Strive CLE Counseling LLC, and its affiliates are committed to protecting your health information. This Notice of Privacy Practices (or “Notice”) describes your rights and our duties under Federal Law to protect your health information. We are required by law to maintain the privacy of your health information; provide you with notice of our legal duties and privacy practices with respect to your health information; and to notify you following a breach of unsecured health information related to you. We are required to abide by the terms of this Notice. This Notice is effective as of the date listed above. This Notice will remain in effect until it is revised. We are required to modify this Notice when there are material changes to your rights, our duties, or other practices contained here We reserve the right to change our privacy policy and practices and the terms of this Notice, consistent with applicable law and our current business processes, at any time. Any new Notice will be effective for all health information that we maintain at that time. Notification of revisions of this Notice will be provided as follows: 1.) upon request; 2.) electronically via our website or via other electronic means; and 3.) as posted in our place of business. In addition to the above, we have a duty to respond to your requests (e.g., those corresponding to your rights) in a timely and appropriate manner. We support and value your right to privacy and are committed to maintaining reasonable and appropriate safeguards for your health information.

How We May Use and Disclose Health Information About You:

Treatment: We may use and disclose your health information to provide you with medical treatment or services. For example, a health care provider, such as a physician, nurse, or other person providing health services will access your health information to understand your medical condition and history. This information may be provided to other health care professionals or facilities that are involved in treating you. We may also request your medical

information from other health care providers you have previously seen to assist in your care. Our records may contain information we receive from other sources, such as a hospital (if you have been inpatient). If another doctor or provider (hospital or nursing home) treating you asks for your records, our policy is to send the entire record. We believe that is in the best interests of patient care and treatment. Please let us know if you have a concern about our sending the entire record.

Payment: We will use and disclose your medical information to obtain or provide compensation or reimbursement for providing your health care. For example, a bill will be sent to you if you have an outstanding balance or to an outside collection agency to help us collect amounts owed. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis. As another example, we may disclose information about you to your health plan so that the health plan may determine your eligibility for payment of certain benefits.

Health Care Operations: We may use and disclose your health information for operational purposes. For example, your health information may be used by, and disclosed to, risk or quality improvement personnel and others to evaluate the performance of our staff, to assess the quality of care and outcomes in your case and similar cases, to learn how to improve our services, for training, to arrange for legal or risk management services and to determine how to continually improve the quality and effectiveness of the health care we provide.

Business Associates: We may disclose your health information to business associates (individuals or entities that perform functions on our behalf) provided they agree to safeguard the information.

Required by Law: We may use and disclose information about you as required by law. For example, we are required to disclose information about you to the U.S. Department of Health and Human Services if it requests such information to determine that we are complying with federal privacy law.

Research: We may disclose health information for certain research purposes when the research has been approved by an institutional review board that has established protocols to ensure the privacy of your health information.

Others Involved in Your Care: Unless you object, we may disclose relevant health information to a family member, friend, or anyone else you designate to be involved in your care or payment related to your care. We may also disclose health information to those assisting in disaster relief efforts so that others can be notified about your condition, status, and location.

Appointment Reminders: We may call, e-mail, or send you notification through the online patient portal to remind you of scheduled appointments, missed appointments, or that it is time to make your appointment. We may also call or write to notify you of other treatments or services available at our office that might benefit you. Unless you tell us otherwise, we may leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.

Public Health: We may use or disclose your health information to assist public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other public health activities such as reporting reactions to medications or problems with products, enabling product recalls, repairs or replacements to the Food and Drug Administration.

Reporting Suspected Abuse: We may disclose health information to an appropriate government authority, including a protective services agency, if we believe an individual is the victim of abuse, neglect, or domestic violence. We will inform the individual that we have made such a report, unless we believe that doing so would place the individual at serious risk of harm. We will make such reports only as required or authorized by law, or if the individual agrees.

Health Oversight: We may disclose your health information to a health oversight agency for activities required to oversee the health care system, government benefits programs, entities subject to governmental regulation and civil rights laws, such as audits and civil investigations.

Law Enforcement: Under certain circumstances, we may disclose your health information to law enforcement officials. These circumstances include reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises and crimes in emergencies.

Judicial and Administrative Proceedings: We may disclose information in response to an appropriate subpoena, discovery request or court order.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Specialized Government Functions: Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, and for medical suitability determinations for the Department of State.

Decedents: Health information may be disclosed to funeral directors, medical examiners, or coroners to enable them to carry out their lawful duties.

Organ/Tissue Donation: Your health information may be used or disclosed for cadaveric organ, eye, or tissue donation purposes.

Health and Safety: We may disclose your health information as necessary to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

Workers’ Compensation: We may disclose health information when authorized and necessary to comply with laws relating to Workers’ Compensation or other similar programs. Other than as described above, we may not use or disclose your health information without your written

authorization. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your health information for marketing purposes or sell your health information, unless you have signed an authorization. You may revoke the authorization at any time in writing to the address below. Your revocation will not be effective for any use or disclosure previously made in reliance on your authorization.

You have the right:

To request a restriction on uses and disclosures of your health information for treatment, payment, or health care operations. We are not required to agree to a requested restriction, except for requests to limit disclosures to your health plan for purposes of payment or health care operations when you have paid for the item or service covered by the request out-of pocket and in full and when the uses or disclosures are not required by law. To request restrictions, please send a written request to the Privacy Officer at the contact information listed below.

To receive confidential communications of health information about you in a certain manner or at a certain location. For instance, you may request that we only contact you at work or by mail. To make such a request, select your contact preferences on the patient portal or contact the office directly.

To inspect and obtain a copy of your health information that we maintain or direct us to send a copy of your health information to another person designated by you in writing. In most cases we will provide this access to you, or the person you designate, within 30 days of your request.

You may be charged a fee for the cost of copying and mailing in advance. If you are denied access to your health information, we will send you a written explanation. You may request that the denial be reviewed. Another licensed health care professional will then review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. To make such a request, send a written request to the Privacy Officer at the contact information listed below.

To amend health information. If you feel the health information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must write to the Privacy Officer at the contact information listed below. You must also give us a reason to support your request. We may deny your request to amend your health information if it is not in writing or does not provide a reason to support your request. We may also deny your request if:

1. The information was not created by us, unless the person who created the information is no longer available to make the amendment.

2. The information is not part of the health information kept by or for us.

3. The information is not part of the information you would be permitted to inspect or copy; or

4. The information is accurate and complete.

To receive an accounting (a list) of disclosures of your health information, you must submit a request in writing to the Medical Services department. We are not required to account for certain disclosures of your health information, such as disclosures you authorize. Your request must state a time period of no longer than six years. Your request must state how you would like to receive the report. Medical services fees will apply. For additional requests, there may be an added charge. We will notify you of this cost and you may choose to withdraw or modify your request before charges are incurred.

To receive paper copies of this Notice upon request, even if you have previously agreed to receive this notice electronically. Please send your request to the address listed below.

Please send requests to:

Strive CLE Counseling
26777 Lorain Road | Suite 314
North Olmsted, OH. 44053

(216) 264-3686

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