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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.

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Transform Mental Healthcare, P.C. (the “Practice”) is committed to protecting your privacy. The Practice is required by federal and state law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.

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Your records include:

  • Personally identifying information, such as your name, address, phone number, or email address

  • Mental exams

  • Diagnosis information, including diagnostic justification

  • Treatment plans

  • Evaluations

  • Medications

  • Notes about services provided, letters, and other documents found in your file

Your Rights

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 a copy of your paper or electronic medical record

  • If you are age 12 or older, 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.

  • If you are under 18 and inspecting your own records, you can get help interpreting them. You cannot be charged a fee for this assistance.

  • 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.

  • The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.

  • You cannot be denied access to your records because you do not want assistance in interpreting them.

Upon request we will provide access to your records to any of the following individuals:

  • The parent or guardian of a patient who is under age 12.

  • The personal representative of a patient under HIPAA, regardless of the patient’s age.

  • The legal guardian of a patient who is age 18 or over.

  • An attorney or guardian ad litem representing a minor age 12 years or older, with a court order.

  • An agent appointed by the patient under a Power of Attorney for Health Care or Property.

  • An attorney-in-fact named in a declaration of preferences or instructions regarding mental health treatment.

Parents or guardians of children ages 12 to 18 may have access to information about:

  • The child’s current condition

  • Diagnosis

  • Treatment provided

  • Treatment needed

  • These individuals may have access to other records only if the child does not object, or the clinician does not feel sufficient cause to deny access.

Any person not listed above may only receive access to information via written consent, provided by:

  • The patient

  • Their parent

  • Their guardian

  • Power of Attorney agent

  • Attorney-in-fact named in a declaration of preferences regarding mental health treatment.

Correct your paper or electronic 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 communication

  • 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.

Ask us to limit the information we 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 your 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.

File a complaint if you believe your privacy rights have been violated

  • You can complain if you feel we have violated your rights by contacting:
    Transform Mental Healthcare, P.C.
    attn: Daniel K. Sheff LCSW
    1 E Main St Ste 240
    Champaign, IL 61820
    (217) 281-4093

  • You can file a complaint with the Department of Health and Human Services:

  • 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.

You have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • 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.

Our Uses and Disclosures

How do we typically use or share your health information? 
The Practice is permitted under federal law to use and disclose your information, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
To treat you
We can use your health information and share it with other professionals who are treating you.

  • Your clinician may reveal your records to other clinicians assisting them.

  • Your clinician may reveal your records to a supervisor to provide adequate care.

  • Your clinician may reveal your records to their attorney.

  • Your clinician will notify you if any of these disclosures may be made.

Example: Your primary care doctor asks about your mental health treatment.
To run our organization
The Practice can use and share your information to run the business, improve your care, and contact you.
Example: The Practice uses your information to send you appointment reminders if you choose.
To bill for your services
The Practice can use and share your information to bill and get payment from health plans or other entities. Without written consent, the information disclosed may include only:

  • Your identity

  • Your clinician’s identity

  • A description of the nature, purpose, quantity, and date of services

  • Other information only if necessary to determine qualification of receipt of benefits

Example: The Practice gives your information to your health insurance plan so it will pay for your services.

Uses & Disclosures of your information that may be made without your authorization or opportunity to object

The Practice may use or disclose your information without your authorization or an opportunity for you to object, including:

To ensure protection from harm

  • We may disclose your information if needed to protect you from serious harm.

  • We may disclose your information if needed to prevent you from causing immediate and serious harm to others, including to protect a person against whom you have threatened violence.

  • This may include disclosures to the police, the State’s Attorney’s Office, and the Attorney General’s Office.

To help with public health and safety issues

  • Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.

  • Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.

  • Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.

  • Serious threat to health or safety: To prevent a serious and imminent threat.

  • Abuse or Neglect: To report abuse, neglect, or domestic violence.

To comply with the law, law enforcement, or other government requests

  • Required by law: If required by federal, state or local law.

  • Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.

    • Note that you or your clinician have the privilege to refuse to disclose and to prevent the disclosure of patient records or communications, with limited exceptions such as:

      • Cases when you have introduced your mental condition into the legal proceedings as a claim or defense,

      • Cases to decide if you need a legal guardian,

      • Cases involving a court-ordered examination, as long as you were informed before the exam that your records would not be confidential,

      • Cases involving your payment or nonpayment for mental health services,

      • Cases to determine your fitness to stand trial, if the records were made within the 180 days immediately before the date of the therapist's, psychologist's, or psychiatrist's court appointment,

      • Cases involving a petition filed under the Juvenile Court Act for wardship of a child,

      • Cases involving an abused, neglected, or dependent child, if you are the parent, guardian, or legal custodian.

      • In these cases, the judge or hearing officer must privately review the records, and only permit disclosure if the need for the records outweighs the need to protect your privacy.

  • Law enforcement: For law enforcement officers to locate and identify you or disclose information about a victim of a crime.

  • Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.

  • National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.

  • Workers' Compensation: To comply with workers' compensation laws or support claims.

To comply with other requests

  • Coroners and Funeral Directors: To perform their legally authorized duties.

  • Research: For research that has been approved by an institutional review board.

  • Inmates: The Practice created or received your PHI in the course of providing care.

  • Business Associates: To organizations that perform functions, activities or services on our behalf.

Uses & Disclosures of your information that may be made with your authorization or opportunity to object

Unless you object, the Practice may disclose your information:

  • To your family, friends, or others if the information directly relates to the person’s involvement in your care.

  • If it is in your best interest because you are unable to state your preference.

Uses & Disclosures of your information based on your written authorization

The Practice must obtain your written authorization to use and/or disclose your information for the following purposes:

  • Marketing and the sale of protected health information

  • Psychotherapy notes. These are your clinician’s personal notes regarding your services and are the personal property of the clinician. These are not considered part of your record, and disclosure cannot be compelled, even by court order.

  • You may revoke your authorization, at any time, by contacting the Practice in writing, using the information above. The Practice will not share or use your information other than as described in this Notice unless you give your permission in writing.

Our Responsibilities

  • The Practice is required by law to maintain the privacy and security of PHI.

  • The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.

  • The Practice reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website https://transformpc.com/privacy/.

  • The Practice will inform you if PHI is compromised in a breach.

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 website.

 

This notice is effective June 1, 2026.

Website Privacy Policy

This Privacy Policy governs the manner in which Transform Mental Healthcare, P.C. collects, uses, maintains and discloses information collected from users (each, a “User”) of the TransformPC.com website (“Site”). This privacy policy applies to the Site and all products and services offered by Transform Mental Healthcare, P.C.

Personal identification information

We may collect personal identification information from Users in a variety of ways, including, but not limited to, when Users visit our site, subscribe to the newsletter, fill out a form, and in connection with other activities, services, features or resources we make available on our Site. Users may be asked for, as appropriate, name, email address, phone number. Users may, however, visit our Site anonymously. We will collect personal identification information from Users only if they voluntarily submit such information to us. Users can always refuse to supply personally identification information, except that it may prevent them from engaging in certain Site related activities.

Non-personal identification information

We may collect non-personal identification information about Users whenever they interact with our Site. Non-personal identification information may include the browser name, the type of computer and technical information about Users means of connection to our Site, such as the operating system and the Internet service providers utilized and other similar information.

Web browser cookies

Our Site may use “cookies” to enhance User experience. User’s web browser places cookies on their hard drive for record-keeping purposes and sometimes to track information about them. User may choose to set their web browser to refuse cookies, or to alert you when cookies are being sent. If they do so, note that some parts of the Site may not function properly. Click here to opt out.

How we use collected information

Transform Mental Healthcare, P.C. may collect and use Users personal information for the following purposes:

  • To improve patient service
    Information you provide helps us respond to your service requests and support needs more efficiently.

  • To improve our Site
    We may use feedback you provide to improve our products and services.

  • To send periodic emails
    We may use the email address to respond to their inquiries, questions, and/or other requests. If a User decides to opt-in to our mailing list, they will receive emails that may include company news, updates, related product or service information, etc. If at any time the User would like to unsubscribe from receiving future emails, we include detailed unsubscribe instructions at the bottom of each email.

How we protect your information

We adopt appropriate data collection, storage and processing practices and security measures to protect against unauthorized access, alteration, disclosure or destruction of your personal information, username, password, transaction information and data stored on our Site.

Sharing your personal information

We do not sell, trade, or rent Users personal identification information to others. We may share generic aggregated demographic information not linked to any personal identification information regarding visitors and users with our business partners, trusted affiliates and advertisers for the purposes outlined above.We may use third party service providers to help us operate our business and the Site or administer activities on our behalf, such as sending out newsletters or surveys. We may share your information with these third parties for those limited purposes provided that you have given us your permission.

Changes to this privacy policy

Transform Mental Healthcare, P.C. has the discretion to update this privacy policy at any time. When we do, we will revise the updated date at the bottom of this page. We encourage Users to frequently check this page for any changes to stay informed about how we are helping to protect the personal information we collect. You acknowledge and agree that it is your responsibility to review this privacy policy periodically and become aware of modifications.

Your acceptance of these terms

By using this Site, you signify your acceptance of this policy. If you do not agree to this policy, please do not use our Site. Your continued use of the Site following the posting of changes to this policy will be deemed your acceptance of those changes.

Contacting us

If you have any questions about this Privacy Policy, the practices of this site, or your dealings with this site, please contact us at:

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Transform Mental Healthcare, P.C.

1 E Main St Ste 240

Champaign, IL 61820-3641

(217) 281-4093

​info@TransformPC.com

This policy was updated June 1, 2026.

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