Notice of privacy practices
Heal ATL Counseling & Wellness
1117 Perimeter Center West
Suite N102
Atlanta, GA 30338
833-HEAL-ATL
Health Insurance Portability and Accountability Act (HIPAA)
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.
I. COMMITMENT TO YOUR PRIVACY: Heal ATL Counseling & Wellness (henceforth referred
to as “This Practice”) is dedicated to maintaining the privacy of your protected health
information (PHI) and electronic protected health information (ePHI) (henceforth condensed
and referred to as simply PHI). PHI is information that may identify you and that relates to
your past, present, or future physical or mental health condition and related health care
services either in paper or electronic format. This Notice of Privacy Practices (“Notice”) is
required by law to provide you with the legal duties and the privacy practices that This
Practice maintains concerning your PHI. It also describes how medical and mental health
information may be used and disclosed, as well as your rights regarding your PHI. Please
read carefully and discuss any questions or concerns with your therapist.
II. LEGAL DUTY TO SAFEGUARD YOUR PHI: By federal and state law, This Practice is required
to ensure that your PHI is kept private. This Notice explains when, why, and how This
Practice would use and/or disclose your PHI. Use of PHI means when This Practice shares,
applies, utilizes, examines, or analyzes information within its practice; PHI is disclosed when
This Practice releases, transfers, gives, or otherwise reveals it to a third party outside of This
Practice. With some exceptions, This Practice may not use or disclose more of your PHI than
is necessary to accomplish the purpose for which the use or disclosure is made; however,
This Practice is always legally required to follow the privacy practices described in this
Notice.
III. CHANGES TO THIS NOTICE: The terms of this notice apply to all records containing
your PHI that are created or retained by This Practice. Please note that This Practice
reserves the right to revise or amend this Notice of Privacy Practices. Any revision or
amendment will be effective for all of your records that This Practice has created or
maintained in the past and for any of your records that This Practice may create or maintain
in the future. This Practice will have a copy of the current Notice available in a visible
location or on our website at all times, and you may request a copy of the most current
Notice at any time. The date of the latest revision will always be listed at the end of This
Practice’s Notice of Privacy Practices.
IV. HOW HEAL ATL COUNSELING & WELLNESS MAY USE AND DISCLOSE YOUR PHI: This
Practice will not use or disclose your PHI without your written authorization, except as
described in this Notice or as described in the “Information, Authorization and Consent to
Treatment” document. Below, you will find the different categories of possible uses and
disclosures with some examples.
1. For Treatment: This Practice may disclose your PHI to physicians, psychiatrists,
psychologists, and other licensed healthcare providers who provide you with healthcare
services or are otherwise involved in your care. Example: If you are also seeing a psychiatrist
for medication management, This Practice may disclose your PHI to her/him in order to
coordinate your care. Except for in an emergency, This Practice will always ask for your
authorization in writing prior to any such consultation.
2. For Health Care Operations: This Practice may disclose your PHI to facilitate the efficient
and correct operation of its practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
3. To Obtain Payment for Treatment: This Practice may use and disclose your PHI to bill and
collect payment for the treatment and services This Practice provided to you. Example: This
Practice might send your PHI to your insurance company or managed health care plan to
get payment for the health care services that have been provided to you. This Practice could
also provide your PHI to billing companies, claims processing companies, and others that
process health care claims for This Practice’s office if either you or your insurance carrier are
not able to stay current with your account. In this latter instance, This Practice will always do
its best to reconcile this with you first prior to involving any outside agency.
4. Employees and Business Associates: There may be instances where services are provided
to This Practice by an employee or through contracts with third-party “business associates.”
Whenever an employee or business associate arrangement involves the use or disclosure of
your PHI, This Practice will have a written contract that requires the employee or business
associate to maintain the same high standards of safeguarding your privacy that is required
of This Practice.
Note: Federal law provides additional protection for certain types of health information,
including alcohol or drug abuse, mental health, and AIDS/HIV, and may limit whether and
how This Practice may disclose information about you to others.
V. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES – This
Practice may use and/or disclose your PHI without your consent or authorization for the
following reasons:
1. Law Enforcement: Subject to certain conditions, This Practice may disclose your PHI
when required by federal, state, or local law; judicial, board, or administrative proceedings;
or law enforcement. Example: This Practice may make a disclosure to the appropriate
officials when a law requires This Practice to report information to government agencies,
law enforcement personnel and/or in an administrative proceeding.
2. Lawsuits and Disputes: This Practice may disclose information about you to respond to
a court or administrative order or a search warrant. This Practice may also disclose
information if an arbitrator or arbitration panel compels disclosure, when arbitration is
lawfully requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for
mental health records) or any other provision authorizing disclosure in a proceeding before
an arbitrator or arbitration panel. This Practice will only do this if efforts have been made to
tell you about the request and you have been provided an opportunity to object or to obtain
an appropriate attorney to quash the subpoena or court order protecting the information
requested.
3. Public Health Risks: This Practice may disclose your PHI to public health or legal
authorities charged with preventing or controlling disease, injury, disability, to report births
and deaths, and to notify persons who may have been exposed to a disease or at risk for
getting or spreading a disease or condition.
4. Food and Drug Administration (FDA): This Practice may disclose to the FDA, or persons
under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods,
supplements, products and product defects, or post-marketing surveillance information to
enable product recalls, repairs, or replacement.
5. Serious Threat to Health or Safety: This Practice may disclose your PHI if you are in such
mental or emotional condition as to be dangerous to yourself or the person or property of
others and if This Practice determines in good faith that disclosure is necessary to prevent
the threatened danger. Under these circumstances, This Practice may provide PHI to law
enforcement personnel or other persons able to prevent or mitigate such a serious threat to
the health or safety of a person or the public.
6. Minors: If you are a minor (under 18 years of age), This Practice may be compelled to
release certain types of information to your parents or guardian in accordance with
applicable law.
7. Abuse and Neglect: This Practice may disclose PHI if mandated by local child, elder, or
dependent adult abuse and neglect reporting laws. Example: If This Practice has a
reasonable suspicion of child abuse or neglect, This Practice will report this to the
appropriate authorities.
8. Coroners, Medical Examiners, and Funeral Directors: This Practice may release PHI
about you to a coroner or medical examiner. This may be necessary, for example, to
identify a deceased person, determine the cause of death, or perform other duties as
authorized by law. This Practice may also disclose PHI to funeral directors, consistent with
applicable law, to carry out their duties.
9. Communications with Family, Friends, or Others: This Practice may release your PHI to
the person you named in your Durable Power of Attorney for Health Care (if you have one),
to a friend or family member who is your personal representative (i.e., empowered under or
other law to make health-related decisions for you), or any other person you identify,
relevant to that person’s involvement in your care or payment related to your care. In
addition, This Practice may disclose your PHI to an entity assisting in disaster relief efforts so
that your family can be notified about your condition.
10. Military and Veterans: If you are a member of the armed forces, This Practice may
release PHI about you as required by military command authorities. This Practice may also
release PHI about foreign military personnel to the appropriate military authority.
11. National Security, Protective Services for the President, and Intelligence Activities: This
Practice may release PHI about you to authorized federal officials so they may provide
protection to the President, other authorized persons, or foreign heads of state to conduct
special investigations for intelligence, counterintelligence, and other national activities
authorized by law.
12. Correctional Institutions: If you are or become an inmate of a correctional institution,
This Practice may disclose PHI to the institution or its agents when necessary for your health
or the health and safety of others.
13. For Research Purposes: In certain limited circumstances, This Practice may use
information you have provided for medical/psychological research, but only with your
written authorization. The only circumstance where written authorization would not be
required would be if the information you have provided could be completely disguised in
such a manner that you could not be identified directly or through any identifiers linked to
you. The research would also need to be approved by an institutional review board that has
examined the research proposal and ascertained that the established protocols have been
met to ensure the privacy of your information.
14. For Workers' Compensation Purposes:
This Practice may provide PHI in order to comply with Workers' Compensation or similar
programs established by law.
15. Appointment Reminders: This Practice is permitted to contact you, without your prior
authorization, to provide appointment reminders or information about alternative or other
health-related benefits and services that you may need or that may be of interest to you.
16. Health Oversight Activities: This Practice may disclose health information to a health
oversight agency for activities such as audits, investigations, inspections, or licensure of
facilities. These activities are necessary for the government to monitor the health care
system, government programs, and compliance with laws. Example: When compelled by
the U.S. Secretary of Health and Human Services to investigate or assess This Practice’s
compliance with HIPAA regulations.
17. If Disclosure is Otherwise Specifically Required by Law.
18. In the Following Cases, This Practice Will Never Share Your Information Unless You Give
Us Written Permission: Marketing purposes, sale of your information, most sharing of
psychotherapy notes, and fundraising. If we contact you for fundraising efforts, you can tell
us not to contact you again.
VI. Other Uses and Disclosures Require Your Prior Written Authorization: In any other
situation not covered by this notice, This Practice will ask for your written authorization
before using or disclosing medical information about you. If you choose to authorize use or
disclosure, you can later revoke that authorization by notifying This Practice in writing of
your decision. You understand that This Practice is unable to take back any disclosures it
has already made with your permission, This Practice will continue to comply with laws that
require certain disclosures, and This Practice is required to retain records of the care that its
therapists have provided to you.
VII. RIGHTS YOU HAVE REGARDING YOUR PHI:
1. The Right to See and Get Copies of Your PHI either in paper or electronic format: In
general, you have the right to see your PHI that is in This Practice’s possession or to get
copies of it. You will also be allowed to inspect your PHI in person and take notes or
photographs of their PHI. However, you must request the above in writing. If This Practice
does not have your PHI but knows who does, you will be advised how you can get it. You will
receive a response from This Practice within 15 days of receiving your written request.
Under certain circumstances, This Practice may feel it must deny your request, but if it does,
This Practice will give you, in writing, the reasons for the denial. This Practice will also
explain your right to have its denial reviewed. If you ask for copies of your PHI, you will be
charged a reasonable fee per page and the fees associated with supplies and postage. This
Practice may see fit to provide you with a summary or explanation of the PHI, but only if you
agree to it, as well as to the cost, in advance.
2. The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask
that This Practice limit how it uses and discloses your PHI. While This Practice will consider
your request, it is not legally bound to agree. If This Practice does agree to your request, it
will put those limits in writing and abide by them except in emergency situations. 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. You do
not have the right to limit the uses and disclosures that This Practice is legally required or
permitted to make.
3. The Right to Choose How This Practice Sends Your PHI to You: It is your right to ask that
your PHI be sent to you at an alternate address (for example, sending information to your
work address rather than your home address) or by an alternate method (for example, via
email instead of by regular mail). This Practice is obliged to agree to your request providing
that it can give you the PHI, in the format you requested, without undue inconvenience.
4. The Right to Get a List of Disclosures. You are entitled to a list of disclosures of your PHI
that This Practice has made. The list will not include uses or disclosures to which you have
specifically authorized (i.e., those for treatment, payment, or health care operations, sent
directly to you or to your family; neither will the list include disclosures made for national
security purposes or to corrections or law enforcement personnel. The request must be in
writing and state the time period desired for the accounting, which must be less than a 6-
year period and starting after April 14, 2003.
This Practice will respond to your request for an accounting of disclosures within 60 days of
receiving your request. The list will include the date of the disclosure, the recipient of the
disclosure (including address, if known), a description of the information disclosed, and the
reason for the disclosure. This Practice will provide the list to you at no cost unless you
make more than one request in the same year, in which case it will charge you a reasonable
sum based on a set fee for each additional request.
5. The Right to 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.
6. The Right to Amend Your PHI: If you believe that there is some error in your PHI or that
important information has been omitted, it is your right to request that This Practice correct
the existing information or add the missing information. Your request and the reason for
the request must be made in writing. You will receive a response within 60 days of This
Practice receipt of your request. This Practice may deny your request, in writing, if it finds
that the PHI is: (a) correct and complete, (b) forbidden to be disclosed, (c) not part of its
records, or (d) written by someone other than This Practice. Denial must be in writing and
must state the reasons for the denial. It must also explain your right to file a written
statement objecting to the denial. If you do not file a written objection, you still have the
right to ask that your request and This Practice denial be attached to any future disclosures
of your PHI. If This Practice approves your request, it will make the change(s) to your PHI.
Additionally, This Practice will tell you that the changes have been made and will advise all
others who need to know about the change(s) to your PHI.
6. The Right to Get This Notice by Email: You have the right to get this notice by email. You
have the right to request a paper copy of it as well.
7. Submit all Written Requests: Submit to This Practice’s Director and Privacy Officer,
Brittany Hewitt, at brittany@healatl.com.
VIII. COMPLAINTS: If you are concerned your privacy rights may have been violated, or if
you object to a decision This Practice made about access to your PHI, you are entitled to file
a complaint. You may also send a written complaint to the Secretary of the Department of
Health and Human Services Office of Civil Rights. This Practice will provide you with the
address. Under no circumstances will you be penalized or retaliated against for filing a
complaint. Please discuss any questions or concerns with your therapist. Your signature on the
“Information, Authorization, and Consent to Treatment” (provided to you separately)
indicates that you have read and understood this document.
IX. HEAL ATL COUNSELING & WELLNESS’ RESPONSIBILITIES: We are required by law to
maintain the privacy and security of your PHI. 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.
Date of Last Revision: 09/22/23