect and Copy: You have the right, which may be restricted only in exceptional circumstances to inspect and copy PHI that is maintained in a "designated record set." A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to copy and inspect PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. Your therapist may charge a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI.
  • Right to Amend: If you feel that the PHI your therapist has about you is incorrect or incomplete, you may ask your therapist to amend the information although your therapist is not required to agree to the amendment. If your therapist denies your request for amendment, you have the right to file a statement of disagreement with your therapist. Your therapist may prepare a rebuttal to your statement and will provide you with a copy. Please contact your therapist if you have any questions.
  • Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures that your therapist makes of your PHI. Your therapist may charge you a reasonable fee if you request more than one accounting in any 12 month period.
  • Right to Request Restrictions: You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. Your therapist is not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid out of pocket. In that case, your therapist is required to honor your request for a restriction.
  • Right to Request Confidential Communication: You have the right to request that your therapist communicate with you about medical matters in a certain way or at a certain location.
  • Breach Notification: If there is a breach of unsecured protected health information concerning you, your therapist may be required to notify you of this breach, including what happened and what you can do to protect yourself.
  • Right to a Copy of this Notice: You have a right to a copy of this notice.


If you believe that your therapist has violated your privacy rights, you have the right to file a complaint in writing with your therapist or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W., Washington, DC 20201 or by calling (202) 619-0257. No one will retaliate against you for filing a complaint.



OFFICE: (860) 830-7838
FAX: (860) 454-0667


Mo: 8:30 am - 4:30 pm
Tu: 8:30 am - 4:30 pm
We: 8:30 am - 4:30 pm
Th: 8:30 pm - 4:30 pm
Fr: 8:30 am - 4:30 pm
Sa: by appointment