Clients may request restriction on the use and disclosure of protected health information [PHI] ( PHI is individually identifiable health information that is maintained or transmitted by our office. In other words, private data that could be traced back to you, such as progress notes, evaluations, diagnosis, etc.). Clients may also terminate a restriction on the use and disclosure of protected health information. Clients requesting restriction on the disclosure of PHI need to complete a request form.

Clients have the right to request our office communicates with them in the most private way possible. Please let us know if you wish we communicate with you in only certain ways (e.g. e-mail, work telephone, home telephone, or cellular phone).

You have a right to review your entire clinical record and to obtain a copy of your entire record. Parents of minors (persons under 18) have a right to view the entire clinical record of their child(ren) in treatment. Non-custodial parents have equal rights under Ohio law to view the entire clinical record of a child(ren) receiving therapy services at our office. This right can only be restricted by a Court Order. A request to review and/or copy records requires that you complete a special form which you can obtain from our Privacy Officer, Mr. David Zachau.

Minor clients have the right to privacy and confidentiality in therapy, but this right is limited. Minor clients should understand that their parents can review their treatment record. Minor clients should also understand if they speak about abuse or neglect of themselves or another minor the information must be reported to Children Services by the therapist. Minor clients should ask their parents and therapist any questions they have about the limitations to confidentiality before counseling begins.

Clients have the right to amend the PHI in their clinical record. You must make a formal request to amend a record. Mr. Zachau can review the record amendment procedure with you at any time.

Clients have a right to know who has requested PHI from their records.

Clients have the right to complain about any problem they encounter at our office. If you would like to make a complaint please ask for a Complaint Form. Complaint Forms can be mailed to:

David Zachau
Psychiatric and Psychological Services
750 South Abbe Road
Elyria, Ohio 44035