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Practice Privacy Statement:

This notice describes how your medical information may be used and disclosed.  It also explains how you can obtain access to this information. Please review the below information carefully.

This is a formal notification, as required by Health Insurance Portability and Accountability Act of 1996 (HIPAA).  HIPPA addresses the privacy policy of this practice and your treating therapist. It is important that all clients and staff understand the importance of guarding patient information.

This practice has a legal obligation to maintain all medical records and information in the strictest of confidence as required by law. What this means to the client is that we must safeguard client information. This means we cannot release information to others without your written consent, including conversations, reminder calls, test results and other information that may be of a confidential nature. Client information about health care is identified as "PHI" or protected health information.

This change in policy requires that you, the client, identify and clarify at the time of registration or re-registration with this practice who we can talk to, how we can leave information on your behalf, and the process for ongoing continuity of your medical care. You can change this information at any time with written notification. Changes can only impact the care or information from that point in time forward.

All employees of Antone F. Feo, Ph.D. & Associates, Inc. and your therapist follow the terms of this Notice.


When you become a client of this office, we will use your health information within the office and disclose your health information outside the office for the reasons described in this Notice. The following categories describe some of the ways that we will use and disclose your health information.

Treatment - We use your health information to provide you with health care services. We may disclose your health information to other persons we are affiliated with who need that information to take care of you. This may involve talking to doctors and others not employed by us. We also may disclose your health information to people outside this office who may be involved in your health care, such as treating doctors, other professionals, and family members.

Payment - We may use and disclose your health information so that the health care you receive may be billed and paid for by you, your insurance company, or another third party. For example, we may give information about your treatment here to your health plan so it will pay us or reimburse us for treatment. We may also tell your health plan about a treatment you are going to receive so that we can get prior payment approval or learn if your plan will pay for the treatment.

Patient Information - This office will include limited information about you in its patient directories, such as your name, when your appointment is, and possibly why you are in the office.

Legal Matters - We will disclose health information about you outside of this office when required to do so by federal, state, or local law, or by the court process. We may disclose health information about you for public health reasons, like child abuse or neglect. We may release health information to help control the spread of disease or to notify a person whose health or safety may be threatened.


As described above, we will use your health information and disclose it outside of this office for treatment, payment, health care operations, and when required by law. We will not use or disclose your health information for other reasons without your written authorization. You may revoke the authorization, in writing, at any time, but we cannot take back any uses or disclosures of your health information already made with your authorization.


Rights to Accounting - You may request an accounting, which is a listing of the entities or persons (other than yourself) to whom this office has disclosed your health information without your written authorization. The accounting would not include disclosures for treatment, payment, health care operations, and certain other disclosure exempted by law. Your request for an accounting of disclosures must be in writing, signed, and dated. It must identify the time period of the disclosures and the office that maintains the records about which you want the accounting. We will not list disclosures made before April 14, 2003, or those made earlier than 6 years before your request. Your request should indicate the form in which you want the list (for example, on paper or electronically). You must submit your written request to this office to the attention of the Office Manager. We will respond to you within 60 days. We will give you the first listing within any 12-month period free, but we will charge you for all other accountings requested with the same 12 months.

Right to Amend - If you feel that health information we have about you is incorrect or incomplete, you have the right to ask us to amend your medical records. Your request for an amendment must be in writing, signed, and dated. It must specify the records you wish to amend and give the reason for your request. You must address your request to this office to the attention of the Office Manager. We will respond to you within 60 days. We may deny your request; if we do, we will tell you why and explain your options.

Right to Request Restrictions - You have the right to ask us to restrict the uses or disclosures we make of your health information for treatment, payment, or health care operations, but we do not have to agree. You also may ask us to limit the health information that we use or disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Again, we do not have to agree. A request for a restriction must be signed and dated and submitted to this office. We will tell you if we agree with your request or not. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to Request Confidential Communications - You have the right to request that we communicate with you about your health in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request for confidential communications must be in writing, signed and dated. It must specify how or where you wish to be contacted. You need not tell us the reason for your request, and we will not ask. You must send your written request to this office to the attention of the Office Manager. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice - You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.


If you believe your privacy rights have been violated, you may file a complaint with this office or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with this office, you must submit your complaint in writing to the Office Manager. You will not be penalized for filing a complaint.

Contact the Office Manager Phone 440.899.1300

If you are not satisfied with this response, you may report the provider to:

Office of Civil Rights
Regional Manager
Department of Health & Human Services
233 N. Michigan Avenue #240
Chicago, IL 60601
(312) 886.1807

Contact the Office of Civil Rights: http://www.hhs.gov/ocr/hipaa/assist.html


We may change this Notice at any time. Any change in the Notice could apply to medical information we already have about you, as well as any information we receive in the future.