NOTICE OF PRIVACY PRACTICES

Saha Counseling

Effective Date: May 1, 2026

This notice describes how your health information may be used and disclosed and how you can access your information. Please review it carefully.

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES. This notice describes how your health information may be used and disclosed and how you can get access to this information. Please review it carefully.

You have the right to:

  • Get a copy of your electronic or paper medical record

  • Ask us to correct your medical record

  • Request confidential communications

  • Ask us to limit the information we use or share

  • Get a list of those with whom we have shared your information

  • Get a copy of this privacy notice

  • Choose someone to act for you

  • File a complaint if you believe your privacy rights have been violated

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition or care

  • Provide mental health care

  • Market our services or sell your information

We may use and share your information as we:

  • Treat you

  • Run our organization and practice operations

  • Bill for your services

  • Help with public health and safety issues

  • Do research

  • Comply with the law

  • Work with a medical examiner or funeral director

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

  • Respond to lawsuits and legal actions

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

  • We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

We may say no to your request, but we will tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way, such as by phone, email, portal message, or mail at a different address.

  • We will say yes to all reasonable requests

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say no if it would affect your care.

  • If you pay for a service or health care item out of pocket in full, you can ask us not to share that information with your health insurer for payment or operations purposes. We will say yes unless a law requires us to share that information.

Get a list of those with whom we have shared information

  • You can ask for an accounting of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why.

  • We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures such as any you asked us to make. We will provide one accounting each year for free but may charge a reasonable, cost-based fee if you ask for another within 12 months

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will provide a paper copy promptly

Choose someone to act for you

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

  • We will make sure the person has authority and can act for you before we take action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting Saha Counseling using the contact information in this packet.

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, tell us what you want us to do and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

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

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.

We never share your information for the following purposes, unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Psychotherapy notes, except when allowed by law, including for training purposes, to defend against legal proceedings brought by the individual, for HHS compliance investigations, to avert a serious and imminent threat to health or safety, to a health oversight agency for lawful oversight of the originator of the notes, or for the legal activities of a coroner or medical examiner

OUR USES AND DISCLOSURES

We typically use or share your health information in the following ways

Treat you

  • We can use your health information and share it with other professionals who are treating you.

    • Example: When you are receiving two services, such as individual and couples therapy or individual therapy and psychiatric services, your providers may exchange information about your treatment.

Run our practice

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

    • Example: We use health information about you to manage treatment, scheduling, billing, quality review, and other practice operations.

Bill for your services

  • We can use and share your health information to bill and get payment from health plans or other entities.

    • Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

  • We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We must meet certain legal requirements before we can share your information for these purposes.

  • Help with public health and safety issues

    • We can share health information about you for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.

  • Do research

    • We can use or share your information for health research when permitted by law.

  • Comply with the law

    • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

  • Work with a medical examiner or funeral director

    • We can share health information with a coroner, medical examiner, or funeral director when an individual dies, as permitted by law.

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

    • We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.

  • Respond to lawsuits and legal actions

    • We can share health information about you in response to a court or administrative order, or in response to a subpoena, as permitted or required by law.

OUR RESPONSIBILITIES

  • 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 by notifying us in writing.

Changes to the Terms of this Notice

  • We may 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 website.

ADDITIONAL INFORMATION

  • Saha Counseling will not use or disclose your protected health information for marketing purposes and will not sell your protected health information in the regular course of business.

  • Questions or concerns related to this notice should be directed to Saha Counseling at contact@sahacounseling.com or (419) 407-6273.

  • Saha Counseling will evaluate and determine whether your protected health information is subject to more stringent laws or regulations prior to use or disclosure. Federal and state regulations, including mental health and substance use privacy rules, may impact our use and disclosure of information

Privacy contact: Shyam Suchak, MOL, MA, LPC, NCC  |  contact@sahacounseling.com  |  (419) 407-6273

Effective date of this notice: May 1, 2026

Complaint or questions: Contact Saha Counseling at the address, phone number, or email listed in the footer of this form.