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NOTICE OF PRIVACY PRACTICES
This notice describes how and why your health information may be used and how you can gain access to this information. Please review the information carefully.
(If there are any areas which you might need more clarification on please do not hesitate to ask.)
The most significant variable which motivated the Federal government to legally enforce the privacy of health information is the rapid evolution of electronic technology in the health care business. The government has sought to standardize and protect the electronic exchange of your health information. This has challenged us to review how your information is used on our computers, on the Internet, as well as phones, fax machines, and any device used to copy or transfer patient data. We want to advise you that we have developed policies and procedures for our practice to ensure your personal health information will be shared only as required for the purpose of administering your care. Our office is subject to State and Federal laws regarding the confidentiality of your health information. We also want you to understand our procedures and your rights as a valued patient. Your health information will be communicated only for the purpose of conducting health care business. Be assured that without your written permission, your health information will not be used for any other purpose.
Why Your Health Information May Be Used To Provide Treatment:
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information (protected health information) used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of I how we are required to maintain the privacy of your health information and how we may use and disclose your health information. Without specific written authorization, we are permitted to use and disclose your health care records for the purposes of treatment, payment, and health care operations.
Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. Examples of treatment would include psychotherapy, medication management, etc.
In addition, your confidential information may be used to remind you of an appointment (by phone or mail) or provide you with information about treatment' options or other health-related services. We will use and disclose your PROTECTED HEALTH INFORMATION when we are required to do so by federal, state or local law. We may disclose your PROTECTED HEALTH INFORMATION to public health authorities that are authorized by law to collect information; to a health oversight agency for activities authorized by law included but not limited to: response to a court or administrative order, if you are involved in a lawsuit or similar proceeding; response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
We may release your PROTECTED HEALTH INFORMATION to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. We may use and disclose your PROTECTED HEALTH INFORMATION when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization. You have certain rights in regards to your PROTECTED HEALTH INFORMATION, which you can exercise by presenting a written request to our Privacy Officer at the practice address listed below:
We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all PROTECTED HEALTH INFORMATION that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from this office. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.
For more information about our Privacy Practices, please contact: South Carolina Labor, Licensing, and Regulation at: www.llr.state.sc.us/pol/counselors/index.asp?file=CCE.htm
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services Office of Civil Rights 200 Independence Avenue, S.W. Washington, D.C 20201
Authorization to Use or Disclose Health Information
Other than the information stated above, or information that Federal, State, and Local laws require, we will not disclose your health information without your written authorization.
Use your finger (touchscreen) or your mouse to "sign" your full name below:
INFORMED CONSENT FOR ONLINE THERAPY
I indicate my understanding of the following and that I have the following rights with respect to online therapy:
DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTOOD THE ABOVE
I have read the above, and I have had my questions answered to my satisfaction. By signing below I state that I have understood what is involved in undergoing treatment and have decided that it is in my best interest to undergo online therapy. Having been informed of the nature and parameters of online therapy, I hereby give my consent to online therapy.
Once you have finished the form, check the 2 boxes above indicating you have read and understood both documents. Then, click "Submit Form" button below and your form will be sent securely to Journey To Truth Counseling, LLC.