This is a Notice of Privacy Practices which all therapists who are covered entities must provide to each client by April 14, 2003. This is required bythe Health Insurance Portability and Accountability Act (HIPAA). This Notice is based on online HIPAA information, information from other professionalorganizations, and the Code of Maryland. Ef ective April 14, 2003

 

This notice describes how medical/mental health information about you may be used and disclosed and how you can get access to this information. Pleasereview it carefully. We have a duty to maintain privacy of your health information and to provide you with this notice. Once you have signed this Notice,we may use or disclose your Protected Health Information (PHI) for the purposes of diagnosis, treatment, obtaining payment, or to conduct healthcareoperations. For example, if you choose to use insurance, to receive payment we must provide information about you to your insurance company.

 

Other permitted and required uses and disclosures that may be made without your consent, authorization or opportunity to object:

Abuse or Neglect: If we suspect abuse or neglect of a child or elder, present or past, we are mandated to make a report to the appropriate publicauthorities. This applies to abuse occurring in the present or the past.

 

Danger: If we suspect you are in imminent danger of harming yourself or someoneelse, we are mandated to make a report to the person at risk and to the public authorities.

 

Clinical Coordination and Consultation: As an entity, staff ofSSC share patient charts and thus have access to patient information as is relevant to their staff roles. There are times in which patient information will beshared among professional staff for treatment coordination and consultation purposes. Non-clinical staff do not have access to clinical information.

 

Legal Proceedings: We may disclose your PHI in response to a court order or subpoena or in certain other legal proceedings. Impairment: In the circumstancethat we are unable to contact the patient personally due to impairment by injury, illness, or otherwise, arrangements have been made to provide a trustedcolleague the minimum of information to address immediate treatment concerns such as appointment cancellations.

 

Technology: We make every effort toutilize HIPAA compliant technologies, including email and billing software. However, we are unable to guarantee privacy with commonly utilized modesof technology that are not regulated in accordance with HIPAA rules, such as cell phones and texting. It is your choice and with your consent whether/notyou want to actively engage in those modes of communication with this provider. Under no circumstances is audio recording or video recording permittedduring a session, telephone call, or video contact, by either client/patient or provider without explicit and written permission by all parties

 

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy: You have the right to inspect andrequest copies of information that may be used to make decisions about your care. Usually this includes demographic and billing records but does notinclude 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 fifteen days ofreceipt.

 

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 theright to request an amendment for as long as the information is kept by us. Your request for the amendment must be in writing and must provide a reasonsupporting your request.

 

Right to an Accounting of Disclosures: You have the right to request an Accounting of Disclosures we have made of informationabout you. You must submit your request in writing to: Stone Soup Counseling, LLC, 4407 Meadowcliff Rd, Glen Arm, MD 21057. Your request muststate a time period for the disclosures, which may not be longer than six years.

 

Right to Request Restriction on Uses and Disclosures: You may requestthat disclosure of confidential information be limited. If we are unable to agree to that restriction, we can discuss other options, such as referral to anothertherapist.

 

Right to Limit Reception of Confidential Information: For example, you may request that we only contact you at a certain telephone numberor address. You do not have to give a reason for your request.

 

Right to a Paper Copy of this Notice: You have the right to a paper copy of this notice.Other uses and disclosures of Protected Health Information and any disclosure of Psychotherapy Notes will be made only with your writtenauthorization. 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 directly with your therapist AND our Clinical Director Sharon Calvano, LCSW-C. Such a complaint will not result in any retaliation by us. You may also 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/