Disclaimer

This website is owned and operated by Matlack Counseling. Information on this website is meant for general information purposely only about Matlack Counseling. 

Website content is not to be used for therapy or clinical advise:

Information on this website (diagnosis, treatment or therapies used) is not to be used for mental health advice. Please seek a mental health professional for advice. 

Legal fees:

In the event that you request I appear in court proceedings my hourly fee is $200 per hour. 

Crisis or Emergency:

Matlack Counseling website is not monitored 24/7 and should not be used as a Crisis or Emergency contact. If you need to seek Crisis or Emergency assistance outside of session time due to Thoughts of Self Harm, Thoughts of Harm to Others or being Harmed by Another Individual, please contact any of the following: 

• Local Emergency Rooms/ Hospitals

• Youth < 17 (Nationwide Children’s Hospital): (614) 722-1800

• Adults > 18 (Netcare): (614) 276-2273

• Central Ohio Suicide Prevention Hotline at (614) 221-5445.  

•  National Suicide Prevention Lifeline at 1-800-273-8255          

Hippa: Notice of Policies and Practices to Protect the Privacy of Your Health Information

Uses and Disclosures for Treatment, Payment, and Health Care Operation: 

I may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes in most instances without your consent under HIPAA, but will obtain consent in another form for disclosing PHI is required. In all instances I will only disclose the minimum necessary information in order to accomplish the intended purpose. 

Serious Threat to Health or Safety: 

If I believe that you pose a clear and imminent serious threat of harm, or a clear and present danger, to yourself or another person I may disclose your relevant confidential information to public authorities, the potential victim, other professionals, and/or your family in order to protect from such harm. If you communicate in session or outside of session to me an explicit threat of inflicting imminent and serious harm or causing the death of one or more identifiable victims, and I believe you have the intent and means to carry out the threat, then I may take one or more of the following actions: Seek hospitalization, Establish and undertake a treatment plan to eliminate the possibility that you will carry out the threat, and seek out a second opinion risk assessment with another mental health professional, Communicate to a law enforcement agency and, if feasible, to the potential victim(s), or victims parent or guardian if a minor, all of the following information:  The nature of the threat, Client identity, Identity of the potential victim(s). I will inform you about these notices and obtain a release of information if I deem it appropriate under the circumstances.

Uses and Disclosures Requiring Authorization

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances, when I am asked for information for purposes outside of treatment, payment and health care operations, I will obtain an authorization from you before releasing this information, including uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI. Times when there is a disclosures requiring an authorization: confidential information to your partner, your spouse, your children, except in some limited instances where they are involved in your health care, in which case I will obtain your consent first. Any disclosure involving psychotherapy notes, will require your signed authorization, unless I am otherwise allowed or required by law to release them. You may revoke an authorization for future disclosures, but this will not be effective for past disclosures which you have authorized.

Patient’s Rights and Duties

You have the right to request conditions on certain uses and disclosures of protected health information about you for treatment, payment or health care operations. However, I am not required to agree to conditions you request. 

You have the right to request and receive confidential communications of PHI by alternative means and at
alternative locations. If your request is reasonable, then I will honor it.

You have the right to inspect or obtain a copy (or both) of PHI in my medical records used to make decisions about you for as long as the PHI is maintained in the record, except under some limited circumstances. This does not apply to information created for use in a civil, criminal or administrative action or proceeding. I may charge you reasonable amounts for copies, mailing or associated supplies under most circumstances. I may deny your request to inspect and/or copy your record or parts of your record in certain limited circumstances. If you are denied copies of or access to your PHI, you may ask that my denial be reviewed. Under certain circumstances where I feel, for clearly stated treatment reasons, the disclosure of your record might have an adverse effect on you, I will provide your records to another mental health therapist of your choice if that is allowable under state and federal law.

You have the right to request an amendment of PHI for as long as the PHI is maintained
in the record. I may deny your request, but will note that you made the request. Upon your request, I will
discuss with you the details of the amendment process.

You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.
Matlack Counseling Duties:

I am required by law to maintain the privacy of PHI, to provide you with this notice of my legal duties and
privacy practices with respect to PHI, and to abide by the terms of this notice.

 I reserve the right to change the privacy policies and practices within Matlack Counseling for all of the PHI entailed.

If I revise my policies and procedures, I will maintain one, and one will always be available at my office. You can always request that a paper copy be sent to you by mail.

In the event that I learn that there has been a use or disclosure of your unsecured PHI,
unless there is a low risk that your unsecured PHI has been compromised, I will notify you of this breach.