Confidentiality Policy

The contents of our counseling, intake, or assessment forms and sessions are considered to be confidential. Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client’s legal guardian. It is the policy of this clinic not to release any information about a client without a signed release of information. Noted exceptions are as follows:

Duty to Warn and Protect

When a client discloses intentions or a plan to harm another person, the health care professional is required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a plan for suicide, the health care professional is required to notify legal authorities and make reasonable attempts to notify the family of the client.

Abuse of Children and Vulnerable Adults

If a client states or suggests that he or she is abusing a child (or vulnerable adult) or has recently abused a child (or vulnerable adult), or a child (or vulnerable adult) is in danger of abuse, the health care professional is required to report this information to the appropriate social service and/or legal authorities.

Prenatal Exposure to Controlled Substances

Health care professionals may be required to report admitted prenatal exposure to controlled substances that are potentially harmful if the life of the unborn child is placed at risk. In the Event of a Client’s Death In the event of a client’s death, the spouse or parents of a deceased client have a right to access their child’s or spouse’s records.

Professional Misconduct

Professional misconduct by a health care professional must be reported by other health care professionals. In cases in which a professional or legal disciplinary meeting is being held regarding the health care professional’s actions, related records may be released in order to substantiate disciplinary concerns.

Court Orders

Health care professionals are required to release records of clients when a court order has been placed. It is our policy to inform you of the Court Order or Subpoena and or our intent to release your records prior to releasing them to any party.

Minors/Guardianship

Parents or legal guardians of non-emancipated minor clients have the right to access the client’s records.

Other Provisions

When fees for services are not paid in a timely manner, various methods may be utilized in collecting unpaid debts. The specific content of the services (e.g., diagnosis, treatment plan, case notes, testing) is not disclosed. If a debt remains unpaid it may be reported to credit agencies, and the client’s credit report may state the amount owed, time frame, and the name of the clinic.

Insurance companies and other third-party payers are given information that they request regarding services to clients. Information which may be requested includes type of services, dates/times of services, diagnosis, treatment plan, description of impairment, progress of therapy, case notes, and summaries. This information is only given upon written request and to supply them with information needed to process claims and to approve further or additional treatment services. If you request, we will notify you prior to the release of any of your information. Please note that certain demographic and diagnosis information is released to permit your insurance company to pay for the services that I have rendered. Information about clients may be disclosed in consultations with other professionals in order to provide the best possible treatment. In such cases the name of the client, or any identifying information, is not disclosed. Clinical information about the client is discussed when you are referred or when you request that information be sent to another provider. When couples, groups, or families are receiving services, a joint file is kept for individuals for information disclosed that is of a confidential nature. The information includes (a) testing results, (b) information given to the mental health professional not in the presence of other person(s) utilizing services, (c) information received from other sources about the client, (d) diagnosis, (e) treatment plan, (f) individual reports/summaries, and (h) information that has been requested to be separate. The material disclosed in conjoint family or couples sessions, in which each party discloses such information in each other’s presence, is kept in the client of records file in the form of case notes and clinical data. In the event in which the clinic or mental health professional must telephone the client for purposes such as appointment cancellations or reminders, or to give/receive other information, efforts are made to preserve confidentiality. Please tell us where we may reach you by phone and how you would like us to identify ourselves. For example, you might request that when we phone you at home or work, we do not say the name of the clinic or the nature of the call, but rather the mental health professional’s first name only. If this information is not provided to us during the intake process, we will adhere to the following procedure when making phone calls: First we will ask to speak to the client (or guardian) without identifying the name of the clinic. If the person answering the phone asks for more identifying information we will say that it is a personal call. We will not identify the clinic (to protect confidentiality). If we reach an answering machine or voice mail we will follow the same guidelines.

I also understand that all electronic transmission of data is covered by these policies and procedures. I understand that all efforts will be taken by Steven C. Holeman, PhD and Living Solutions, LLC to maintain my information in a confidential manner and that I can inquire at any time about the confidentiality of my information and clinical record.

I agree to the above limits of confidentiality and understand their meanings and ramifications and agree to these policies during the time that I am in treatment with Steven C. Holeman, PhD and Living Solutions, LLC.

As a patient of the Steven C. Holeman, PhD and Living Solutions, LLC, you are entitled to the rights outlined in the Mental Health and Developmental Disabilities Confidentiality Act and Chapter 2 of the Mental Health and Developmental Disabilities Code. These rights include, but are not limited to, the following:

  1. You have the right to be provided with adequate and humane care and services in the least restrictive environment.
  2. You have the right to be free from abuse and neglect.
  3. You have the right to have services provided to you following the development of an individualized treatment plan.
  4. You have the right to have your treatment plan reviewed periodically, but at least once every six months.
  5. You have the right to participate in the development and review of your treatment plan, when appropriate.
  6. You have the right to be notified in writing of the side-effects of medication if your service includes the administration of psychotropic medication(s).
  7. You have the right to refuse services, including medication, and to be informed of any consequences related to service delivery should you refuse medication.
  8. You have the right to be free from physical restraint/seclusion, unless such restraint/seclusion is being used as a therapeutic measure to prevent you from causing physical harm to yourself or others.
  9. You have the right to contact MO Center for Disability Law or any other agency to advocate on your behalf. You have the right to be offered staff assistance in contacting these organizations including being given the addresses and phone numbers.
  10. You have the right to present grievances or to appeal adverse decisions related to your services. You have the right to make such grievances or appeals to the highest level possible in the agency.
  11. You are entitled to have your rights explained to you using a language or method of communication you understand upon commencement of services.
  12. You have the right not to have services denied, suspended, reduced or terminated for exercising your rights.
  13. You have the right not to be denied mental health services because of age, sex, race, religious belief, ethnic origin, marital status, physical or mental disability, or criminal record that is unrelated to present dangerousness.
  14. Your Records are protected under the Federal Confidentiality Regulation and cannot be disclosed without your consent.

HIPAA Notice of Information and Privacy 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 IT CAREFULLY.

Understanding Your Health Record Information

I understand the necessity of maintaining and assuring your medical information remains private and confidential at all times.  I have always been committed to safeguarding your privacy.  I want you to understand how I protect the personal and medical information you share with me.

Each time you visit a hospital, a physician, or another health care provider, the provider makes a record of your visit.  Typically, this record contains your health history, current symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment.  This information, often referred to as your medical record, serves as the following:

v      Basis for planning your care and treatment.

v      Means of communication among the many health professionals who contribute to your care.

v      Legal document describing the care that you received.

v      Means by which you or a third-party payer can verify that you actually received the services billed for.

v      Tool in medical or psychological education.

v      Source of information for public health officials charged with improving the health of the regions they serve.

v      Tool to assess the appropriateness and quality of care that you received.

v      Tool to improve the quality of health care and achieve better patient outcomes.

Understanding what is in your records and how your health information is used helps you to--

v      Ensure its accuracy and completeness.

v      Understand who, what, where, why, and how others may access your health information.

v      Make informed decisions about authorizing disclosure to others.

v      Better understand the health information rights detailed below.

Your Rights under the Federal Privacy Standard

Although your health records are the physical property of the health care provider who completed it, you have the following rights with regard to the information contained therein:

v      Request restriction on uses and disclosures of your health information for treatment, payment, and health care operations.  “Health care operations” consist of activities that are necessary to carry out the operations of the provider, such as quality assurance and peer review.  The right to request restriction does not extend to uses or disclosures permitted or required under the following sections of the federal privacy regulations: § 164.502(a)(2)(i) (disclosures to you),  or 164.512 (uses and disclosures not requiring a consent or an authorization).  The latter uses and disclosures include, for example, those required by law, such as mandatory communicable disease reporting.  In those cases, you do not have a right to request restriction.  The consent to use and disclose your individually identifiable health information provides the ability to request restriction.  We do not, however, have to agree to the restriction.  If we do, we will adhere to it unless you request otherwise or we give you advance notice. You may also ask us to communicate with you by alternate means, and if the method of communication is reasonable, we must grant the alternate communication request.  You may request restriction or alternate communications on the consent form for treatment, payment, and health care operations.

v      Obtain a copy of this notice of information practices.

v       Inspect and copy your health information upon request.  Again, this right is not absolute.  In certain situations, such as if access would cause harm, we can deny access.  You do not have a right of access to the following:

²       Psychotherapy notes.  Such notes consist of those notes that are recorded in any medium by a health care provider who is a mental health professional documenting or analyzing a conversation during a private, group, joint, or family counseling session and that are separated from the rest of your medical record.

²       Information compiled in reasonable anticipation of or for use in civil, criminal, or administrative actions or proceedings.

²       Protected health information (“PHI”) that is subject to the Clinical Laboratory Improvement Amendments of 1988 (“CLIA”), 42 U.S.C. § 263a, to the extent that giving you access would be prohibited by law.

²      Information that was obtained from someone other than a health care provider under a promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information.

In other situations, I may deny you access, but if I do, I must provide you the reason for denying access.  These reasons may include the following:

v      A licensed healthcare professional, such as your attending physician or counselor, has determined, in the exercise of professional judgment, that the access is reasonably likely to endanger the life or physical safety of yourself or another person.

v      PHI makes reference to another person (other than a health care provider) and a licensed health care provider has determined, in the exercise of professional judgment, that the access is reasonably likely to cause substantial harm to such other person.

v      The request is made by your personal representative and a licensed health care professional has determined, in the exercise of professional judgment, that giving access to such personal representative is reasonably likely to cause substantial harm to you or another person.

If I grant access, I will tell you what, if anything, you have to do to get access.  I reserve the right to charge a reasonable, cost-based fee for making copies.

v      Request amendment/correction of your health information.  I do not have to grant the request if the following conditions exist:

v      I did not create the record.  If, as in the case of a consultation report from another provider, we did not create the record, we cannot know whether it is accurate or not.  Thus, in such cases, you must seek amendment/correction from the party creating the record.  If the party amends or corrects the record, we will put the corrected record into our records.

v      The records are not available to you as discussed immediately above.

v      The record is accurate and complete.

v      Obtain an accounting of non-routine uses and disclosures, those other than for treatment, payment, and health care operations.  We do not need to provide an accounting for the following disclosures:

v      To you for disclosures of protected health information to you.

v      To persons involved in your care and persons acting on your behalf. 

v      For national security or intelligence purposes.

v      To correctional institutions or law enforcement officials.

v      That occurred before April 14, 2003.

I must provide the accounting within 60 days.  The accounting must include the following information:

v      Date of each non-routine disclosure.

v      Name and address of the organization or person who received the protected health information.

v      Brief description of the information disclosed.

v      Brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure or, in lieu of such statement, a copy of your written authorization or a copy of the written request for disclosure.

I reserve the right to charge a reasonable, cost-based fee. 

Our Responsibilities under the Federal Privacy Standard

In addition to providing you your rights, as detailed above, the federal privacy standard requires me to take the following measures:

v      Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information.

v      Provide you this notice as to our legal duties and privacy practices with respect to individually identifiable health information that we collect and maintain about you.

v      Abide by the terms of this notice.

v      Train our personnel concerning privacy and confidentiality.

v      Implement a sanction policy to discipline those who breach privacy/ confidentiality or our policies with regard thereto.

v      Mitigate (lessen the harm of) any breach of privacy/confidentiality.

We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required.

How to Get More Information or to Report a Problem

 If you have questions, would like to report a problem, and/or would like additional information, you may contact me at (816) 739-0876.  The effective date of this Notice is April 1, 2003.


I RESERVE THE RIGHT TO CHANGE MY PRACTICES AND TO MAKE THE NEW PROVISIONS EFFECTIVE FOR ALL INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION THAT I MAINTAIN.  IF I CHANGE OUR INFORMATION PRACTICES, I WILL MAIL A REVISED NOTICE TO THE ADDRESS THAT YOU HAVE GIVEN ME.

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