Notice of Privacy Practices
In accordance with state and federal law, the privacy practices of this counseling center must be posted on our webpage. This form will also be present in the entry paperwork that is filled out in the Patient Portal when a new client enters counseling services with the practitioner. Please read this form carefully before signing it on the Portal as it details the limits of confidentiality and the center’s legal responsibilities when it comes to protected health information (PHI).
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.
EJFinizioLMHC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.
YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.
To inspect and copy PHI.
• You can ask for an electronic copy of PHI. The Practice may charge you a reasonable fee.
• The Practice may deny your request if it believes the disclosure will endanger your life or another person's life, or in another way cause irreparable harm. You may have a right to have this decision reviewed.
To amend PHI.
• You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
• The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.
To request confidential communications.
• You can ask the Practice to contact you in a specific way. The Practice will agree to reasonable requests.
To limit what is used or shared.
• You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.
• You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.If an ROI or Emergency Contact form is not stored for an individual or agency and the client is a legal adult, information will not be shared unless sharing it falls under the heading of Duty To Warm or Mandated Reporting, or another exception listed later in this form.
* If there is a medical emergency, the therapist will share confidential information in order to avert a medical crisis. An example of this would be if a client with a heart problem had heart medication in his pocket, and had a heart episode where he could not call emergency services himself. In that case the clinician would both call emergency services and notify them that he has his medication in his pocket, in order to assist them in saving his life. This is just an example and not an exhaustive list.
* If information is mandated by a court order to be shared in a legal setting, it will be complied with.
* If a client is a minor, their legal guardian (in most cases a parent) will make the decisions of who clinical information will be shared with, and sign the ROIs if applicable. Information shared in therapy sessions by the minor will be shared with the parent, at the discretion of the clinician, at the parent's request unless it is prohibited by law to share the information. An example where law prohibits sharing of confidential information is if a minor who is 16 years old or older discloses information about sexual interactions or intentions (unless it is illegal behavior - all illegal behavior will be reported to the authorities). This is just an example and not an exhaustive list.
This Clinician is a Mandated Reporter and must comply with reporting any cases where a client confirms that abuse to an elderly person or a minor is occurring (negligence, sexual abuse, physical abuse, verbal abuse, emotional abuse, and other types of significant harm constitute "abuse") and also must tell the proper authorities or Crisis. if a client is thinking of killing themselves or another person, or knows about another person making plans to kill the client or someone else, or if irreversible harm is being planned by the client against someone else, the person who is being threatened with violence will be warned of the risk, and the police will be called. Significant harm to themselves, including the the thought, action, or urge to kill themselves, cutting/ burning /pulling out clumps of hair/ other similar activities done for the purpose of self harm, or other unlisted self harm actions on the part of the client will be reported to Crisis services. For kink informed therapy, any kink activity that involves a minor or other protected population, causes significant physical harm, is non consensual, or is not withing the confines of responsible and safe behavior among consenting adults, will be reported to the authorities and/ or crisis. For all clients, if any inappropriate behavior with minors is reported, either DCF or the police or both will be contacted.
In the event that the Clinician is not available to respond to a client in a crisis situation, please call :
BHN Crisis at 413-733-6661 or the police at 911. BHN Crisis's number and the National Suicide and Crisis Hotline Number of 988 will be provided to all clients as part of thier Portal paperwork.
To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
To 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. They must be listed as such on your paperwork and, in the case of a legal power of attorney, or other entity able to make legal decisions for the client, paperwork must be on file showing that they serve this role in the client's life.
If you feel your rights have been violated, it is your right as a US Citizen to file a complaint. However, if you feel uncomfortable about something that is not a violation of your rights, but rather something that comes up in therapy, we ask that you communicate with the therapist directly. This is because if there are any issues in therapy, they should be treated as part of the therapeutic process, and that involves that they be addressed with the therapist if at all possible. If you feel something more serious has occurred and do not feel it is appropriate to discuss it within the confines of the therapeutic arrangement, please contact the
US Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.,
Washington, D.C. 20201,
phone number 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 contact you for fundraising efforts, but you can ask not to be contacted again.
To file a complaint or otherwise give feedback, contact the practice using the information below:
E. J. Finizio, LMHC
94 North Elm St, Suite 301, Unit B
Westfield, MA, 01085
EJFinizioLMHC@IAmAUniverse.com
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, except for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. No ROI is required in a Mandated Reporting/ Duty To Warn situation. The Practice typically uses or shares your health information in the following ways:
To treat you.
• The Practice can use and share PHI with other professionals who are treating you.
• Example: Your primary care doctor asks about your mental health treatment.
To run the health care operations.
• The Practice can use and share PHI to run the business, improve your care, and contact you.
• Example: The Practice uses PHI to send you appointment reminders if you choose.
To bill for your services.
• The Practice can use and share PHI to bill and get payment from health plans or other entities.
• Example: The Practice gives PHI to your health insurance plan so it will pay for your services.
2. Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object
The Practice may use or disclose PHI without your authorization or an opportunity for you to object, including:
To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
• Serious threat to health or safety: To prevent a serious and imminent threat.
• Abuse or Neglect: To report abuse, neglect, or domestic violence.
To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law.
• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
• Law enforcement: For law locate and identify you or disclose information about a victim of a crime.
• Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
• National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
• Workers' Compensation: To comply with workers' compensation laws or support claims.
To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized duties.
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional review board.
• Inmates: The Practice created or received your PHI in the course of providing care.
• Business Associates: To organizations that perform 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 your family, friends, or others if PHI directly relates to that person's involvement in your care.
• If it is in your best interest because you are unable to state your preference.
4. Uses and Disclosures of PHI Based Upon Your Written Authorization
The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes:
• Marketing,
• Sale of PHI, or
• Psychotherapy notes.
5. Use and Disclosure of Substance Use Disorder Records Subject to 42 CFR Part 2:
(A) If applicable, your substance use disorder (“SUD”) records are protected by federal law under 42 C.F.R. Part 2 (“Part 2”). This law provides extra confidentiality protections and requires a separate patient consent for the use and disclosure of SUD counseling notes. Each disclosure made with patient consent must include a copy of the consent or a clear explanation of the scope of the consent. It must also be accompanied by a written notice containing the language in 42 CFR Part 2.32(a). Disclosure of these records requires your explicit written consent, except in limited circumstances such as:
• Medical Emergencies: to the extent necessary to treat you,
• Reporting Crimes on Program Premises,
• Child Abuse Reporting: In connection with incidents of suspected child abuse or neglect to appropriate state or local authorities, and
• Fundraising: We will provide you with an opportunity to decline to receive any fundraising communications prior to making such communications.
You may revoke this consent at any time.
(B) Prohibitions on Use and Disclosure of Part 2 Records:
SUD records received from programs subject to Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested SUD record is used or disclosed. If SUD records are disclosed to us or our business associates pursuant to your
written consent for treatment, payment, and healthcare operations, we or our business associates may further use and disclose such health information without your written consent to the extent that the HIPAA regulations permit such uses and disclosures, consistent with the other provisions in this Notice regarding PHI.
You may revoke your authorization, at any time, by contacting the Practice in writing, using the information above. The Practice will not use or share PHI other than as described in Notice unless you give your permission in writing.
OUR RESPONSIBILITIES
• The Practice is required by law to maintain the privacy and security of PHI.
• The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.
• The Practice reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website www.IAmAUniverse.com
• The Practice will inform you if PHI is compromised in a breach.
This Notice is effective on 6/2/2026.