NOTICE OF PRIVACY POLICY AND CLIENT RIGHTS

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

OUR LEGAL DUTIES

Pendleton Counseling Services is required by federal and Indiana law to:

Maintain the privacy and security of your Protected Health Information (“PHI”)
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of this Notice currently in effect
Notify you promptly if a breach occurs that may have compromised the privacy or security of your information

We may change the terms of this Notice at any time. Changes will apply to all PHI we maintain. The updated Notice will be available in our office and on our website.

SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)

If we create or receive records related to substance use disorder diagnosis, treatment, or referral for treatment, those records may be protected under 42 CFR Part 2, in addition to HIPAA.

Part 2 provides stricter confidentiality protections.

We will not use or disclose substance use disorder records:

For civil, criminal, administrative, or legislative investigations or proceedings against you
Without your written consent
Unless specifically authorized by a court order in compliance with 42 CFR Part 2

When applicable, disclosures will comply with federal Part 2 regulations and Indiana confidentiality laws.

HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

1. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your health care with other relevant professionals who are treating you.

If your information includes substance use disorder records protected under Part 2, disclosures for treatment require your written consent unless otherwise permitted by law.

2. Payment

We may use and disclose PHI to bill and receive payment.

If you pay out-of-pocket in full for a service, you may request that we not disclose that information to your health plan. We will honor that request unless required by law.

Part 2-protected information will not be disclosed for payment purposes without your written consent.

3. Health Care Operations

We may use PHI for practice operations, quality improvement, credentialing, supervision, and administrative functions.

If Part 2 applies, disclosures for operations require patient consent unless specifically permitted by regulation.

4. Required by Law

We may disclose PHI when required by federal or Indiana law, including:

Mandatory reporting of child abuse or neglect
Reporting abuse of endangered adults (Indiana Code 12-10-3)
Duty to warn/protect when there is a serious threat of harm

Part 2 records will only be disclosed as permitted under 42 CFR Part 2.

5. Judicial and Administrative Proceedings

We may disclose PHI in response to a court order or lawful subpoena.

If records are protected under 42 CFR Part 2, we will not disclose them in legal proceedings without your written consent or a specific Part 2 court order.

6. Appointment Reminders & Communication

We may contact you via phone, voicemail, text, email, or mail only for appointment reminders or practice-related communications. You may request restrictions or alternative communication methods. We do not sue your information for marketing purposes or share with any third party and affiliate company for marketing purposes.

Standard message and data rates may apply, depending on your carrier’s pricing plan. You may opt-out of receiving appointment reminders via text by replying “Stop” to any text message you receive, or contact Pendleton Counseling Services directly, by calling 765-221-9495 x 1 or 2.

PSYCHOTHERAPY NOTES

We maintain psychotherapy notes as defined under federal law (45 CFR §164.501). These notes are kept separately from your clinical record.

We will not use or disclose psychotherapy notes without your written authorization except:

For treatment by the originating provider
For supervision and training
For legal defense if you initiate legal action
As required by law
To prevent or lessen a serious and imminent threat

USES REQUIRING WRITTEN AUTHORIZATION

We will obtain written authorization before:

Marketing communications
Sale of PHI
Most disclosures of psychotherapy notes
Disclosures of substance use disorder records protected under 42 CFR Part 2 (unless otherwise permitted)

You may revoke authorization in writing at any time.

YOUR RIGHTS

You have the right to:

Inspect and obtain a copy of your PHI (excluding psychotherapy notes) within 30 days
Request amendments to your record (response within 60 days)
Receive an accounting of disclosures (past 6 years)
Request restrictions on certain disclosures
Request confidential communications
Receive a paper copy of this Notice
File a complaint without fear of retaliation

FILE A COMPLAINT

If you believe your privacy rights have been violated, you may file a complaint with:

Pendleton Counseling Services, LLC
Lindsey Lawrence
207 W State Street
Pendleton, IN 46064

or via phone (765) 221-9495 x 2.

You may also file a complaint with:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

EFFECTIVE DATE OF THIS NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. You may print a copy of this notice or request one from Pendleton Counseling Services, LLC.

Updated Feb. 2026