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. Please review it carefully.

Our Commitment to Your Privacy

Wellbound Counseling, PLLC is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How We May Use and Disclose Your Information

We may use and disclose your PHI for the following purposes:

• Treatment — to provide, coordinate, or manage your healthcare
• Payment — to obtain payment for services we provide to you
• Healthcare Operations — for quality assessment, training, and business management

Your Rights

You have the right to:

• Request restrictions on certain uses and disclosures
• Request confidential communications
• Inspect and obtain a copy of your health information
• Request an amendment to your health information
• Receive an accounting of disclosures
• Obtain a paper copy of this notice

When We May Disclose Without Authorization

We may disclose your PHI without your authorization in certain situations, including when required by law, for public health activities, to prevent a serious threat to health or safety, and when there is suspected abuse or neglect of children, adults, or elders.

Contact

For questions about this notice or to exercise your rights, please contact Tony Iacubino, MA, LCPC at (847) 780-0055 or 508 Central Avenue, Suite 210, Highland Park, IL 60035.