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