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NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective Date: September 6, 2026

Advanced Counseling OC
Jackie Girgis, Licensed Clinical Social Worker
California License No. 24895
Privacy Contact: Jackie Girgis, LCSW
Email: Jackie@AdvCounseling.com
Telephone: (714) 455-9424

THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL-HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN ACCESS THIS INFORMATION, AND YOUR RIGHTS REGARDING YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.

My Responsibilities

I understand that information concerning your health, mental-health treatment, and healthcare services is personal. I am committed to protecting the privacy and security of your protected health information (“PHI”).

I create and maintain records of the services you receive. These records may be needed to provide treatment, coordinate care, obtain payment, conduct healthcare operations, and comply with legal and professional requirements.

I am required to:

• Maintain the privacy and security of your PHI;

• Provide you with this Notice explaining my legal duties and privacy practices;

• Follow the terms of the Notice currently in effect;

• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information; and

• Use or disclose your information only as permitted or required by law or as authorized by you.

California law may provide additional protections for mental-health and other sensitive health information. When California law provides greater privacy protection than federal law, I will follow the more protective requirement.

How I May Use and Disclose Your Information

Treatment

I may use your PHI to provide, coordinate, and manage your treatment. When clinically appropriate and legally permitted, I may share relevant information with another healthcare professional involved in your care.

For example, with your authorization when required, I may communicate with a psychiatrist, physician, or other treating provider to coordinate services.

Payment

I may use and disclose information necessary to bill for services, obtain payment, verify benefits, submit insurance claims, respond to requests from a health plan, or address billing questions.

Information may be shared with Headway or another authorized billing or administrative platform when that platform is involved in scheduling, eligibility verification, claims administration, payment, or related healthcare operations.

Healthcare Operations

I may use and disclose PHI for activities necessary to operate the practice, including quality improvement, clinical consultation, supervision, documentation, licensing and credentialing, legal and accounting services, compliance activities, audits, security, and practice administration.

Vendors that create, receive, maintain, or transmit PHI on behalf of the practice will be required to provide appropriate privacy and security protections when applicable law requires them to act as business associates.

Appointment Reminders and Service Information

I may use your contact information to provide appointment reminders, scheduling information, treatment-related communications, or information about services that may be relevant to your care.

Uses and Disclosures Required or Permitted by Law

Subject to applicable federal and California requirements, I may use or disclose PHI without your written authorization:

• When required by federal or state law;

• To report suspected child abuse, elder abuse, or dependent-adult abuse;

• To address a serious and imminent threat to health or safety when disclosure is legally permitted or required;

• For legally authorized public-health activities;

• For health-oversight activities, including licensing investigations, audits, and inspections;

• In response to a valid court order, subpoena, warrant, or other lawful process, subject to applicable legal protections;

• For legally authorized law-enforcement purposes;

• To a coroner, medical examiner, or funeral director as permitted by law;

• For workers’ compensation or similar programs as authorized by law;

• For research only when the applicable authorization, waiver, review, and privacy requirements have been satisfied;

• To the U.S. Department of Health and Human Services when necessary to determine compliance with federal privacy law; or

• For other purposes specifically permitted or required by law.

The fact that a request, subpoena, or legal demand has been made does not automatically mean that every requested record may be disclosed. I will evaluate requests under applicable federal and California law.

Uses Requiring Written Authorization

Except when otherwise permitted or required by law, I will obtain your written authorization before:

• Using or disclosing PHI for marketing;

• Selling PHI;

• Disclosing psychotherapy notes as that term is specifically defined by HIPAA;

• Releasing mental-health records when California law requires authorization;

• Recording a confidential therapy session; or

• Using or disclosing PHI for another purpose not described in this Notice.

If you provide written authorization, you may revoke it in writing at any time. Revocation will not affect actions already taken in reasonable reliance on the authorization.

Family Members and Other People Involved in Your Care

You may identify family members, friends, caregivers, or other people involved in your care or payment for care. When legally permitted, I may share information relevant to that person’s involvement unless you object or have instructed me otherwise.

If you cannot communicate your preference during an emergency, I may share limited information when legally permitted and when I reasonably determine that doing so is in your best interest or is necessary to reduce a serious and imminent threat.

Substance-Use-Disorder Records

To the extent that I receive, create, or maintain substance-use-disorder patient records protected by 42 C.F.R. Part 2, those records receive additional protections.

Such records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order and subpoena that meet applicable Part 2 requirements.

This provision does not mean that Advanced Counseling OC represents itself as a federally assisted Part 2 treatment program.

Your Rights

Obtain a Copy of Your Records

You may request to inspect or obtain an electronic or paper copy of the health information you are legally entitled to access.

Under California law, subject to applicable exceptions:

• Inspection will generally be permitted during business hours within five working days after receipt of a valid request; and

• Copies will generally be transmitted within 15 days after receipt of a valid request.

I may charge only a reasonable, cost-based fee permitted by law. Certain records, including separately maintained psychotherapy notes as defined by HIPAA, may not be subject to the same right of access.

If access is restricted or denied, I will provide the information and review rights required by applicable law. When appropriate, an agreed-upon summary may be offered instead of a complete copy.

Ask Me to Correct Your Record

You may ask me to correct information you believe is inaccurate or incomplete. I may deny the request under circumstances permitted by law, but I will provide a written explanation and information about any rights you have to submit a statement of disagreement.

Request Confidential Communications

You may ask me to communicate with you in a particular way or at a particular address, telephone number, or email address. I will accommodate reasonable requests.

Request Restrictions

You may ask me to limit certain uses or disclosures of your information. I am not required to agree to every request, except when the law requires me to do so.

If you pay for a service completely out of pocket and ask me not to disclose information about that service to your health plan for payment or healthcare operations, I will honor that request unless disclosure is required by law.

Receive an Accounting of Disclosures

You may request a list of certain disclosures made during the six years before your request. The accounting does not include every disclosure, such as many disclosures for treatment, payment, healthcare operations, or disclosures you authorized.

One accounting during a 12-month period will be provided without charge. A reasonable, cost-based fee may apply to additional requests when permitted by law.

Receive a Copy of This Notice

You may request a paper or electronic copy of this Notice at any time, even if you previously agreed to receive it electronically.

Choose a Personal Representative

If another person has legal authority to act for you, that person may exercise your privacy rights. I may request documentation and take reasonable steps to verify the person’s authority before acting.

File a Privacy Complaint

You may file a complaint if you believe your privacy rights have been violated.

Complaints concerning Advanced Counseling OC may be directed to:

Jackie Girgis, LCSW, Privacy Contact
Email: Jackie@AdvCounseling.com
Telephone: (714) 455-9424

You may also file a complaint with the:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Telephone: 1-877-696-6775
Online: https://www.hhs.gov/hipaa/filing-a-complaint/

You will not be retaliated against, denied treatment, or penalized for filing a good-faith privacy complaint.

Privacy complaints are not emergency communications. Please do not include unnecessary clinical details in an ordinary email.

Changes to This Notice

I may revise this Notice and apply the revised terms to information already maintained, as well as information received in the future. The current Notice will be available on the Advanced Counseling OC website and through the practice’s applicable client platform. A paper or electronic copy is available upon request.

Delivery and Acknowledgment

This Notice may be delivered electronically through Headway or another secure client platform. You may be asked to acknowledge that you received it.

An acknowledgment of receipt confirms only that the Notice was made available to you. It does not mean that you agree with every provision, waive any privacy right, authorize an optional disclosure, or consent to session recording or AI-assisted documentation.

AI-Assisted Documentation and Session Recording

YOU HAVE THE RIGHT TO DECLINE THE USE OF AI TECHNOLOGY. I have a legal and ethical responsibility to make my best efforts to protect all communications that are part of our psychotherapy sessions. I have chosen to use ARTIFICIAL INTELLEGENCE (including Mentalyc) note-taking system for psychotherapy as part of my effort to provide the best care to my clients. It provides me with an automatically generated transcript and summarization of our sessions. This system is HIPAA compliant and uses up-to-date encryption methods, firewalls, and backup systems to help keep your information private and secure. You are consenting for me to record our sessions using AI systems.

Details 

Recordings of our sessions will be transcribed and summarised by HIPAA-compliant technology. This system doesn’t store the recordings and client personal information. I may choose to keep the summarised notes as part of your confidential medical record. The system only keeps anonymized data to help improve the tool. As with any technology, there are certain risks and benefits, which you can ask about and discuss with me at any time.

Acknowledgement of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By entering into therapy with me, you are acknowledging that you have reviewed and understood this HIPAA Notice of Privacy Practices.

Emergency and Crisis Support

Advanced Counseling OC is an outpatient psychotherapy practice and does not provide emergency services, crisis intervention, or 24-hour monitoring. Website messages, email, telephone calls, and voicemail are not monitored continuously and should not be used when immediate assistance is needed.

If you or someone else is in immediate danger or experiencing a medical or psychiatric emergency:

• Call 911;

• Go to the nearest hospital emergency department; or

• Contact an appropriate local emergency service.

For immediate emotional support or assistance with a suicidal, mental-health, or substance-use crisis, call or text the 988 Suicide & Crisis Lifeline at 988, or visit 988lifeline.org to use the online chat.

If you are outside the United States, contact the emergency or crisis service available in your location.

Established clients should follow any crisis or safety plan developed during treatment. Psychotherapy appointments are not a substitute for emergency evaluation or crisis-response services.

Electronic Communications

Email, text messages, website links, and voicemail may involve privacy and security risks. Please limit initial messages to basic contact, scheduling, availability, or insurance questions. Do not include detailed clinical information, highly sensitive personal information, payment information, or urgent safety concerns.

Messages are reviewed during regular business hours. A response within a particular period cannot be guaranteed. If your concern is urgent, use the emergency and crisis resources listed above rather than waiting for a response.

Email, voicemail, or submission of information through a scheduling link does not establish a therapist-client relationship. A therapeutic relationship begins only after we have mutually agreed to work together and the required intake and informed-consent process has been completed.

During telehealth treatment, clients may be asked to confirm their current physical location and provide appropriate emergency-contact information so that assistance can be coordinated if an emergency arises during a session.

(OMB Control Number: 0938-1401)

Jackie Girgis, LCSW#24895 714-455-9424

jackie@advcounseling.com

NPI#1699831255

Under the federal No Surprises Act, individuals who do not have health insurance or who do not intend to submit a claim to their health plan generally have the right to receive a written Good Faith Estimate of the expected cost of scheduled or requested healthcare services.

This includes individuals who have insurance but choose not to use it for the services described in the estimate.

When an Estimate Is Available

If you are uninsured or self-pay, you may request a Good Faith Estimate before scheduling services or at any time during treatment.

When the federal requirements apply, an estimate will generally be provided:

• Within one business day after scheduling services that will be provided at least three but fewer than 10 business days later;

• Within three business days after scheduling services that will be provided at least 10 business days later; or

• Within three business days after an estimate is requested when services have not yet been scheduled.

You may request an estimate orally or in writing. When appropriate, your individualized estimate may be delivered electronically through a secure client platform.

Estimated Fees

Current private-pay fees generally range from $160 to $250 per session, depending on the type and length of service.

Common services may include:

• 90791: Initial diagnostic evaluation;

• 90837: Individual psychotherapy; and

• 90847: Family or couples psychotherapy with the client present.

The fee listed in your individualized Good Faith Estimate will reflect the service and rate reasonably anticipated for you. It will not automatically assume the lowest fee in the practice’s published range.

What Your Individualized Estimate Will Include

Based on information reasonably available when it is prepared, your Good Faith Estimate will identify:

• The client receiving services;

• The provider furnishing the services;

• The anticipated service or services;

• Applicable service codes;

• The expected charge for each service;

• The reasonably anticipated frequency and duration of services;

• The expected total charges for the estimated period of care; and

• Other information required by applicable federal regulations.

A diagnosis will be included only when one has been clinically established and its inclusion is appropriate or required. Receiving or requesting a Good Faith Estimate does not, by itself, establish a mental-health diagnosis.

For recurring psychotherapy, an estimate may cover a defined period of treatment not exceeding 12 months. Because the appropriate duration and frequency of psychotherapy cannot always be known in advance, the estimate will be based on information available at the time and on the anticipated course of care.

Changes in Treatment or Cost

A Good Faith Estimate is an estimate rather than a contract. It does not require you to receive the listed services and does not require you to continue treatment for a particular number of sessions.

The actual course of treatment may change because of your clinical needs, preferences, progress, scheduling, or other circumstances. If a material change in the anticipated services, frequency, duration, or fees becomes known, a revised estimate may be provided before the changed services are furnished when required.

Unexpected services that could not reasonably have been anticipated may not appear in the original estimate.

Cancellation, late-cancellation, or missed-appointment charges are governed by the practice’s financial agreement and are not estimates of healthcare treatment charges.

If Your Bill Is Substantially Higher Than the Estimate

If the final billed charges from a particular provider are at least $400 more than the amount listed for that provider in your Good Faith Estimate, you may be eligible to use the federal Patient-Provider Dispute Resolution process.

You must generally begin the dispute process within 120 calendar days of the date on the original bill. A federal administrative fee may apply.

You may first contact Advanced Counseling OC to:

• Ask whether the bill should be corrected;

• Request clarification of the difference;

• Ask that the bill be updated to match the estimate when appropriate; or

• Discuss available payment or resolution options.

Using the federal dispute process will not adversely affect the quality of the services you receive.

For information about Good Faith Estimates or the dispute process, visit:

https://www.cms.gov/nosurprises
Telephone: 1-800-985-3059

Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. 

Last updated: September 5, 2026

Advanced Counseling OC respects your privacy. This Website Privacy Policy explains how information may be collected, used, retained, and shared when you visit www.advcounseling.com or contact Advanced Counseling OC through information or links provided on the website.

This Website Privacy Policy applies to website activity and general inquiries. It is separate from Advanced Counseling OC’s HIPAA Notice of Privacy Practices, which describes how protected health information may be used and disclosed in connection with clinical services.

Information Collected

Information you voluntarily provide

Advanced Counseling OC may receive personal information when you voluntarily:

• Send an email using an address or email link listed on the website;

• Call or leave a voicemail using a telephone number listed on the website; or

• Communicate with Advanced Counseling OC in another manner initiated by you.

This information may include your name, email address, telephone number, and anything you choose to include in your communication.

The website does not currently contain an intake or contact form operated by Advanced Counseling OC and does not process payments or create client accounts. Please do not send sensitive health information, detailed clinical information, Social Security numbers, payment information, or other confidential information through the website or ordinary email.

Submitting an inquiry does not establish a therapist-client relationship.

Information collected automatically

This website is hosted through Google Sites. When you visit the website, Google and related service providers may automatically collect limited technical or usage information, such as:

• Internet Protocol address;

• Browser and device type;

• Operating system;

• Approximate geographic location;

• Referring website;

• Pages visited;

• Links selected; and

• Date, time, and duration of visits.

This information may be collected through cookies and similar technologies. Advanced Counseling OC may receive or review aggregated website-traffic information to understand how the website is used, maintain its functionality, and improve its content.

Cookies and Analytics

Google Sites may use cookies to provide website functionality, maintain security, deliver its services, and analyze traffic. Google controls the placement and operation of its cookies and processes information according to its own privacy practices.

You can learn more by reviewing:

• Google’s Privacy Policy

• How Google uses information from sites or apps that use its services

You may control or delete cookies through your browser settings. Disabling cookies may affect how some website features operate.

Advanced Counseling OC does not use website information to independently track visitors across unrelated websites for targeted advertising. Advanced Counseling OC does not sell or rent personal information collected through this website.

Do Not Track Signals

Some browsers allow users to send a “Do Not Track” signal. Because there is no universally accepted standard governing these signals, this website does not currently respond independently to them. Third-party services used by the website may respond according to their own policies.

Visitors can manage cookies and similar technologies through their browser and device settings.

How Information Is Used

Information collected through or in connection with the website may be used to:

• Operate, maintain, and secure the website;

• Respond to questions or requests initiated by you;

• Provide general information about services;

• Understand general website traffic and improve website content;

• Detect or prevent misuse, security incidents, or technical problems; and

• Comply with applicable legal, regulatory, or professional obligations.

Vendors and Third-Party Services

Advanced Counseling OC may use third-party service providers to operate the website or facilitate communication and scheduling. These may include:

• Google Sites and Google services, for website hosting, cookies, security, and traffic information;

• Headway, when a visitor chooses to follow a link for scheduling, registration, insurance, or related services;

• Email and telephone service providers, when a visitor contacts Advanced Counseling OC; and

• Professional, technical, or legal service providers when reasonably necessary to operate the practice, protect legal rights, or comply with the law.

When you follow a link to an outside website, that company’s privacy practices—not this Website Privacy Policy—govern the information submitted through its service.

Information submitted through Headway is subject to Headway’s applicable policies:

• Headway Privacy Policy

• Headway HIPAA Notice of Privacy Practices

Advanced Counseling OC is not responsible for the privacy, security, content, or availability of independently operated third-party websites.

Clinical and Health Information

This public website is not intended to serve as a patient portal or a secure method for transmitting clinical information.

Information relating to treatment, billing, appointments, or other clinical services may be protected by federal and California health-privacy laws. The use and disclosure of protected health information maintained as part of a clinical relationship are addressed in the applicable HIPAA Notice of Privacy Practices, rather than solely by this Website Privacy Policy.

Advanced Counseling OC’s Notice of Privacy Practices is available on the New Clients page.

Disclosure of Information

Advanced Counseling OC may disclose information:

• To service providers performing functions on behalf of the practice;

• When required by law, subpoena, court order, licensing authority, or other valid legal process;

• When reasonably necessary to prevent fraud, address a security concern, or protect the rights or safety of Advanced Counseling OC or others; or

• With your direction or consent.

Advanced Counseling OC does not sell personal information obtained through this website or share it for cross-context behavioral advertising.

Security

Advanced Counseling OC uses reasonable administrative, technical, and organizational safeguards appropriate to the nature of the information maintained. Vendors are selected with privacy and security considerations in mind when they may have access to personal information.

Nevertheless, no website, email system, telephone system, or Internet transmission can be guaranteed to be completely secure. Visitors should avoid sending sensitive or confidential information through ordinary email or public website communications.

Retention

General inquiries and related communications are retained only as long as reasonably necessary to respond, maintain appropriate business records, comply with legal or professional obligations, resolve disputes, and protect legitimate interests.

Technical and analytics information may be retained according to Google’s policies and the settings applicable to the website.

If information becomes part of a client’s clinical or billing record, its retention is governed by applicable healthcare-record requirements and the practice’s clinical record-retention policies.

Your Choices and Requests

You may contact Advanced Counseling OC to ask whether personal information voluntarily submitted through a general website-related communication is maintained, or to request that inaccurate information be corrected or deleted.

Requests will be considered subject to identity verification and any legal, ethical, insurance, clinical-record, or professional obligations requiring the information to be retained. Advanced Counseling OC may not be able to delete information that must be preserved by law or as part of a clinical record.

Children’s Privacy

This website is intended to provide information to adults, including parents and legal guardians, and is not directed toward children under 13. Advanced Counseling OC does not knowingly collect personal information directly from children under 13 through the website. A parent or legal guardian should initiate inquiries concerning services for a minor.

Changes to This Policy

Advanced Counseling OC may update this Website Privacy Policy as website features, vendors, or legal requirements change. The revised policy will be posted on this page with an updated “Last updated” date.

If a material change significantly affects how information is collected, used, or disclosed, a notice may also be posted prominently on the website.

Privacy Contact

Questions, concerns, or requests relating to this Website Privacy Policy may be directed to:

Jackie Girgis, LCSW
Advanced Counseling OC
Email: Jackie@AdvCounseling.com
Telephone: (714) 455-9424

Please do not include sensitive clinical information in an initial email. Email and website communications are not monitored continuously and should not be used for emergencies.