HIPAA Policies

Client Rights:

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. You have the right to:

Get a copy of your paper or electronic medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Correct your paper or electronic medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communication

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

  • We will say “yes” to all reasonable requests.

Ask us to limit the information we share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared your information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

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 and make choices about your health information.

  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you believe your privacy rights have been violated

  • You can complain if you feel we have violated your rights

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

  • We will not retaliate against you for filing a complaint.

Your Choices:

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have the right and the choice to:

  • Tell us to share information with your family, close friends, or others involved in your care

  • Tell us to share information in a disaster relief situation

  • Tell us to include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures:

How do we typically use or share your health information? We typically use or share your health information in the following ways. We may use and share your information as we:

Treat you

  • We can use your health information and share it with other professionals who are treating you.

Run our organization

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Bill for your services

  • We can use and share your health information to bill and get payment from health plans or other entities.

Help with public health and safety issues

  • We can share health information about you for certain situations such as: preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety.

Do research

  • We can use or share your information for health research.

Comply with the law

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

  • We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

  • We can use or share health information about you: for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, for special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities:

  • We are required by law to maintain the privacy and security of your protected health information.

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this notice and give you a copy of it.

  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

  • For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice:

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

This notice is effective as of April 6, 2025.

Mandatory Disclosure

This statement is being provided to you so that you are aware of your rights as a patient and client. Please read and discuss any questions or concerns you have before signing. This disclosure is made pursuant to C.R.S §12-145-216 of the Mental Health Practice Act of Colorado.

Taylor Damitio, (720) 446 - 6363, 3801 E Florida Avenue, Suite 500, Denver, CO 80210, Bachelor of Science in Psychology, Master of Arts in Mental Health and Rehabilitation Counseling, Nationally Certified Counselor. I am a Licensed Professional Counselor with the State of Colorado (LPC.0022003).

The Colorado Department of Regulatory Agencies (DORA) has the general responsibility of regulating the practice of licensed psychologists, licensed social workers, licensed professional counselors, and licensed marriage family therapists, license school psychologist practicing outside of the school setting, and unlicensed individuals who practice psychotherapy. All questions/complaints/concerns should be addressed to: Department of Regulatory Agencies, Mental Health Section, Board of Psychologist Examiners, 1560 Broadway, Suite 1350, Denver, Colorado, 80202, (303)-894-7800.

At any point in time, a client is entitled to receive any information about the various methods of therapy, techniques used, duration of therapy (if known), and the fee structure of treatment.

As a client, you may at anytime exercise your right to seek out a second opinion from another licensed therapist. You may also exercise your right to terminate therapy at anytime.

In a professional relationship sexual relations or intimacy be tolerated between a licensed therapist and a client. Any instance of sexual advances, relationships, or intimacy shall be reported to the board that licenses, registers, or certified any licensee, registrant or certificate holder.

CLIENT RIGHTS AND IMPORTANT INFORMATION:

Pursuant to C.R.S §12-245-200, information provided by and to you as the client during any therapy sessions is legally confidential pursuant. Due to confidentiality, I cannot be forced to disclose any of your information without your express consent. Information disclosed to me is privileged communication and cannot be disclosed in any court of law with competent jurisdiction in the State of Colorado without the express consent of the person to whom the testimony sought relates.

However, there are exceptions to the general rule of confidentiality pursuant to C.R.S §12-245-220(2(a-d). You should be aware that provisions concerning the disclosure of confidential communications shall not apply to any delinquency or criminal proceedings, expect as required by C.R.S §13-90-107. Confidentiality may also be waived in the event of physical abuse and/or neglect of a child, including past or present sexual contact with a minor. All therapists are required by law to report such instances to the Denver Department of Social Services.

As to the regulatory requirements applicable to mental health professionals: a Licensed Clinical Social Worker, a Licensed Marriage and Family Therapist, and a Licensed Professional Counselor must hold a master’s degree in their profession and have two years of post-master’s supervision. A Licensed Psychologist must hold a doctorate degree in psychology and have one year of post-doctoral supervision. A Licensed Social Worker must hold a master’s degree in social work. A Psychologist Candidate, a Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in the process of completing the required supervision for licensure. A Certified Addiction Counselor I (CAC I) must be a high school graduate and complete the required training hours and 1000 hours of supervised experience. A CAC II must complete additional required training hours and 2,000 hours of supervised experience. A CAC III must have a bachelor’s degree in behavioral health, and complete additional required training hours and 2,000 hours of supervised experience. A Licensed Addiction Counselor must have a clinical master’s degree and meet the CAC III requirements. A Registered Psychotherapist is registered with the State Board of Registered Psychotherapists, is not licensed or certified, and no degree, training or experience is required.

FEE INFORMATION:

My standard fee is $150 for a 50-minute individual session and $175 for a 50-minute couples session. I request payment by check or cash at the time service is rendered. If checks are returned due to insufficient funds, a $25 fee will be charged to you. As a general policy, I request that clients pay me directly. Meetings with auxiliary medical or legal consultants either by phone or in person and report writing will be billed at my standard fee. If payment is in arrears more than 90 days and a fee payment schedule cannot be agreed upon, your account will be turned over to a collection agency, an attorney, or small claims court.

MISSED APPOINTMENT AND CANCELLATIONS:

If you are unable to keep an appointment, please notify me as soon as possible. If you cancel or miss an appointment without giving me 24 hours notice, you will be billed full fee for the session.

TELEPHONE CALLS:

If you need to speak to me between regularly scheduled sessions, please leave a message and I will return your call as soon as possible. Telephone calls for the purpose of scheduling are expected and are not billed. I do not charge for brief conversations but any discussion that goes beyond 10 minutes or more than three 10 minute discussions per week will be billed to you on a prorated basis. I am generally available between the hours of 11am and 7pm, Monday through Thursday. If an emergency arises after those hours, please call 911 or go to the nearest available emergency room.

HEALTH INFORMATION PRIVACY NOTICE (HIPAA):

By signing this disclosure you acknowledge receipt of the HIPAA policies for your review. Once you have reviewed these policies, please return a signed copy to me. You are not required to sign this notice to receive treatment. Please verbally inform me if you elect to not sign the notice.

If you have any questions or would like additional information, please feel free to ask me.

I have read the preceding information, it has also been provided verbally, and I understand my rights as a client.