This notice is effective as of February 13, 2026.
Sarah Quist, Privacy Officer
Gloversville Clinic
11-21 Broadway, Gloversville, NY 12078
(518) 725-4310
The Family Counseling Center of Fulton County, Inc.
HIPAA Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
If you have any questions about this Notice, please contact: HIPAA Privacy Officer
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Health care information in this notice is contained in a designated record set commonly called the medical record. “Protected Health Information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or chemical dependency condition and related health care services.
Our Responsibilities
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. The revised notice will be posted at our locations and you can obtain the current Notice of Privacy Practices by accessing the website at thefamilycounselingcenter.org or calling the Agency and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
In addition to the above, we have a duty to respond to your requests (e.g., those corresponding to your rights) in a timely and appropriate manner. We value your right to privacy and are committed to maintaining reasonable and appropriate safeguards for your PHI.
Uses and Disclosure of PHI: As a Certified Community Behavioral Health Clinic (CCBHC), we provide integrated mental health, substance use disorder, and primary care-related services. Your Protected Health Information (PHI) may be permitted, required, or authorized for use and disclosure. The following categories outline the various ways we use and disclose PHI.
The Family Counseling Center Employees: We use or disclose information among staff members who need the information for their duties related to the provision of diagnosis, treatment, or referral for treatment. This communication occurs within our Agency and is used for purposes such as providing care, billing, tracking charges and credits, checking eligibility for insurance coverage, and preparing insurance claims. We may also use and disclose your PHI for our healthcare business and to perform functions associated with our business activities, including accreditation and licensing. Secretary of Health and Human Services: We are required to disclose PHI to the Secretary of the U.S. Department of Health and Human Services when the Secretary investigates or determines our compliance with HIPAA Privacy Rules.
Business Associates: We may disclose your PHI to Business Associates contracted by us to perform services on our behalf, which may involve receipt, use, or disclosure of your PHI. All Business Associates must agree to protect your PHI’s privacy, use and disclose the information only for the intended purposes, be bound by 42 CFR Part 2, and resist any attempts to access patient records in judicial proceedings unless permitted by law.
Payments: We may disclose your PHI to Medicaid, Medicare and other payers, including CCBHC prospective payment system (PPS) for reimbursement of services, unless client is self-pay.
Crimes on Premises: We may disclose information related to crimes committed on our premises or against our personnel, or threats of such crimes, to law enforcement officers.
Suspected Abuse and Neglect Reporting: We may disclose information required for reporting suspected abuse and neglect under state law to the appropriate state or local authorities. However, original patient records may not be disclosed for civil or criminal proceedings arising from suspected abuse and neglect reports without consent or court order.
Court Order: We may disclose information required by a court order, provided certain regulatory requirements are met.
Emergency Situations: We may disclose information to medical personnel to treat you in an emergency.
Research: We may use and disclose your information for research if certain requirements are met, such as approval by an Institutional Review Board.
Audit and Evaluation Activities: We may disclose your information to persons conducting audit and evaluation activities, provided they agree to certain restrictions on information disclosure.
Cause of Death Reporting: We may disclose information related to the cause of death to an authorized public health authority.
Authorization to Use or Disclose PHI: Apart from the instances stated above, we will not use or disclose your PHI without your written authorization. We will not use or disclose psychotherapy notes, use or disclose your PHI for marketing purposes, or sell your PHI unless you have signed an authorization. You or your representative may revoke an authorization in writing at any time to stop future uses or disclosures. We will honor oral revocations upon authenticating your identity until a written revocation is obtained. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
Confidentiality for Substance Use Disorder Records: Records that identify you as having, having had, or being treated for a substance use disorder are subject to special federal confidentiality protections under 42 CFR Part 2. In general, we may not disclose substance use disorder records without your consent, even for treatment, payment or healthcare operations, unless otherwise permitted by law. Exceptions to this include: medical emergencies, audit or program evaluation, or court orders that meet disclosure requirements. Recipients of confidential SUD information that are also a covered entity may only re-disclose information permitted by federal law.
Confidentiality of Reproductive Health Care Information: We will not use or disclose PHI for the purpose of investigating or imposing liability on any person for seeking, obtaining, providing, or facilitating lawful reproductive health care. When required, we will obtain written authorization prior to certain disclosures involving reproductive healthcare information.
Patient/Client Rights
You have several rights regarding the PHI we maintain about you. Information on how to exercise these rights is also provided. We are committed to protecting your PHI and ensuring you have access to it when needed and that you understand your rights as described below.
Right to Notice: You have the right to adequate notice of the uses and disclosures of your PHI, our duties and responsibilities regarding the use and disclosure of your PHI, and the right to request both paper and electronic copies of this Notice.
Right to Access, Inspect, and Copy: You have the right to access, inspect, and obtain a copy of your PHI as long as we maintain it, as required by law. This right can be limited only under specific circumstances as outlined by applicable law. All requests to access your PHI must be in writing. In some cases, we may deny your request, and any denial will be provided to you in writing. If you are denied access to your PHI, you can request a review of the denial. Another licensed healthcare professional chosen by the Agency will review your request and the denial. The reviewer will not be the person who initially denied your request. We will comply with the decision of the designated professional. If you are still denied, you have the right to have the denial reviewed by an unaffiliated, licensed third-party healthcare professional. We will comply with the decision made by this professional.
We may charge a reasonable, cost-based fee for the copying and/or mailing process related to your request. If the PHI is maintained in electronic form and format, you can request a copy in that electronic form and format if readily producible; if not, we’ll provide it in any readable form and format that we agree upon (e.g., PDF). Your request may also include instructions to transmit the information to another individual or entity.
Right to Amend: If you think that the PHI we possess about you is incorrect or incomplete, you have the right to request an amendment to your PHI as long as we maintain it. The request must be in writing, and you need to provide a reason to support the amendment. In some cases, we may deny your request, including when the PHI: 1. The PHI was as not created by us; 2. The PHI is excluded from access and inspection under applicable law; or 3. The PHI is accurate and complete. If we deny the amendment, we’ll provide the rationale for denial in writing. You may write a statement of disagreement if your request is denied. This statement will be part of your PHI and included with any disclosure. If we accept the amendment, we’ll collaborate with you to identify other healthcare stakeholders requiring notification and provide it.
Right to Request an Accounting of Disclosures: We must create and maintain an accounting (list) of specific disclosures of your PHI. You have the right to request a copy of this accounting within a timeframe specified by applicable law before the date of the request (up to six years). Any request for accounting must be in writing. We are not required by law to document disclosures with your signed authorization If you request this accounting more than once in 12 months, we may charge a reasonable, cost-based fee for responding to additional requests. We’ll notify you of the fee (if any) when you make the request.
Right to Request Restrictions: You can request restrictions or limitations on how we use and disclose your PHI for treatment, payment, and operations. We are not obligated to agree to restrictions for treatment, payment, and healthcare operations, except in limited circumstances as described below. This request must be in writing. If we agree to the restriction, we’ll comply with it going forward, unless you revoke it or we believe, based on our professional judgment, that an emergency necessitates bypassing the restriction to provide appropriate care or if the use or disclosure is otherwise allowed by law. In rare cases, we reserve the right to end a restriction we previously agreed to, but only after notifying you.
Out-of-Pocket Payments: If you have paid out-of-pocket (meaning you or someone other than your health plan has paid for your care) in full for a specific item or service, you can request, in writing, that your PHI regarding that item or service not be disclosed to a health plan for payment or healthcare operations purposes. We are legally required to honor this request unless you terminate it in writing, and when disclosures aren’t required by law.
Right to Confidential Communication: You can request that we communicate with you about your PHI and health matters through alternative means or at alternative locations. This request must be in writing and specify the alternative means or location. We’ll accommodate reasonable requests in line with our responsibility to properly protect your PHI.
Right to Notification of a Breach: You have the right to be informed if we (or one of our Business Associates) discover a breach involving unsecured PHI.
Complaints: You may file a written complaint in writing to the Privacy Officer on the ‘Privacy Complaint Form’. You may also file a Complaint with the following entities, if you believe we have violated your privacy rights:
Contact Information:
The Family Counseling Center of Fulton County, Inc.11-21 Broadway
Gloversville, NY 12078
Phone: 1-518-725-4310
Fax: 1-518-725-2556
Or contact:
Office of Civil RightsDepartment of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
Phone: 1-800-368-1019
Fax: 1-202-619-3818
TDD: 1-800-537-7697