HIPAA PRIVACY STATEMENT
JLC THERAPY LLC
HIPAA DISCLOSURES RE: CONFIDENTIAL INFORMATION
THIS NOTICE CONTAINS INFORMATION CONCERNING HOW CONFIDENTIAL MENTAL HEALTH TREATMENT INFORMATION CONCERNING YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY AND LET ME KNOW OF ANY QUESTIONS THAT YOU MAY HAVE CONCERNING THIS NOTICE.
During the process of providing services to you, JLC THERAPY LLC will obtain and use mental health and medial information concerning you that is both confidential and privileged. Ordinarily, this confidential information will be used in the manner that is described in this statement, and will not be disclosed without your consent, except for the circumstances described in this Notice.
I. USES AND DISCLOSURES OF PROTECTED INFORMATION
A. General Uses and Disclosures Not Requiring the Client’s Consent. JLC Therapy LLC, 2432 S. Downing Street, Suite
201, Denver, CO 80210, will use and disclose protected health information in the following ways.
- Treatment. Treatment refers to the provision, coordination, or management of mental health care and related
services by one or more health care providers. For example, JLC Therapy LLC therapists and staff involved
with your care may use your information to plan your course of treatment and consult with other health care
professionals or their staff concerning services needed or provided to you. - Payment. Payment refers to the activities undertaken by a health care provider to obtain or provide
reimbursement for the provision of health care. For example, JLC Therapy LLC and other health care
professionals may use information that identifies you, including information concerning your diagnosis,
services provided to you, dates of services, and services needed by you, and may disclose such information
to insurance companies and to businesses that review bills for health care services and handle claims for
payment of health care benefits in order to obtain payment for services. - Healthcare operations. Healthcare Operations means activities undertaken by health insurance companies,
businesses that administer health plans, and companies that review bills for health care services in order to
process claims for health care benefits. These functions include management and administrative activities. - Contacting the Client. JLC Therapy LLC may contact you to remind you of appointments and to tell you
about treatments or other services that might be of benefit to you. - Required by Law. JLC Therapy LLC will disclose protected health information when required by law. This
includes, but is not limited to: (a) reporting child or elder abuse or neglect to the Department of Human
Services or to law enforcement; (b) when court ordered to release information; (c) when there is a legal duty
to warn of a threat that a client has made of imminent physical violence , health care professionals are
required to notify the potential victim of such a threat, and report it to law enforcement; (d) when a client is
imminently dangerous to themselves or others, or is gravely disabled, health care professionals may have a
duty to hospitalize the client in order to obtain a 72-hour evaluation of the client; and (e) when required to
report a threat to the national security of the United States. - Health Oversight Activities. Your confidential, protected health information may be disclosed to health
oversight agencies for oversight activities authorized by law and necessary for the oversight of the health
care system, government health care benefit programs, regulatory programs or determining compliance with
program standards. - Crimes On the Premises or Observed by JLC Therapy LLC Personnel. Crimes that are observed by JLC
Therapy LLC staff, that are directed toward staff or occur on JLC Therapy LLC premises will be reported to
law enforcement. - Business Associates. Confidential healthcare information concerning you provided to insurers or to plans for
purposes of payment for services that you receive may be disclosed to business associates. For example,
some administrative, clinical, quality assurance, billing, legal, auditing and practice management services may be provided by contracting with outside entities to perform these services. In those situations, protected
health information will be provided to those contractors as is needed to perform their contracted tasks.
Business associates are required to enter into an agreement maintaining the privacy of the protected health
information released to them. - Research. Protected health information concerning you may be used, with your permission, for research
purposes if the relevant provisions of the Federal HIPAA Privacy Regulations are followed. - Involuntary Clients. Information regarding clients who are being treated involuntarily, pursuant to law, will
be shared with other treatment providers, legal entities, third-party payers and others, as necessary to
provide the care and management coordination needed in compliance with Colorado law. - Family Members. Except for certain minors, incompetent clients, or involuntary clients, protected healthy
information cannot be provided to family members without the client’s consent. In situations where family
members are present during a discussion with the client, and it can be reasonably inferred from the
circumstances that the client does not object, information may be disclosed in the course of that discussion.
However, if the client objects, protected health information will not be disclosed. - Emergencies. In life threatening emergencies, JLC Therapy LLC staff will disclose information necessary to
avoid serious harm or death. - Individuals Involved in Your Care. We may from time to time disclose your personal health information to
designated family and others who are involved in your care, or in payment of your care, in order to facilitate
that person’s involvement in your care or in paying for your care. We may also disclose limited personal
health information to a public entity that is authorized to assist in disaster relief efforts to enable that entity
to locate a family member who may be involved in some aspect of caring for you.
B. Client Release of Information or Authorization. JLC Therapy LLC and other health care professionals may not use or
disclose protected health information in any way without a signed release of information or authorization. When you
sign a release of information or an authorization, it may later be revoked, provided that the revocation is in writing.
The revocation will apply, except to the extent JLC Therapy LLC has already taken action in reliance thereon.
II. YOUR RIGHTS AS A CLIENT
A. Access to Protected Health Information. You have the right to receive a summary of confidential health information
concerning you, concerning mental health services needed or provided to you. There are some limitations to this
right, which will be provided to you at the time of your request, if any such limitation applies. To make a request, ask
JLC THERAPY LLC staff for the appropriate request form.
B. Amendment of Your Record. You have the right to request that JLC Therapy LLC or your health care professionals
amend your protected health information. JLC Therapy LLC is not required to amend the record if it is determined
that the record is accurate and complete. There are other exceptions, which will be provided to you at the time of
your request, if relevant, along with the appeal process available to you. To make a request, ask JLC Therapy LLC
staff for the appropriate request form.
C. Accounting of Disclosures. You have the right to receive an accounting of certain disclosures JLC Therapy LLC has
made regarding your protected health information. However, that accounting does not include disclosures that were
made for the purpose of treatment, payment, or health care operations. In addition, the accounting does not include
disclosures made to you, disclosures made pursuant to a signed Authorization, or disclosures made prior to April 14, 2003. There are other exceptions that will be provided to you should you request an accounting. To make a request,
ask JLC Therapy LLC staff for the appropriate request form.
D. Additional restrictions. You have the right to request additional restrictions on the use or disclosure of your health
information. JLC Therapy LLC does not have to agree to that request, and there are certain limits to any restriction
which will be provided to you at the time of your request. To make a request, ask JLC Therapy LLC staff for the
appropriate request form.
E. Alternative Means of Receiving Confidential Communications. You have the right to request that you receive
communications of protected health information from JLC Therapy LLC by alternative means or at alternative
locations. For example, if you do not want JLC Therapy LLC to mail bills or others materials to your home, you can
request that this information be sent to another address. There are limitations to the granting of such requests, which
will be provided to you at the time of the request process. To make a request, ask JLC Therapy LLC staff for the
appropriate request form.
F. Copy of this Notice. You have a right to obtain another copy of this Notice upon request.
III. ADDITIONAL INFORMATION
A. Privacy Laws. JLC Therapy LLC is required by State and Federal law to maintain the privacy of protected health
information. In addition, JLC Therapy LLC is required by law to provide clients with notice of its legal duties and
privacy practices with respect to protected health information. That is the purpose of this Notice.
B. Terms of the Notice and Changes to the Notice. JLC Therapy LLC is required to abide by the terms of this Notice, or
any amended Notice that may follow. JLC Therapy LLC reserves the right to change the terms of its Notice and to
make the new Notice provisions effective for all protected health information that it maintains. When the Notice is
revised, the revised Notice will be posted on JLC Therapy LLC’s website and will be available upon request.
C. Complaints Regarding Privacy Rights. If you believe JLC Therapy LLC has violated your privacy rights, you have
the right to complain to JLC Therapy LLC management. Please submit a statement, in writing, addressed to JLC
THERAPY LLC, PO BOX 100592, DENVER, CO 80250, concerning your complaint and the basis for it. You also
have the right to complain to the United States Secretary of Health and Human Services. Information about how to
file a complaint to HHS is available at hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html. It is the policy
of JLC Therapy LLC that there will be no retaliation for your filing of such complaints.
D. Additional Information. If you desire additional information about your privacy rights at JLC Therapy LLC, please
ask the Privacy Officer, Julie Chrzanowski.
IV. EFFECTIVE DATE
This Notice is effective October 15, 2025.