Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Because Olive Tree Counseling, Inc., hereafter referred to as OTC, sees clients under 18, all references to “you” include your child as the parent or guardian of the child. OTC understands that your health information is personal to you, and OTC is committed to protecting your information. This Notice of Privacy Practices and Client Rights, hereafter referred to as Notice, describes how OTC will use and disclose protected information and data OTC receives or creates related to your health care.
Our Duties
OTC is required by law to maintain the privacy of your health information and to give you this Notice describing our legal duties and privacy practices. OTC is also required to follow the terms of this Notice currently in effect.
Use and Disclosure of Health Information
OTC will not use or disclose your health information without your authorization except in the following situations:
• Treatment
OTC may use and disclose your information while providing, coordinating, or managing your care. Information obtained by a member of your counseling team will be documented in your record and used to determine the course of treatment that should work best for you. OTC may also provide other healthcare providers with the minimum information that will prepare them in treating you.
• Payment
OTC may use and disclose your information to obtain or offer payment for providing your care. If OTC sends you, your insurance, or health plan a bill, the information on or accompanying the bill may include information that identifies you, your diagnosis, procedures, or supplies used. OTC may be required to disclose information to your health plan to determine your eligibility for payment for certain benefits. It is your responsibility to know what personal information is required by your insurance company.
• Health Care Operations
OTC may use and disclose health information for administrative aspects of your health care and manage OTC more efficiently. OTC’s medical staff may use information in your record to assess the quality of care and outcomes in your case and others like it. This information will be used to improve the quality and effectiveness of the healthcare and services OTC provides.
• Business Associates
OTC may disclose your information to its business associates to complete tasks OTC has requested of these associates, such as accounting or legal analysis. However, OTC requires the business associates to take precautions to protect your health information.
• Emergencies
In an emergency, OTC may use or disclose information, your location, or general condition to notify or assist a family member, personal representative, or other person responsible for your care. OTC may provide hospital staff or responding officers with information relevant to your care or recovery in the event of a medical emergency, including but not limited to attempted suicide, self-harm, or assault.
• Communication With Family
OTC may disclose to a family member, relative, friend—or other person with whom you identify—health information relevant to said individual’s involvement in your care.
• Mandatory Reporting
If OTC perceives you to be a threat to others, including minors, OTC has a mandatory obligation to report you to OCS or other protective human services, to which OTC will provide the required information for investigation.
• Court Proceeding
OTC may disclose your health information in response to requests made during judicial and administrative proceedings, court orders, or subpoenas as required by law.
Confidentiality and Privacy
Confidentiality at OTC is maintained according to the AAMFT Code of Ethics, State Professional Counseling regulations and HIPAA regulations. OTC cannot guarantee that your data will be kept private where disclosing information is required by law. There are limits and exceptions to confidentiality. Understand what can and cannot be kept private:
OTC may use and disclose your personal health information for the following purposes:
Use and Disclosure of Health Information
OTC will not use or disclose your health information without your authorization except in the following situations:
• Treatment
OTC may use and disclose your information while providing, coordinating, or managing your care. Information obtained by a member of your counseling team will be documented in your record and used to determine the course of treatment that should work best for you. OTC may also provide other healthcare providers with the minimum information that will prepare them in treating you.
• Payment
OTC may use and disclose your information to obtain or offer payment for providing your care. If OTC sends you, your insurance, or health plan a bill, the information on or accompanying the bill may include information that identifies you, your diagnosis, procedures, or supplies used. OTC may be required to disclose information to your health plan to determine your eligibility for payment for certain benefits. It is your responsibility to know what personal information is required by your insurance company.
• Health Care Operations
OTC may use and disclose health information for administrative aspects of your health care and manage OTC more efficiently. OTC’s medical staff may use information in your record to assess the quality of care and outcomes in your case and others like it. This information will be used to improve the quality and effectiveness of the healthcare and services OTC provides.
• Business Associates
OTC may disclose your information to its business associates to complete tasks OTC has requested of these associates, such as accounting or legal analysis. However, OTC requires the business associates to take precautions to protect your health information.
• Emergencies
In an emergency, OTC may use or disclose information, your location, or general condition to notify or assist a family member, personal representative, or other person responsible for your care. OTC may provide hospital staff or responding officers with information relevant to your care or recovery in the event of a medical emergency, including but not limited to attempted suicide, self-harm, or assault.
• Communication With Family
OTC may disclose to a family member, relative, friend—or other person with whom you identify—health information relevant to said individual’s involvement in your care.
• Mandatory Reporting
If OTC perceives you to be a threat to others, including minors, OTC has a mandatory obligation to report you to OCS or other protective human services, to which OTC will provide the required information for investigation.
• Court Proceeding
OTC may disclose your health information in response to requests made during judicial and administrative proceedings, court orders, or subpoenas as required by law.
Confidentiality and Privacy
Confidentiality at OTC is maintained according to the AAMFT Code of Ethics, State Professional Counseling regulations and HIPAA regulations. OTC cannot guarantee that your data will be kept private where disclosing information is required by law. There are limits and exceptions to confidentiality. Understand what can and cannot be kept private:
- OTC is required by law to report physical danger by you or another person. OTC will reveal the minimum information necessary to protect you or other individuals.
- If OTC has reason to believe you are threatening harm to another person, OTC is required by law to protect said person. OTC is required to inform said person and the police, or have you hospitalized.
- If you threaten or act to harm yourself, OTC reserves the right to have you hospitalized or call family to protect you. OTC will attempt to fully discuss the situation with you before acting unless there is an exceptional reason not to.
- In an emergency of imminent threat or danger where you cannot grant consent, OTC may provide minimum information to another professional to protect your life. OTC will first attempt to get permission and discuss the situation as soon as possible.
- If OTC suspects you are abusing, neglecting, physically assaulting, or sexually molesting a child, elderly person, or disabled person, the law requires OTC to file a report with a state agency. Discuss legal aspects in detail before you disclose related information to OTC.
- OTC may consult with a qualified individual about your treatment without providing your name. Likewise, when OTC is unavailable, another therapist may have access to client records at the client’s request. Your information will remain protected under HIPAA guidelines.
- OTC is required to keep records and notes of your treatment. If you have specific or unusual concerns, please speak with your own attorney—OTC does not give legal advice.
- OTC sees people individually, as couples, or as families. OTC will keep information confidential except for the previously listed situations. However, if another facility requires your information for your continued progression in therapy, OTC may encourage and work with you to disclose relevant information.
OTC may use and disclose your personal health information for the following purposes:
- Leave messages for patients regarding upcoming appointments or other administrative matters at the contact numbers on file.
- Describe or recommend treatment alternatives to you.
- Provide information about health-related benefits or services that may be of interest.
Prohibition on Other Uses or Disclosures
OTC will not make any other use or disclosure of your personal health information without your written authorization. Your name and identity will only be disclosed in accordance with AS 08.29.200. Once given, you may revoke the authorization in writing. OTC is unable to reverse any disclosure that had been previously authorized.
Records Requests for Minors
While parents have legal rights to information their children share in therapy, for the mental well-being of the child, OTC encourages parents to not request this data. OTC may encourage and assist children in sharing information, but OTC will not share data unless necessary to protect the life and well-being of an individual. OTC’s code of ethics prohibits harm to clients; therefore, OTC will not willingly release records unless required by law. OTC does not believe it is in a minor’s best interest to release therapeutic records and reserves the right to review or reject any request for records where compliance is not lawfully required.
Other Records Requests
OTC does not release marriage and family therapeutic records to spouses without both spouses’ written consent. Only your own individual records are available for you to request. However, it is not in the best interest of an individual to obtain therapeutic records. Any request for records with which OTC is legally obligated to comply will include a written statement declaring that you were informed as such.
Records Requests for Minors
While parents have legal rights to information their children share in therapy, for the mental well-being of the child, OTC encourages parents to not request this data. OTC may encourage and assist children in sharing information, but OTC will not share data unless necessary to protect the life and well-being of an individual. OTC’s code of ethics prohibits harm to clients; therefore, OTC will not willingly release records unless required by law. OTC does not believe it is in a minor’s best interest to release therapeutic records and reserves the right to review or reject any request for records where compliance is not lawfully required.
Other Records Requests
OTC does not release marriage and family therapeutic records to spouses without both spouses’ written consent. Only your own individual records are available for you to request. However, it is not in the best interest of an individual to obtain therapeutic records. Any request for records with which OTC is legally obligated to comply will include a written statement declaring that you were informed as such.
Individual Privacy Rights
Clients have the right to confidentiality of client health information. As a client, you have the right to:
OTC may also deny your request if:
I. The information was not created by OTC, unless the original provider of the information is no longer available to make the amendment.
II. The information is not part of the health information kept on record by or for OTC.
III. The information is not part of the health information you are permitted to inspect or copy.
IV. The information is accurate and complete.
To receive an accounting of disclosures of your health information. You must submit a request in writing to the address listed at the end of this document. Not all health information is subject to this request. Your request must state a time no longer than six years from the time of this Notice’s revise date and whether you would like to receive the report in paper or electronically. OTC may charge you the cost of providing this service. OTC will notify you of this cost, and you may choose to withdraw or modify your request before any charges are made. To receive copy of your records—even if you have agreed to receive the records electronically—you must submit a request in writing to the address listed at the end of this Notice. All requests to restrict use of your health information for treatment, payment, and health care operations, to inspect and copy health information, to amend your health information, or to receive an accounting of disclosures of health information must be made in writing to the contact person listed at the end of this Notice.
Other Client Rights
As a client, you have the right to:
- Request restrictions on the health information OTC may use and disclose for treatment, payment, and health care operations. To request restrictions, please send a written statement to the address listed at the end of this Notice.
- Receive confidential communications regarding your health information in a certain manner or at a certain location. For instance, you may request that OTC only contact you at work or by mail. To make such a request, you must write the address listed at the end of this Notice stating how or where you wish to be contacted.
- Inspect or copy your health information in paper or digital format. You must submit your request in writing to the address listed at the end of this Notice. If you request a copy of your health information, OTC will charge a fee for the cost of copying, mailing, and other supplies. OTC reserves the right to deny your request to inspect or copy your health information. However, you may request that the denial be reviewed by a separate licensed professional to which OTC will comply with the outcome.
- Amend health information. If the health information that OTC has on record is incorrect or incomplete, you may ask to amend the information. To request an amendment, you must write to the address at the end of this Notice with the reason to support your request. OTC may deny your request to amend your health information if it is not in writing or a reason to support your request is not provided.
OTC may also deny your request if:
I. The information was not created by OTC, unless the original provider of the information is no longer available to make the amendment.
II. The information is not part of the health information kept on record by or for OTC.
III. The information is not part of the health information you are permitted to inspect or copy.
IV. The information is accurate and complete.
To receive an accounting of disclosures of your health information. You must submit a request in writing to the address listed at the end of this document. Not all health information is subject to this request. Your request must state a time no longer than six years from the time of this Notice’s revise date and whether you would like to receive the report in paper or electronically. OTC may charge you the cost of providing this service. OTC will notify you of this cost, and you may choose to withdraw or modify your request before any charges are made. To receive copy of your records—even if you have agreed to receive the records electronically—you must submit a request in writing to the address listed at the end of this Notice. All requests to restrict use of your health information for treatment, payment, and health care operations, to inspect and copy health information, to amend your health information, or to receive an accounting of disclosures of health information must be made in writing to the contact person listed at the end of this Notice.
Other Client Rights
As a client, you have the right to:
- Be treated with respect regarding psycho-social, spiritual, and cultural variables that influence perceptions.
- Have a safe environment, free from discrimination of race, color, religion, gender, sex, handicap, national origin, or political standing. OTC treats individuals with respect and recognizes basic human rights.
- Receive information about therapist qualifications, including license, education, training experience, membership in professional groups, special areas of practice, and limits of practice.
- Have written information about fees, methods of payment, insurance coverage, and number of sessions the therapist thinks will be needed, and cancellation policies.
- Have informed consent to procedures, benefits and risks, and alternative options for your care.
- Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
- Privacy and confidentiality of your assessment and records, with exceptions listed in this Notice.
- Refuse audio or video recordings of your sessions if asked.
- Be informed of your progress.
- Request a list of those with whom your information has been shared and limit with whom or what is shared.
- File a complaint if you feel your rights have been violated or report any illegal or immoral therapist behavior.
Proper and Improper Therapist Conduct
A therapist should never use threatening or coercing behavior as part of your treatment plan. If you feel threatened by your therapist, confront the behavior immediately and contact OTC’s office at (907) 357-6513. Sexual contact with any therapist is strictly prohibited and against the professional code of conduct for all professional groups of mental health workers, i.e., psychologists, psychiatrists, licensed counselors, and marriage and family counselors. You are encouraged to contact OTC’s office for more information on any of OTC’s therapists or to file a complaint.
No Guaranteed Outcome
OTC strives to help clients reach the goals they desire. However, therapy does not guarantee success, e.g., divorce. If therapy seems ineffective, OTC will explore alternative methods or resources or refer you to another provider.
Complaints
OTC will never retaliate against a formal complaint. If you believe your privacy rights have been violated, you may file a complaint at (907) 357-6513 or to the address listed below. For severe violations of human or privacy rights, file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ or mailing a letter to the following address:
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
Contact Person
Please contact the following OTC contact person for all written complaints, questions, requests, or further information related to the privacy of your health information:
Holly Hoff
Attn: Privacy Officer
1981 E Palmer-Wasilla Hwy Ste 220
Wasilla, AK 99654
Office: (907) 357-6513 Fax: (907) 357-6514
Changes to This Notice
OTC reserves the right to change its privacy practices and apply revisions to previous health information. Any revision to our privacy practices will be described in a revised Notice that will be posted prominently in our facility.
Effectiveness date: Jan. 2025. Reviewed and revised: Jul. 2026.
Complaints
OTC will never retaliate against a formal complaint. If you believe your privacy rights have been violated, you may file a complaint at (907) 357-6513 or to the address listed below. For severe violations of human or privacy rights, file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ or mailing a letter to the following address:
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
Contact Person
Please contact the following OTC contact person for all written complaints, questions, requests, or further information related to the privacy of your health information:
Holly Hoff
Attn: Privacy Officer
1981 E Palmer-Wasilla Hwy Ste 220
Wasilla, AK 99654
Office: (907) 357-6513 Fax: (907) 357-6514
Changes to This Notice
OTC reserves the right to change its privacy practices and apply revisions to previous health information. Any revision to our privacy practices will be described in a revised Notice that will be posted prominently in our facility.
Effectiveness date: Jan. 2025. Reviewed and revised: Jul. 2026.
