Privacy Policy

WILLOW & STONE COUNSELING PLLC NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Willow & Stone Counseling PLLC. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information.

I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that I use and disclose health information.

For Treatment, Payment, or Health Care Operations: Federal privacy rules allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information in order to assist the clinician in diagnosis and treatment.

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

Psychotherapy Notes: I do keep “psychotherapy notes” as defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

• For my use in treating you.
• For training or supervising mental health practitioners.
• For defending myself in legal proceedings instituted by you.
• For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
• Required by law, a coroner, or to help avert a serious threat to health and safety.

Marketing & Sale of PHI: As a psychotherapist, I will not use or disclose your PHI for marketing purposes, nor will I sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for:

• Public health activities (reporting abuse/neglect).
• Health oversight activities, audits, and investigations.
• Law enforcement purposes occurring on my premises.
• Research purposes or specialized government functions (military, intelligence).
• Workers’ compensation purposes.
• Appointment reminders: I may contact you to remind you of an appointment or to tell you about treatment alternatives I offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT

Disclosures to family or friends: I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or payment, unless you object.

VI. YOUR RIGHTS REGARDING YOUR PHI

• The Right to Request Limits: You can ask me not to use or disclose certain PHI for treatment or payment. I am not required to agree if it affects your care.
• The Right to Request Restrictions for Out-of-Pocket Expenses: If you pay for a service in full out-of-pocket, you can request that I do not share that information with your health plan.
• The Right to Choose How I Send PHI: You can ask me to contact you at a specific address or phone number.
• The Right to See and Get Copies: You have the right to get an electronic or paper copy of your medical record (excluding psychotherapy notes). I will provide this within 30 days.
• The Right to Correct or Update: If you believe there is a mistake, you can request a correction.
• The Right to Get a List of Disclosures: You can request a list of the times I’ve shared your PHI for the past six years (for reasons other than treatment/payment).

VII. GOOD FAITH ESTIMATE NOTICE

If you do not have insurance or are not using insurance, you have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. For more information, visit www.cms.gov/nosurprises.

Acknowledgement of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices from Willow & Stone Counseling PLLC.