Notice of Privacy Practices



Sharon M. Barnes, LCSW, PLLC






Effective April 14, 2003


If you have any questions or requests about this Notice, please contact Sharon M. Barnes, LCSW,

Privacy Information Officer.


My Practice is required by State and Federal law to maintain the privacy of protected health information.

In addition, the Practice is required by law to provide clients with this Notice of Privacy Practices

explaining our legal duties and privacy practices with respect to your mental health information, and to

request that you sign the attached written acknowledgement that you received a copy of this Notice. This

Notice describes how the Practice may use and disclose your protected health information. This Notice

also describes your rights regarding your protected health information and how you may exercise your



“Protected Health Information, PHI”, is information the Practice has created or received about your

physical or mental health condition, the health care we provide to you, or the payment for your health

care; and identifies you or could be reasonably used to identify you. It includes your identity, diagnosis,

dates of service, treatment plan, and progress in treatment.




Permissible Uses and Disclosures Not Requiring Your Written Authorization Your mental health

information may be used and disclosed in the following ways.


  • Treatment: Your mental health information may be used and disclosed in the provision and

coordination of your healthcare. For example, this may include coordinating and managing

your health care with other health care professionals. Your mental health information may be

used and disclosed when I consult with another professional colleague, or if you are referred

for medication, or for coverage arrangements during my absence. In any of these instances

only information necessary to complete the task will be provided.

  • Payment: Your mental health care information will be used to develop accounts receivable

information, to bill you, and with your consent to provide information to your insurance

company or other third party payer for services provided. The information provided to

insurers and other third party payers may include information that identifies you, as well as

your diagnosis, dates and type of service, and other information about your condition and

treatment, but will be limited to the least amount necessary for the purposes of the disclosure.

  • Health Care Operations: Your mental health information may be used and disclosed in

connection with our health care operations, including quality improvement activities, training

programs and obtaining legal services. Only necessary information will be used or disclosed.

  • Required or Permitted by Law: Your mental health care information may be used or

disclosed when I am required or permitted to do so by law or for health care oversight. This

includes, but is not limited to: (a) reporting child abuse or neglect; (b) when court ordered to

release information; (c) when there is a legal duty to warn or to take action regarding

imminent danger to others; (d) when the client is a danger to self or others or gravely disabled;

(e) when a coroner is investigating the client’s death; or (f) to health oversight agencies for

oversight activities authorized by law and necessary for the oversight of the health care

system, government health care benefit programs, or regulatory compliance.

  • Contacting the Client: You may be contacted to remind you of appointments and to tell you

about treatments or other services that might be of benefit to you.

  • Crimes on the premises or observed by the provider: Crimes that are observed by the

therapist or the therapist’s staff, crimes that are directed toward the therapist or the therapist’s

staff, or crimes that occur on the premises will be reported to law enforcement.

  • Business Associates: Some of the functions of the practice may be provided by contracts with

business associates. For example, some of the billing, legal, auditing, and practice

management services may be provided by contracting with outside entities to perform those

services. In those situations, protected health information will be provided to those

contractors as is needed to perform their contracted tasks. Business associates are required to

enter into an agreement maintaining the privacy of the protected health information released to


  • Involuntary Clients: Information regarding clients who are being treated involuntarily,

pursuant to law, will be shared with other treatment providers, legal entities, third party payers

and others, as necessary to provide the care and management coordination needed.

  • Family Members: Except for certain minors, incompetent clients, or involuntary clients,

protected health information cannot be provided to family members without the client’s

consent. In situations where family members are present during a discussion with the client,

and it can be reasonably inferred from the circumstances that the client does not object,

information may be disclosed in the course of the discussion. However, if the client objects,

protected health information will not be disclosed.

  • Emergencies: In life threatening emergencies the practice will disclose information

necessary to avoid serious harm or death.

Uses and Disclosures Requiring Your Written Authorization or Release of Information

Except as described above, or as permitted by law, other uses and disclosures of your mental health

information will be made only with your written authorization to release the information. When you sign

a written authorization, you may later revoke the authorization in writing as provided by law. However,

that revocation may not be effective for actions already taken under the original authorization.

  • Psychotherapy Notes: Psychotherapy notes are maintained separate from your mental health

record. These notes will be used only by your therapist and disclosure will occur only under

these circumstances: (a) you specifically authorize their use or disclosure in a separate written

authorization; or (b) the therapist who wrote the notes uses them for your treatment; or (c)

they may be used for training programs in which students, trainees, or practitioners in mental

health learn under supervision to practice or improve their skills; or (d) if you bring a legal

action and we have to defend ourselves; and (e) certain limited circumstances defined by the


Ó NASW – Colorado Chapter, 2003. Used and adapted by permission