HIPAA Notice of Privacy Practices
Last Updated: August 5, 2026
This Notice describes how medical and mental health information about you may be used and disclosed and how you can access this information. Please review it carefully.
Toledo Counseling & Mental Health, LLC, doing business as Toledo Counseling & Mental Health, is required by law to protect the privacy of your protected health information, provide this Notice of Privacy Practices, follow the terms of the Notice currently in effect, and notify affected individuals following a breach of unsecured protected health information when required by law.
This Notice applies to protected health information maintained by Toledo Counseling & Mental Health in connection with counseling, psychiatry, medication management, telehealth, billing, scheduling, administrative services, and related health care operations.
Our Practice Information
Toledo Counseling & Mental Health, LLC
DBA: Toledo Counseling & Mental Health
Website: www.toledocmh.com
Phone: 419-318-8533
Fax: 888-337-1307
Email: info@toledocmh.com
Toledo Office and Mailing Address:
3454 Oak Alley Court, Suite 504
Toledo, OH 43606
Sylvania Office:
4169 N Holland Sylvania Rd, Suite 203
Toledo, OH 43623
Privacy Officer
Crystal Jankowski, Office Manager
Toledo Counseling & Mental Health
3454 Oak Alley Court, Suite 504
Toledo, OH 43606
Email: info@toledocmh.com
Phone: 419-318-8533 and request the Office Manager
How We May Use and Disclose Your Health Information
We may use and disclose your protected health information for treatment, payment, and health care operations without your written authorization when permitted by law.
Treatment
We may use and disclose your health information to provide, coordinate, or manage your care. This may include sharing information among therapists, psychiatric providers, supervisors, administrative staff, SimplePractice functions, e-prescribing tools, other treating providers, pharmacies, hospitals, laboratories, or other professionals involved in your care when appropriate.
Examples may include using your information to provide counseling, psychiatry, medication management, telehealth, psychological services, referrals, care coordination, safety planning, or consultation.
Payment
We may use and disclose your health information to obtain payment for services. This may include sharing information with insurance companies, billing services, payment processors, clearinghouses, or other entities involved in claims, eligibility, authorization, payment processing, account management, or collections when applicable.
Examples may include verifying insurance, submitting claims, responding to payer requests, processing payments through SimplePractice and Stripe, or communicating about balances.
Health Care Operations
We may use and disclose health information for health care operations, such as quality review, staff training, supervision, compliance, audits, credentialing, business management, scheduling, care coordination, legal review, technology support, and improving services.
Because Toledo Counseling & Mental Health includes trainees, clinicians, supervisors, psychiatry providers, and administrative support, your information may be used as appropriate for clinical supervision, consultation, training, documentation review, and coordination of care.
Appointment Reminders and Communications
We may use and disclose your information to contact you about appointments, scheduling, forms, portal access, billing, treatment-related reminders, or administrative matters. Communications may occur by phone, voicemail, email, portal message, or other method you have provided, subject to practice policies and applicable law.
Electronic Systems and Business Associates
We use electronic systems and service providers to support clinical care, telehealth, patient portal functions, documentation, e-prescribing, billing, payment processing, scheduling, and practice operations. These may include SimplePractice, MD Toolbox, Stripe through SimplePractice, technology vendors, billing-related services, and other business associates.
When required, we seek appropriate agreements or safeguards with vendors who create, receive, maintain, or transmit protected health information on our behalf.
Telehealth
We may provide telehealth services through SimplePractice or another approved platform. Telehealth involves the electronic transmission of health information. We use reasonable safeguards to protect telehealth-related information, but clients are also responsible for choosing a private location and using appropriate devices, internet connections, and personal privacy precautions when participating in telehealth.
E-Prescribing and Medication-Related Information
Prescribers may use MD Toolbox or other appropriate tools for electronic prescribing and prescription-related functions. Medication-related information may be shared with pharmacies, pharmacy benefit managers, insurance plans, and other entities involved in medication management, safety, prescribing, or payment when permitted by law.
Uses and Disclosures That May Occur Without Your Authorization
We may use or disclose your protected health information without your authorization when permitted or required by law, including for:
Treatment, payment, and health care operations
Public health and safety activities
Reporting abuse, neglect, or domestic violence when required or permitted by law
Health oversight activities
Judicial or administrative proceedings
Law enforcement purposes when permitted or required by law
Workers’ compensation purposes
Coroners, medical examiners, or funeral directors when applicable
To prevent or lessen a serious and imminent threat to health or safety
As required by federal, state, or local law
Required by Law
We will disclose health information when required to do so by law. This may include reporting obligations related to safety, abuse or neglect, court orders, subpoenas, health oversight, or other legal requirements.
Serious Threat to Health or Safety
We may use or disclose information when necessary to prevent or lessen a serious and imminent threat to your health or safety or the health or safety of another person, consistent with applicable law and ethical duties.
People Involved in Your Care
With your permission, or when otherwise allowed by law, we may share relevant information with a family member, personal representative, guardian, caregiver, or other person involved in your care or payment for care. We use professional judgment and applicable law to determine what is appropriate.
Minors, Parents, and Guardians
Privacy rights for minors can depend on federal and state law, the type of service, consent rules, custody or guardianship status, and clinical circumstances. Parents or legal guardians may have rights to access certain information, but there may also be situations where minor confidentiality is protected by law. We evaluate these issues according to applicable law and clinical obligations.
Psychotherapy Notes
Certain psychotherapy notes may receive special protection under HIPAA. When HIPAA requires authorization for the use or disclosure of psychotherapy notes, we will obtain authorization unless an exception applies. Psychotherapy notes are not the same as general treatment records, diagnoses, medication information, billing information, appointment information, or treatment plans.
Substance Use Disorder Information
Some records related to substance use disorder treatment may be subject to additional federal or state confidentiality protections, including 42 CFR Part 2 when applicable. If those rules apply to certain records or services, we will follow applicable requirements regarding consent, disclosure, redisclosure, and patient rights.
Uses and Disclosures That Require Your Written Authorization
We will obtain your written authorization when required by law, including for most uses or disclosures of psychotherapy notes, uses or disclosures for marketing purposes when authorization is required, and sale of protected health information.
You may revoke an authorization in writing at any time, except to the extent we have already relied on it.
Your Rights Regarding Your Health Information
You have certain rights regarding your protected health information. Some rights may be limited by law or clinical circumstances.
Right to Inspect and Receive a Copy
You have the right to inspect or receive a copy of certain health information we maintain about you. We may provide records electronically or in paper form, depending on the request and applicable law. Some records may be excluded or handled differently under law, including certain psychotherapy notes.
Right to Request an Amendment
You may ask us to amend health information that you believe is incorrect or incomplete. We may deny the request in certain circumstances, but you may have the right to submit a written statement of disagreement.
Right to Request Confidential Communications
You may ask us to contact you in a specific way or at a specific location. We will consider reasonable requests and will accommodate requests when required by law.
Right to Request Restrictions
You may ask us to restrict certain uses or disclosures of your health information. We are not required to agree to every requested restriction, except in certain situations required by law, such as when you pay out of pocket in full for a service and ask that information about that service not be shared with your health plan, where applicable.
Right to an Accounting of Disclosures
You may request a list of certain disclosures of your protected health information. This accounting does not include all disclosures, such as disclosures for treatment, payment, health care operations, disclosures made to you, or disclosures made with your authorization.
Right to Receive a Paper Copy
You have the right to receive a paper copy of this Notice, even if you have agreed to receive it electronically.
Right to File a Complaint
You may file a complaint if you believe your privacy rights have been violated. You may file a complaint with Toledo Counseling & Mental Health or with the U.S. Department of Health and Human Services Office for Civil Rights.
To file a complaint with Toledo Counseling & Mental Health, contact:
Crystal Jankowski, Office Manager
Toledo Counseling & Mental Health
3454 Oak Alley Court, Suite 504
Toledo, OH 43606
Email: info@toledocmh.com
Phone: 419-318-8533 and request the Office Manager
We will not retaliate against you for filing a complaint.
To file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, you may contact the Office for Civil Rights through the methods provided by HHS.
Our Responsibilities
We are required to:
Maintain the privacy and security of protected health information
Provide this Notice of our legal duties and privacy practices
Follow the terms of the Notice currently in effect
Notify affected individuals when required by law following a breach of unsecured protected health information
Refrain from retaliating against anyone who exercises privacy rights or files a complaint
Changes to This Notice
We may change the terms of this Notice at any time, and changes may apply to health information we already maintain as well as information we receive in the future. The current Notice will be posted on our website and available upon request.
Questions
For questions about this Notice or your privacy rights, contact:
Crystal Jankowski, Office Manager
Toledo Counseling & Mental Health
3454 Oak Alley Court, Suite 504
Toledo, OH 43606
Email: info@toledocmh.com
Phone: 419-318-8533 and request the Office Manager
Fax: 888-337-1307