At The Tree House Center for Growth and Learning, we understand and respect that information about you and/or your child is private and personal. We are committed to protecting your health care information. We are also required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI. 

 

We create a record of the care and services you and/or your child receive directly from our medical staff. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice of Privacy Practices (“NPP”) applies to all of the records of your care generated by our office.

 

To help clarify the terms here are some definitions:

• “PHI” (Private Health Information) refers to information in your health record that could identify you and/or your child.

• “Treatment, Payment, and Health Care Operations”

• Treatment is when we provide, coordinate, or manage your health care and other services related to your health care. An example of treatment would be when we consult with another health care provider, such as your family physician, another psychologist or your psychiatrist.

• Payment is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility coverage.

• Heath Care Operations are activities that relate to the performance and operation of our practice. Examples of health care operations are quality assessment and improvement activities, business related matters such as audits and administrative services, and case management and care coordination.

• “Use” applies only to activities within our office and practice such as sharing, employing, utilizing, examining, and analyzing information that identifies you.

• “Disclosure” applies to activities outside of our office and practice such as releasing, transferring, or providing access to information about you to other parties.

• “Authorization” is your written permission to disclose confidential mental health information. All authorizations to disclose must be on a specific legally required form.

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USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS. We may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your written authorization.

 

REGULATORY REQUIREMENTS.  Our office is required by law to maintain the privacy of your Private Health Information (PHI), to provide individuals with notice of our office’s legal duties and privacy practices with respect to PHI, and to abide by the terms described in the Notice currently in effect.  Information disclosed pursuant to this Notice may be subject to redisclosure by the recipient and may no longer be protected by the HIPPA Privacy Rule.

 

PATIENT’S RIGHTS.

• Right to Request Restrictions – You may request that our office restrict the use and disclosure of your PHI. To request restrictions, you must make your request in writing to our privacy officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the restrictions to apply, for example, disclosure to your spouse.

• Right to receive Confidential Communications by Alternate Means and at Alternate Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing a therapist. On your request, we will send your bills to another address.) Your request must be made in writing and sent to our privacy officer.

• Right to Inspect and Copy – Generally, you have the right to inspect and/or copy your PHI that our office maintains, provided that you make your request via certified mail to our privacy officer. On your request, we will discuss with you the details of the request for an access process. If you request copies of your PHI, we will impose a reasonable fee to cover copying and postage. If we deny access to your PHI, we will explain the basis for denial and your opportunity to have your request and the denial reviewed by a licensed therapist or psychologist (who was not involved in the intial denial decision) designated as a reviewing official. If our office does not maintain the PHI you request and if we know where that PHI is located, we will tell you how to redirect your request.

• Right to Amend – If you believe that your PHI maintained by our office is incorrect or incomplete, you may contact our privacy officer via certified mail and ask us to correct your PHI. You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request if your PHI: (i) was not created by our office; (ii) is not part of the records our office maintains; (iii) is not subject to to being inspected by you; or (iv) if it is accurate and complete. If your request is denied, we will provide you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial, (ii) submit a request that any future disclosures of the relevant PHI be made, with a copy of your request and our office’s denial attached; and (iii) complain about the denial.

 

ACCOUNTING OF DISCLOSURES.  You generally have the right to request and receive a list of the disclosures of your PHI we have made at any time during the six (6) years prior to the date of your request (provided that such a list would not include disclosures made prior to April 14, 2003). This right includes an accounting of disclosures made for treatment, payment and healthcare operations through an electronic health record during the three years prior to your request. The list will include disclosures made at your request, with your authorization, and does not include certain uses and disclosures to which this Notice already applies, such as those: (i) for treatment, payment and health care operations; (ii) made to you; (iii) for our office’s patient list; (iv) for national security or intelligence purposes, or (v) to law enforcement officials. You should submit any any such request via certified mail to Dr. Christine Decker, but if you make more than one request in a year you will be charged a fee of the costs of providing that list.

 

All files are kept a minimum of 7 years. After this time, all information except a data sheet is shredded. If you are under age 18 at the time of treatment, all information is kept until you are at the age of 27. At that time, only a data sheet will be kept and the file will be shredded.

 

RIGHT TO A PAPER COPY. You have the right to obtain a paper copy of the notice from us upon request, even if you have agreed to receive the notice electronically. To obtain a paper copy of this notice, please contact your therapist or our office manager.  Or send a request to: Privacy Officer, The Tree House CGL, 3115 N Wilke Rd., Suite HIO, Arlington Heights, IL.60004.

 

USES AND DISCLOSURES WITHOUT AUTHORIZATION - LIMITS OF CONFIDENTIALITY.  We may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when we are asked for information for purposes outside of treatment, payment, or health care operations, we will obtain an authorization from you before releasing this information. We will also need to obtain authorization before releasing our Psychotherapy Notes. “Psychotherapy Notes” are notes we have made about our conversation during a private, group, joint, or family counseling session, which we have kept separate from the rest of your record. These notes are given a greater protection than PHI.

 

You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.

 

In the following situations, no authorization is required and we may use or disclose you or your child’s PHI without obtaining a written consent:

 

• For Treatment: We may occasionally find it helpful to consult with other health and mental health professionals about a case. During a consultation, we make every effort to avoid revealing the identity of the patient. The other professionals are also legally bound to keep information confidential. If you don’t object, we will not tell you about these consultations unless your therapist thinks that it is important to your work together. We will note all consultations in your Clinical Record.

• For Payment: Our office may use and disclose PHI in order to bill and collect payment for the health care services provided to you. For example, we may need to give PHI to your health plan in order to be reimbursed for the services provided to you. We may also disclose PHI to billing companies, claims processing companies and others that assist in processing health claims.

• As Required by Law and Law Enforcement: If you are involved in court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-patient privilege law. We cannot disclose any information without a court order. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order us to disclose information. We will not testify in child custody cases.

• Health and Oversight: If a government agency is requesting the information for health oversight activities, we may disclose protected health information regarding you and/or your child. For example, we may need to release PHI to a health agency for oversight activities authorized by law, including licensure or disciplinary actions.

• Judicial and Administrative Proceedings: If a patient files a complaint or lawsuit against us, we may disclose relevant information regarding that patient in order to defend ourselves.

• Worker’s Compensation: If you file a worker’s compensation claim, and we are rendering treatment or services in accordance with the provisions of Illinois Workers’ Compensation law, we must, upon appropriate request, provide a copy of your record to your employer or his/her/their appropriate designee.

• Serious Threat to Harm or Safety: There are some specific situations in which we are legally obligated to take action, which we believe are necessary to protect against harm or safety. During these situations, we may have to reveal PHI:

• Protect From Harm:  If we have reasonable cause to believe a child under 18 known to us in our professional capacity may be an abused child or a neglected child, the law requires that we file a report with the local office of the Department of Children and Family Services. Once such a report is filed, we may be required to provide additional information.

• Elder Abuse: If we have reason to believe that an adult over the age of 60 living in a domestic situation has been abused or neglected in the preceding 12 months, the law requires that we file a report with the agency designated to receive such reports by the Department of Aging. Once such a report is filed, we may be required to provide additional information.

• Harm to Others: If you or your child has made a specific threats of violence against another person, we may be required to disclose information in order to take protective actions. These actions may include notifying the potential victim, contacting the police, and/or seeking you or your child’s hospitalization.

• Harm to Self: If we believe that you or your child presents a clear, imminent risk of serious physical or mental injury or death to yourself, we may be required to disclose information in order to take protective actions. These actions may include seeking your or your child’s hospitalization and/or contacting family members or others who can assist in protecting you or your child.

 

If any of the above situations with respect to the limits of our confidentiality arise, we will make every effort to fully discuss it with you before taking an action and we will limit our disclosure to only what is necessary. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future.

 

SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS. If our office receives or maintains records protected by federal law relation to substance use disorder (42 CFR Part 2), we will not use or disclose such records in any civil, criminal, administrative, or legislative proceedings against you without your specific written consent or a court order that meets the requirements of law.

 

COMPLAINTS.  At our office, we value the relationships we develop with our patients, our patients’ privacy and the trust our patients’ have in us. As such, we make every effort to quickly remedy any issues or concerns you may have. You may submit any complaint regarding your privacy rights to our privacy officer:

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Dr. Christine Decker

3115 N Wilke Rd

Suite HIO

Arlington Heights, IL 60004

847-975-5598

chris-decker@treehousecgl.com

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You also have the right to file a complaint with the Secretary of the Department of Health and Human Services, Office for Civil Rights in Illinois. You will not be penalized for filing a complaint.

 

EFFECTIVE DATE, RESTRICTIONS AND CHANGES TO PRIVACY POLICY. This notice will go into effect on February 16, 2026. We reserve the right to change the terms of this notice and make the new notice provisions effective for all PHI that we maintain. We will provide you with a revised notice by giving you a copy of revisions via electronically and upon request by a paper copy.

 

PLEASE CONTACT THE PRIVACY OFFICER IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE OF PRIVACY PRACTICES OR YOUR PRIVACY RIGHTS.