This Notice of Privacy Practices (NPP) describes how we may use and  disclose your protected health information (PHI) to carry out  treatment, payment or health care operations (TPO) and for other  purposes that are permitted or required by law. It also describes your  rights to access and control your protected health information.  

PHI is information about you, including demographic information,  that may identify you and that relates to your past, present or future  physical or mental health or condition and related health care services. 

Uses and Disclosures of Protected Health Information: Your protected  health information may be used and disclosed by your therapist, our  office staff and others outside of our office that are involved in your  care and treatment for the purpose of providing health care services to  you, to pay your health care bills, to support the operation of the  therapist’s practice and any other use required by law. 

Treatment: We may use and disclose your protected health  information to provide, coordinate, or manage your health care and  any related services. This includes coordinating or managing your  health care with a third party. For example, we would disclose your  protected health information, as necessary, to a home health agency  that provides care to you. For example, your protected health  information may be provided to a therapist to whom you have been  referred to ensure that the therapist has the necessary information to  diagnose or treat you. 

Payment: Your protected health information will be used, as needed,  to obtain payment for your health care services. For example,  obtaining approval for a hospital stay may require that your relevant  protected health information be disclosed to the health plan to obtain  approval for the hospital admission. 

Healthcare Operations: We may use or disclose, as needed, your  protected health information to support the business activities of your  therapist’s practice. These activities include, but are not limited to,  quality assessment activities, employee review activities, training of  medical students, licensing, and conducting or arranging for other  business activities. In addition, we may use a sign-in sheet at the  registration desk where you will be asked to sign your name and  indicate your therapist. We may also call you by name in the waiting  room when your therapist is ready to see you. We may use or disclose  your protected health information, as necessary, to contact you to  remind you of your appointment. 

We may use or disclose your protected health information in the  following situations without your authorization. These situations  include child abuse or neglect, judicial and administrative  proceedings, deceased patients, medical emergencies, family  involvement in care, health oversight, law enforcement, specialized  government functions, public health, and public safety. 

Other permitted and required uses and disclosures will be made only  with your consent, authorization or opportunity to object unless  required by law. You may revoke this authorization, at any time, in  writing, except to the extent that your therapist or the therapist’s practice has taken an action in reliance on the use or disclosure  indicated in the authorization. 

Your Rights: The following is a statement of your rights with respect to  your protected health information.  

You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following  records: psychotherapy notes, information compiled in reasonable  anticipation of, or use in, a civil, criminal, or administrative action or  proceeding, and protected health information that is subject to law that  prohibits access to protected health information.  

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of  your protected health information for the purposes of treatment, payment or health care operations. You may also request that any part of your  protected health information not be disclosed to family members or friends  who may be involved in your care or for notification purposes as described  in this Notice of Privacy Practices. Your request must state the specific  restriction requested and to whom you want the restriction to apply.  

Your therapist is not required to agree to a restriction that you may request.  If your therapist believes it is in your best interest to permit use and  disclosure of your protected health information, your protected health  information will not be restricted. You then have the right to use another  Healthcare Professional.  

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to  obtain a paper copy of this notice from us, upon request, even if you have  agreed to accept this notice alternatively, i.e. electronically.  

You may have the right to have your therapist amend your protected health information. If we deny your request for amendment, you have the right to  file a statement of disagreement with us and we may prepare a rebuttal to  your statement and will provide you with a copy of any such rebuttal.  

You have the right to receive an accounting of certain disclosures we have  made, if any, of your protected health information.  

We reserve the right to change the terms of this notice and will inform you  by mail of any changes. You then have the right to object or withdraw as  provided in this notice.  

Complaints: You may complain to us or to the Secretary of Health and  Human Services if you believe your privacy rights have been violated by  us at 200 Independence Avenue S.W. Washington, D.C. 20201. You may  also file a complaint by notifying us at 325-261-3074. If you file a  complaint about our privacy practices, we will take no retaliatory action  against you. 

We are required by law to maintain the privacy of, and provide individuals  with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objectionsto this form, please  ask to speak with a staff member in person or by phone at 325-261-3074. 

For more information, please see:  

hhs.gov/ocr/privacy/hipaa/understanding/
consumers/noticepp.html

This notice was published and becomes effective on/or before Jul 3, 2024.