NOTICE OF PRIVACY PRACTICES
It is our duty to maintain privacy of your health information and to provide you with this notice about how mental health information about you may be used and disclosed, and how you can get access to this information. You will be given a Consent to Treatment Form indicating that you have been given the opportunity to read and have accepted the Privacy Practices. Once you have signed that form, we may use or disclose your Protected Health Information for purposes of diagnosis, treatment, obtaining payment, or to conduct healthcare operations. For example, if you choose to use insurance, to receive payment, information about you must be disclosed to your insurance company. Other permitted and required uses and disclosures that may be made without your consent, authorization or opportunity to object include the following:
Abuse or neglect: If we suspect abuse or neglect of a child or elder, we are mandated to report this to appropriate public authorities.
Danger: If we suspect you are in imminent danger of harming yourself or someone else, we are mandated to report this to the person at risk and to public authorities.
Legal Proceedings: We may disclose Protected Health Information in response to a court order or subpoena or in certain other legal proceedings.
You have the following rights regarding health information we maintain about you:
Right to inspect and copy: You have the right to inspect and request copies of information that may be
used to make decisions about your care. This usually includes demographic and billing records but not psychotherapy notes. To inspect and/or receive copies of information, you must submit a request in writing. If you request a copy of information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request. We must respond to your request within 15 days of its receipt.
Right to Amend: If you feel that health information about you is incorrect or incomplete, you may ask us
to amend the information. You have the right to request an amendment for as long as the information is kept by us. Your request for amendment must be in writing and must provide a reason supporting your request.
Right to an Accounting of Disclosures: You have the right to request an Accounting of Disclosures we
have made about you. You must submit a written request and your request must state a time period for the disclosures, which may not be longer than six years.
Right to Request Restriction on Uses and Disclosures: You may request that disclosure of confidential information be limited. If we are unable to agree to that restriction, we can discuss other options, such as referral to another counselor.
Right to Limit Reception of Confidential Information: E.G., you may request that we onlycontact you at a certain telephone number or address. You do not have to give a reason for your request.
Right to a Paper Copy of this Notice: You will be offered a paper copy of this notice.
Other uses and disclosures of Protected Health Information and any disclosure of Psychotherapy Noteswill be made only with your written authorization. After such authorization is given, you may revoke that authorization at any time. This Notice may be amended as needed to comply with federal, state and professional requirements.
If you believe your privacy rights have been violated, please let us know either in writing or by talking with us. Such a complaint will not result in any retaliation on our part. You may also file a complaint with the Secretary of the US Department of Health and Human Services.