Relieve Counseling

Notice of Privacy Practices

Relieve Counseling

Effective date September 16, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Roselia M. Ortega, LCSW, operates Relieve Counseling as a sole proprietorship. This notice applies to protected health information created or received through Relieve Counseling therapy services, including in-person and telehealth care, and to authorized workforce members and business associates that handle protected health information on the practice's behalf.

This notice does not govern the educational parenting classes or ordinary public website information. Those activities are covered by the Website Privacy Policy. Therapy scheduling, intake, secure communications, telehealth, billing, and clinical records are handled through SimplePractice.

Your Rights

You have the rights described below regarding your protected health information.

Inspect and Receive a Copy

You may ask to inspect or receive an electronic or paper copy of your therapy record and other health information we maintain about you. We will respond within the time required by applicable law. We may charge a reasonable, cost-based fee and may deny access only in limited circumstances permitted by law.

Request a Correction

You may ask us to amend health information that you believe is incorrect or incomplete. We may deny the request in limited circumstances. If we deny it, we will explain the reason in writing and describe any additional rights you have.

Request Confidential Communications

You may ask us to contact you in a particular way, such as only by telephone, secure portal, or mail, or to use a different address. We will agree to reasonable requests. Tell us if leaving a message, sending email, or using a particular number could place your privacy or safety at risk.

Request Limits on Uses and Disclosures

You may ask us not to use or disclose certain information for treatment, payment, or health care operations. We are generally not required to agree, but we will consider the request and will follow an agreed restriction except when information is needed for emergency treatment or disclosure is otherwise permitted or required by law.

If you pay in full out of pocket for a service, you may ask us not to disclose information about that service to your health plan for payment or health care operations. We will agree unless a law requires the disclosure.

Receive an Accounting of Disclosures

You may request a list of certain disclosures made during the six years before your request. The list generally does not include disclosures for treatment, payment, or health care operations; disclosures made to you; disclosures you authorized; or certain other disclosures excluded by law. One accounting in a 12-month period is free. We may charge a reasonable, cost-based fee for an additional accounting during that period after telling you the cost.

Receive This Notice

You may request a paper copy of this notice at any time, even if you agreed to receive it electronically. The current notice is also available on our website and through the practice upon request.

Choose a Personal Representative

A person who has legal authority to act for you, such as an authorized health care agent or legal guardian, may exercise your rights. We will verify that person's authority before acting.

Make a Complaint

You may complain to Relieve Counseling or to the U.S. Department of Health and Human Services if you believe your privacy rights were violated. We will not retaliate against you for making a complaint. Complaint information appears at the end of this notice.

Your Choices

You may tell us whether to share relevant information with family members, close friends, or other people involved in your care or payment for care. You may also tell us whether to share information for disaster relief. If you cannot tell us your preference, we may use professional judgment and applicable law to act in your best interest or to address a serious and imminent threat.

We will obtain your written authorization before using or disclosing protected health information for marketing, selling protected health information, or most uses and disclosures of psychotherapy notes when such notes are created and maintained separately from the rest of the record. Relieve Counseling does not use protected health information for fundraising or advertising audiences.

You may revoke an authorization in writing at any time. A revocation will not affect actions already taken in reliance on the authorization.

Routine Uses and Disclosures

Treatment

We may use and disclose your health information to provide, coordinate, or manage therapy and related care. This may include consultations or communications with another health professional involved in your care when permitted by law.

Payment

We may use and disclose information to bill and collect payment from you, a health plan, or another responsible payer. This may include eligibility checks, claims, utilization review, coordination of benefits, and responding to payment questions.

Health Care Operations

We may use and disclose information to operate the practice, improve services, conduct quality and compliance activities, manage records, obtain legal or accounting advice, audit claims, review professional performance, and contact you about appointments or care-related alternatives. We use the minimum information reasonably necessary when the minimum necessary rule applies.

Business Associates

We may disclose information to vendors that perform services involving protected health information, such as electronic health record, telehealth, billing, or secure communication services. We require a Business Associate Agreement when HIPAA requires one and require the vendor to safeguard the information and report improper uses or disclosures.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose protected health information without your written authorization only when HIPAA and other applicable law permit or require it. More protective California confidentiality law will control when it gives greater protection to mental health information. Depending on the circumstances, permitted or required disclosures may include:

  • Disclosures required by federal or California law, including disclosures to the U.S. Department of Health and Human Services for a compliance review.
  • Public health and safety activities authorized by law, including certain disease reporting and actions needed to prevent or reduce a serious and imminent threat.
  • Reports of suspected child abuse, elder or dependent adult abuse, or other mandatory reports required of a licensed clinician.
  • Health oversight activities, such as licensing, audits, investigations, and inspections authorized by law.
  • Workers' compensation matters and other programs that provide benefits for work-related injuries or illness.
  • Court, administrative, or law enforcement requests when all legal requirements are met, including applicable privilege and confidentiality protections.
  • Disclosures to a coroner, medical examiner, or funeral director when authorized by law after a person's death.

Relieve Counseling will not disclose mental health treatment records merely because someone asks for them. We review legal authority, applicable privilege, the scope of the request, and any requirement for your authorization, notice, protective order, or court order before disclosing records.

Substance Use Disorder Records

Relieve Counseling is not a specialized substance use disorder treatment program subject to 42 CFR Part 2. If we receive or maintain a substance use disorder patient record that is protected by Part 2, we will not use or disclose that record in a civil, criminal, administrative, or legislative investigation or proceeding against you unless you provide written consent or the disclosure is authorized by a court order accompanied by a subpoena as required by law. We do not use Part 2 records for fundraising.

Uses and Disclosures Requiring Authorization

Uses or disclosures that are not described in this notice and are not otherwise permitted or required by law will be made only with your written authorization. We do not sell protected health information. We do not disclose protected health information to advertising platforms or use therapy client lists for marketing audiences.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will notify you as required by law if a breach may have compromised the privacy or security of your unsecured protected health information.
  • We must follow the duties and privacy practices in the notice currently in effect.
  • We will not use or disclose your information other than as described in this notice unless you authorize us in writing or another use or disclosure is permitted or required by law.
  • We maintain adult therapy health service records for at least seven years after therapy ends, or longer when required by applicable law or an authorized records hold.

Changes to This Notice

We may change this notice and make the revised terms apply to all protected health information we maintain, including information created or received before the change. The current notice will be available on our website, in the practice upon request, and through the Privacy Officer. A revised notice will state its effective date.

Privacy Questions and Complaints

To exercise a right, ask a privacy question, request a copy of this notice, or make a complaint, contact:

Roselia M. Ortega, LCSW
Privacy Officer | Relieve Counseling
615 13th Street, Suite B4 | Modesto, CA 95354
info@relievecounseling.com | (209) 209-5470
https://relievecounseling.com

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html, calling 1-877-696-6775, or writing to 200 Independence Avenue SW, Washington, DC 20201. Relieve Counseling will not retaliate against you for filing a complaint.