Privacy Policy
Last updated November 13, 2025
Privacy Practices – Willow and Ivy Counseling, PLLC
This notice is a summary how mental health records and information about you may be used and disclosed and how you can get access to this information. Your rights are established pursuant to HIPAA, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, state and federal alcohol and substance abuse privacy laws and the exceptions provided therein. Please review it carefully.
Our Commitment to Your Privacy
Willow and Ivy Counseling is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you.
We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain at Willow and Ivy concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.
We may also disclose your PHI to business associates who perform services on our behalf (such as electronic health record providers or billing services). All business associates are required to safeguard your information through a Business Associate Agreement (BAA).
Your Rights
You have the right to:
Get a copy of your paper or electronic mental health record
o You have the right to request to review or receive your medical files. The procedure for obtaining a copy of your medical information is as follows: You may request a copy of your records in writing with an original signature. If your request is denied, you will receive a written explanation of the denial. You will receive the requested documents within 30 days and will be charged a reasonable, cost-based fee.
Correct your paper or electronic mental health record
o You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended.
o If we deny changing the record, you have the right to make a statement of disagreement, which will be placed in your file.
Request confidential communication
o You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
o For example, you may ask that we contact you only by mail or at work. You must make this request to your clinician, specifying the alternative means or location that you would like us to use to provide you information about your healthcare. We will make every attempt to accommodate reasonable requests.
Ask us to limit the information we share
o You have the right to request a restriction or limitation on the health information we use or disclose about you. For example, you could ask that we not share information with an insurance company, in which case you would be responsible to pay in full for the services provided.
o If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared your information
o You have the right to receive a list of instances in which we have disclosed your health information for a purpose other than treatment, payment, or health care operations. To request an accounting of disclosures, please contact your clinician.
Get a copy of this privacy notice
o You are entitled to receive a paper copy of this notice and any amended notice upon request. Copies will be available from your clinician. You may also obtain a copy of this notice at our website www.willowandivycounseling.com
Choose someone to act for you
o You may choose a person to help manage your care or access your records, such as a health care power of attorney or legal guardian. I will verify their legal authority before sharing any information.
o You may also give written permission for me to share specific information with another person of your choosing. This does not give them decision-making power and you may revoke permission at any time.
o Illinois mental health laws offer additional protections, so some records may only be shared as allowed by the Illinois Mental Health and Developmental Disabilities Confidentiality Act.
File a complaint if you believe your rights have been violated
o If you believe your privacy rights have been violated, you may file a complaint without fear of retaliation.
o For HIPAA privacy concerns, contact the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) at https://www.hhs.gov/ocr/complaints or call 1-800-368-1019.
o For concerns about professional conduct or licensure, contact the Illinois Department of Financial and Professional Regulation (IDFPR) at https://idfprapps.illinois.gov/Admin/Complaints.asp or call 1-888-473-4858.
Filing a complaint with either OCR or IDFPR will not result in retaliation.
Your Choices
You have some choices in the way we use and share information as we:
We may not disclose any mental health records or information except as provided under HIPAA, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, state and federal alcohol and substance abuse privacy laws and the exceptions provided therein.
We may not tell any third party family and friends about your condition except as provided for in the above identified laws. For example: only pursuant to a valid subpoena, release of information, pursuant to the Abused and Neglected Child Reporting Act, and under certain other circumstances of imminent risk of harm.
We May Use and Disclose Your Protected Health Information in the Following Ways
Treatment
o Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services.
o This includes consultation with clinical supervisors or other treatment team members. We may disclose your PHI to any other consultant only with your authorization.
Payment
o We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you.
o Examples could include: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. Also, we may use your PHI to bill you directly for services and items.
o We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
Health care operations
o We may use and disclose your PHI to operate our business.
o As examples of the ways in which we may use and disclose your information for our operations, Willow and Ivy may use your PHI to evaluate the quality of care you received from us. We may disclose your PHI to other health care providers and entities to assist in their health care operations.
Required by law
o We are required to make disclosures of your PHI to you upon your request, and in certain instances required by law as indicated in the Informed Consent.
o In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule under HIPAA.
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 have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html and the Illinois Mental Health and Developmental Disabilities Confidentiality Act, state and federal alcohol and substance abuse privacy laws and the exceptions provided therein.
Subject to certain exceptions, 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
Preventing or reducing a serious threat to anyone’s health or safety
We will always limit disclosures to the minimum necessary to accomplish the intended purpose.
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. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be made available to clients and on our website.
Willow and Ivy Counseling, PLLC
Attn: Elizabeth Tyrpak, LCPC
2501 Chatham Rd
Suite 6113
Springfield, IL, 62704
773.985.4735
lizzi@willowandivycounseling.com
We never market or sell personal information.
If you have any questions regarding this notice or our health information privacy policies, please contact your clinician.