Notice of Privacy Practices

This notice describes how medical and mental-health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. It applies to Mesa Valley Counseling and Jason Cheney, M.Ed., LPC.

Uses and disclosures without authorization

We may use and disclose protected health information for treatment, payment, and health-care operations. Colorado law and professional ethics add tighter limits for psychotherapy communications. We disclose information without your written authorization when required to report child abuse or neglect, abuse of at-risk adults, or a serious and imminent threat of harm to you or another person, and when a court issues a valid order.

Uses that require your authorization

Most exchanges with schools, attorneys, other providers, or family members require a written authorization. You may complete that authorization on the secure Release of Information form. You may revoke an authorization in writing, except to the extent we have already acted on it. Substance-use information, if it exists, is also protected by 42 CFR Part 2.

Your rights

• Request restrictions on certain uses and disclosures.
• Request confidential communications at an alternative address or phone number.
• Inspect and obtain a copy of your designated record set, with limited clinical exceptions.
• Request an amendment if you believe information is incorrect.
• Receive an accounting of certain disclosures.
• Receive a paper copy of this notice.
• File a complaint with this practice or the U.S. Department of Health and Human Services. Retaliation is prohibited.

Electronic forms

Online signatures are intended to satisfy the federal ESIGN Act and the Colorado Uniform Electronic Transactions Act. Completed forms are sent securely to the practice so they can become part of your clinical record.

Questions: jasonjcheney@gmail.com, (970) 762-2267.