Shift Counseling, P.C. 9007 W. Cermak North Riverside, IL 60546
phone: 708-522-4009 fax: 630-233-9332
email: hello@shiftcounselingpc.com
website: https://www.shiftcounselingpc.com
Your Information. Your Rights. Our Responsibilities.

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.
When it comes to your health information, you have certain rights. This section explains
your rights and some of our responsibilities to help you.
Get an electronic
or paper copy of
your medical
record
• You can ask to see or get an electronic or paper copy of your medical
record and other health information we have about you. Ask us how to do
this.
• We will provide a copy or a summary of your health information, usually
within 30 days of your request. We may charge a reasonable, cost-based
fee.
Ask us to correct your
medical record • You can ask us to correct health information about you that you think is
incorrect or incomplete. Ask us how to do this.
• We may say "no" to your request, but we'll tell you why in writing within
60 days.
Request confidential
communications • You can ask us to contact you in a specific way (for example, home or
office phone) or to send mail to a different address.
• We will say "yes" to all reasonable requests.
Notice of Privacy Practices •
Your Rights continued
Ask us to limit what
we use or share • You can ask us not to use or share certain health information for
treatment, payment, or our operations.
• We are not required to agree to your request, and we may say "no" if it
would affect your care.
•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
information
• You can ask for a list (accounting) of the times we've shared your health
information for six years prior to the date you ask, who we shared it with,
and why.
• We will include all the disclosures except for those about treatment,
payment, and health care operations, and certain other disclosures (such
as any you asked us to make). We'll provide one accounting a year for
free but will charge a reasonable, cost-based fee if you ask for another
one within 12 months.
Get a copy of this
privacy notice
• You can ask for a paper copy of this notice at any time, even if you have
agreed to receive the notice electronically. We will provide you with a
paper copy promptly.
Choose someone
to act for you • If you have given someone medical power of attorney or if someone is
your legal guardian, that person can exercise your rights and make choices
about your health information.
• We will make sure the person has this authority and can act for you before
we take any action.

Filing a complaint•
• You can file an internal complaint by contacting the Practice directly using the following information:
Shift Counseling, PC
9007 W Cermak
North Riverside, IL 60546
Rebecca Malley Fitzgerald, LCPC
phone: 708-554-3812 or email: rebecca@shiftcounselingpc.com


You can complain if you feel we have violated your rights by contacting us you feel
your rights are violated • You can file a complaint with the U.S. Department of Health and Human
Services Office for Civil Rights by sending a letter to 200 Independence
Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or
visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear
preference for how we share your information in the situations described below, talk to us. Tell us what
you want us to do, and we will follow your instructions.
Notice of Privacy Practices •
In these cases, you have • Share information with your family, close friends, or others involved in
both the right and choice your care to tell us to:
• Share information in a disaster relief situation
• Include your information in a hospital directory
• Contact you for fundraising efforts
If you are not able to tell us your preference, for example if you are
unconscious, we may go ahead and share your information if we believe it
is in your best interest. We may also share your information when needed
to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
Marketing purposes
Sale of your information (we do not sell any client information)
In the case of fundraising (we do not participate in fundraising that uses PHI)
How do we typically use or share your heath information? We typically use or share your health information
in the following ways.
Treat you: We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization • We can use and share your health information to run our practice, improve your care, and contact you when necessary
Example: We use health information about you to manage your treatment and services.
Bill for your services We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.

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.
Notice of Privacy Practices
Help with public health and safety issues: 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
Do research
We can use or share your information for health research (we currently do not participate in Health Research)
Comply with the law • We will share information about you if state or federal laws require it,
including with the Department of Health and Human Services if it wants
to see that we're complying with federal privacy law.
Respond to organ and
tissue donation requests
We can share health information about you with organ procurement
organizations.
Work with a medical examiner
or funeral director We can share health information with a coroner, medical examiner, or
funeral director when an individual dies.
Address workers'
compensation, law
enforcement, and
other government
requests
• We can use or share health information about you:
• For workers' compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national
security, and presidential protective services
Respond to lawsuits and We can share health information about you in response to a court or legal actions
administrative order, or in response to a subpoena.
Special notes:

Updates to Privacy Policy due to new rules for "Part 2" records (involving information about Substance Use Disorders) as of Feb 16, 2026:

Stricter confidentiality for SUD records: SUD records are subject to Part 2’s heightened protections and generally may not be used or disclosed even for treatment, payment, or health care operations without written patient consent, which overrides standard HIPAA permissions.

  • Restrictions in legal proceedings: SUD records and testimony may not be used in civil, criminal, administrative, or legislative proceedings against a patient without the patient’s written consent or a court order.

  • More stringent law and redisclosure warnings: When Part 2 or another law is more restrictive than HIPAA, the stricter standard applies, and patients must be warned that information disclosed under HIPAA may be redisclosed by the recipient and lose protection.

Fundraising limitations: If SUD records may be used or disclosed for fundraising, patients must first be given a clear and meaningful opportunity to opt out. (We do not currently participate in fundraising that uses client PHI or SUD information)
We do not maintain a hospital directory. Psychotherapy notes are written using a HIPAA approved Electronic
Medical Records website and are not saved on any personal devices.
Psychotherapy/substance abuse treatment notes cannot be shared without either your written consent or a
court order. We do not participate in research.
COMMUNICATION: For the purposes of communicating with us, some people chose to use text
messages or email. While we use password protection for professional cell phone and email accounts, these
forms of communication are not 100% secure. If you would prefer for us not to communicate with you
by text or email, please let us know. The most secure ways to connect with your provider are to use the Spruce App.

Other uses or disclosures of your information which do not require your consent: For example, but not
limited to: l) lnformation you and/or your child or children report about physical or sexual abuse- by Illinois
State Law, I am obligated to report this to the Department of Children and Family Services. 2)lf you
provide information that informs me that you are in danger of harming yourself or others- I may need to
disclose information about you to emergency responders, police officers, or other individuals in order to
maintain your safety and the safety of others. 3) I am mandated to report individuals who I believe present
a "clear and present danged' to the FOID/DHS reporting system. Individuals who make threats to harm
themselves or others may lose their right to own a firearm.
Notice of Privacy Practices • Page
e 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 available upon request, in our office, and on our web site.
This notice is valid as of 02/16/2026

This Notice of Privacy Practices applies to the following organizations.
Shift Counseling, PC
9007 W Cermak Road
North Riverside, IL 60546
708-522-4009