HIPAA Notice of Privacy Practices

Effective Date: 9/1/2017

This Notice describes how medical and mental health information about you may be used and disclosed, and how you can access this information. Please review it carefully.

Our Responsibilities

We are required by law to:

Maintain the privacy of your protected health information (PHI)
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of this Notice currently in effect
Notify you if a breach occurs that may compromise your information

How We May Use and Disclose Your Information

We may use or disclose your PHI without your written authorization for the following purposes:

Treatment
To provide, coordinate, or manage your mental health care, including telehealth services and consultation with other providers involved in your care.

Payment
To bill and collect payment from insurance companies, third-party payers, or you directly for services rendered.

Health Care Operations
For practice operations such as documentation, supervision, quality review, billing support, and legal compliance.

Other Uses and Disclosures Permitted or Required by Law

We may disclose your information without your authorization when required or permitted by law, including:

To prevent a serious and imminent threat to your safety or others
Reports of abuse, neglect, or domestic violence
Court orders, subpoenas, or lawful requests
Workers’ compensation claims
Public health and law enforcement activities

Uses Requiring Written Authorization

All other uses or disclosures of your PHI require your written authorization, including:

Release of records to third parties not involved in treatment or payment
Marketing purposes

You may revoke your authorization at any time in writing.

Your Rights

You have the right to:

Access and obtain a copy of your records
Request corrections to your records
Request restrictions on certain uses or disclosures
Request confidential communications
Receive a paper copy of this Notice
Be notified of a breach
File a complaint without retaliation

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Practice Contact:
Sally Bennett, LCSW
Email: sally@therapywithsallyb.com

U.S. Department of Health & Human Services (HHS):
https://www.hhs.gov/ocr/privacy/hipaa/complaints/

How to File a Complaint

You have a right to have your complaints heard and resolved in a timely manner. If we
cannot work things out to your satisfaction, you may file a complaint with our licensing
board:

Texas Behavioral Health Executive Council
1801 Congress Avenue, Suite 7.300
Austin, TX 78701
Telephone: 1-800-821-3205
Link to Complaint Form: http://www.bhec.texas.gov/wp-content/uploads/2020/07/BHEC-Complaint-Form.pdf.

If you have a complaint concerning the HIPAA Privacy Regulations, you may contact the U. S. Department of Health and Human Services, Office for Civil Rights, at: OCRMail@hhs.gov.

If you believe that you have a Consumer Complaint regarding the privacy and security of your health information, you may contact the Texas Office of the Attorney General and file a consumer complaint by clicking this link:
https://www.texasattorneygeneral.gov/consumer-protection/health-care/patient-privacy

Changes to This Notice

We reserve the right to change this Notice. Any changes will apply to all information we maintain and will be posted on this website.