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.
The Caring Collective LLC believes that healing happens within supportive, collaborative, and respectful relationships. Providers are committed to providing high-quality, trauma-informed care rooted in dignity, compassion, and empowerment. As part of our shared work, it is important that clients understand their rights and responsibilities in the counseling process. The Caring Collective LLC (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 are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.
To be treated with dignity and respect. Receive services without discrimination based on race, ethnicity, religion, gender, sexual orientation, gender identity, disability, marital status, age, socioeconomic status, or cultural background.
To receive quality of care. Expect professional, ethical care provided by a qualified mental health provider committed to ongoing education, competence, and ethical practice.
To inspect and copy PHI. You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee up to $40.The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. 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 be informed if your PHI is compromised in a breach
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.
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 previously 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.
To file a complaint if you feel your rights are violated. You can file a complaint by contacting the Practice using the following information: The Caring Collective LLC P.O. Box 145, Berlin Heights, Ohio 44814You can file a complaint with the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board through their online portal www.elicense.ohio.govThe Practice will not retaliate against you for filing a complaint.
OUR USES AND DISCLOSURES
The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
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.
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. 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 regarding audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws. If a situation is present where we have a duty to warn to prevent a serious and imminent threat to others. When there are concerns of suspected or potential abuse or neglect of a minor, an individual with developmental and/or intellectual disability, or adults over the age of 60 years old.
To comply by federal, state, or local law, law enforcement, or other government requests Judicial and administrative proceedings in response to a court order, subpoena, or discovery request. To disclose information to local law enforcement assisting in locating and/or identifying you or providing information regarding a victim of a crime. To comply with workers’ compensation laws or support claims. Specialized government functions regarding military or national security concerns, including intelligence, protective services for heads of state, or your security clearance. National security about 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.
The Practice may use and disclose PHI with your authorization, until you object. You may revoke your authorization, at any time, by contacting the Practice in writing.
To your family, friends, or others you identify if PHI directly relates to that person's involvement in your care. To your treatment team including case workers, case manager, medical doctors, and other specialists.
The Practice must obtain your written authorization along with an authorized legal subpoena to use and/or disclose PHI for the following purposes: Releasing any psychotherapy notes and/or substance abuse treatment records.
OUR COMMITMENT
Create welcoming and psychologically safe spaces for all backgrounds, identities, and experiences to be able to show up authentically.
Treat every person with inherent respect, valuing self-determination and empowering decision-making capabilities.
Respect and celebrate the uniqueness of each individual, culture, and community.
Uphold honesty, transparency, and the highest ethical standards.
Provide services grounded in trauma informed and evidence-based best practices.
Actively listen without judgement and respond with empathic feedback.
Foster open, honest, and respectful dialogue so all can feel heard and understood.
Provide support, knowledge, and practical tools that inspire self-discovery, strengthen personal boundaries, and guide informed confident decision-making.
Advocate and thoughtfully question limiting beliefs, systems, and practices to spark dialogue and inspire meaningful action.
Partner with others to foster healing and growth towards shared goals strengthening healthy relationships both individually and collectively within families, organizations, and the broader community.
CLIENT RESPONSIBILITIES
Engage in treatment by actively participate in the counseling process and communicate openly with the Provider to the best of your ability.
Attend sessions, arrive on time, and notify the Provider at least 24 hours in advance if you need to cancel or reschedule.
Provide accurate, honest communication about your history, symptoms, needs, and concerns to support effective treatment.
Treat your Provider and the environment (physical and therapeutic) with respect. Threats, harassment, intoxication, or unsafe behaviors may lead to interruption or termination of services.
Inform your Provider of any demographic updates throughout your care such as changes in address, phone number, emergency contact, financial responsibility, custody/guardianship or insurance coverage.
This Notice is effective on January 30, 2026.