HIPAA
Health Insurance Portability and Accountability Act (HIPAA) protects the use and/or disclosure of protected health
information for purposes of treatment, payment and health care operation. CCCC therapists recognize and affirm
that confidentiality is an essential aspect of the therapeutic process and therefore will do everything possible to
support and maintain confidentiality. However, in order to carry out treatment, payment and health care operations,
it is necessary for CCCC to use and disclose certain health information concerning your treatment. You may revoke
this consent at any time by notifying your therapist in writing. You have the right to request that CCCC restrict the
manner in which your protected health information is used or disclosed. Your signature provides CCCC the necessary
authorization to use your protected health information. A more complete description of the limits of your confidentiality,
found in the “Notice of Privacy Practices,” can be forwarded to you upon request.