Effective Date: February 16, 2026
Roe Counseling (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice must provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties, privacy practices, and your rights regarding PHI that we collect and maintain.
Your rights regarding PHI are explained below. To exercise these rights, submit a written request to the Practice at the address noted below.
1. Inspect and Copy PHI
You may request an electronic or paper copy of PHI. The Practice may charge a reasonable fee.
The Practice may deny your request if it believes disclosure will endanger your life or another person’s life. You may have the right to have this decision reviewed.
2. Amend PHI
You may request correction of PHI you believe is incorrect or incomplete. Requests must be in writing and include a reason.
The Practice may deny your request but will provide a written explanation and allow you to submit a statement of disagreement.
3. Request Confidential Communications
You may request the Practice to contact you in a specific way. The Practice will accommodate all reasonable requests.
4. Limit Uses or Disclosures
You may request restrictions on PHI used or shared for treatment, payment, or operations. The Practice is not required to agree if it would affect your care.
You may request that PHI not be shared with family members or friends, specifying the restriction and the individuals involved.
If you pay out-of-pocket in full for a service, you may request that PHI not be shared with your insurer.
5. Accounting of Disclosures
You may request a list of disclosures of your PHI. One accounting per 12 months is free; additional requests may incur a reasonable fee.
6. Receive a Copy of this Notice
You may request a paper copy even if you agreed to receive it electronically.
7. Designate a Personal Representative
If you have a medical power of attorney or legal guardian, that person can exercise your rights.
8. File a Complaint
Complaints may be submitted to the Practice or to the U.S. Department of Health and Human Services Office for Civil Rights:
Address: 200 Independence Avenue, S.W., Washington, D.C. 20201
Phone: 1-877-696-6775
The Practice will not retaliate for filing a complaint.
9. Opt Out of Fundraising Communications
The Practice may contact you for fundraising but you may opt out at any time.
Contact Information
Roe Counseling
P.O. Box 441, Galena, MD 21635
Alexandra Roe, LCPC, NCC
Phone: 410.708.4307 | Email: hello@roecounseling.com
The Practice may use or disclose PHI without your authorization for:
Treatment: Sharing with other providers for your care.
Healthcare Operations: Managing the practice, improving care, appointment reminders.
Billing and Payment: Submitting claims to insurance or receiving payment.
The Practice may use or disclose PHI without authorization for:
Public health and safety
Health oversight activities (audits, investigations)
Serious threats to health or safety
Abuse, neglect, or domestic violence reporting
Law enforcement, legal obligations, specialized government functions, and workers’ compensation
Unless you object, the Practice may disclose PHI to family, friends, or others involved in your care if it is in your best interest.
Written authorization is required for:
Marketing
Sale of PHI
Psychotherapy notes
SUD records are subject to extra confidentiality protections and require separate written consent for disclosures.
Exceptions include medical emergencies, reporting crimes on program premises, child abuse reporting, and optional fundraising.
Revocation of consent is permitted in writing.
Maintain the privacy and security of PHI.
Abide by this Notice and more stringent state or federal laws.
Amend the Notice as needed; changes will apply to PHI maintained by the Practice.
Notify patients if PHI is compromised in a breach.