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Notice of Privacy Practices (HIPPA)

In compliance with HIPPA policy, this notice is posted here and is distributed in new client paperwork. 

This notice describes how health information about you may be used and disclosed, and how you can get access to this information. All requests that you have regarding your health information must be submitted in writing to the address on this form.


You Have the Right to:


Obtain a Copy of Your Medical Record: 

  • Please submit a written request for this information to the address on this form.

  • The personal notes of Kathleen Salmon documenting or analyzing the contents of counseling sessions are called psychotherapy notes, and access to these notes are excluded from your right to view or receive a copy. Access to psychotherapy notes will be decided at the sole discretion of Kathleen Salmon, LLC.

  • Kathleen Salmon, LLC will provide a copy or a summary of your health information, within 30 days of your request. You may be charged a reasonable, cost-based fee for this service. 


Request Corrections to Your Medical Record:

  • Kathleen Salmon, LLC may say “no” to your request, but you will be informed why in writing within 60 days. 


Request Confidential Communication:

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


Ask Kathleen Salmon, LLC to Limit What We Use or Share:

  • Kathleen Salmon, LLC will comply with your request unless a law requires it to share that information, or if complying with your request would negatively affect your care.


Get a List of Those with Whom Kathleen Salmon, LLC Has Shared Your information:

  • This list will include the times Kathleen Salmon, LLC has shared your health information for six (6) years prior to the date you ask, with whom it was shared, and why. 


Choose Someone to Act for You:

  • If you have given someone medical power of attorney, or if someone is your legal guardian, that person is entitled to exercise your rights and make choices about your health information. 

  • Kathleen Salmon, LLC will verify that the person has the authority to act for you before any action is taken. 


File a Complaint if You Feel Your Rights Are Violated:

  • You have the right to complain if you feel that your rights have been violated. 

  • 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

  • You may also complain by calling 1-877-696- 6775, or visiting www.hhs.gov/ocr/privacy/hipaa/ complaints/. 

  • Kathleen Salmon, LLC will not retaliate against you for filing a complaint. 


You Have Choices: 

For certain health information, you can tell Kathleen Salmon, LLC your choices about what is shared. If you have a clear preference for how your information is shared in the situations described below, let Kathleen Salmon, LLC know and your instructions will be followed. 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.

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In these cases, you have both the right and choice to tell Kathleen Salmon, LLC to: 

  • Share information with your family, close friends, or others involved in your care 

  • Share information in a disaster relief situation 

  • Include your information in a hospital directory 


If Your Health Information Needs to Be Disclosed:

You may request that Kathleen Salmon, LLC share your health information with another entity such as another provider, residential facility, or treatment program. An “Authorization to Release/Request Information” must be completed in order for this information to be sent to another entity. 


How Your Information Will Be Shared:

Kathleen Salmon, LLC will generally use or share your health information in the following ways: 

  • To Treat You: To share it with other professionals who are treating you. 

  • To Run Kathleen Salmon, LLC: To run our practice, improve your care, and contact you when necessary. 

  • To Bill for Your Services: To bill and get payment from health plans or other entities. 

  • To Comply with the Law: To comply with the law in certain situations such as: 

    • Reporting suspected abuse, neglect, or domestic violence;

    • Preventing or reducing a serious threat to anyone’s health or safety;

    • If state or federal laws require it;

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

    • Respond to lawsuits and legal actions; and 

    • In response to a court or administrative order, or in response to a subpoena. 


Responsibilities of Kathleen Salmon, LLC:

  • 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.


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.


If you have any concerns, questions, or requests, please contact Kathleen Salmon at:

Kathleen Salmon, LLC, PO Box 20261, Boulder, CO

Tel. (720) 903 - 2870 

Notice of Privacy Practices: About Me
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