Compassionate Counseling & Behavioral Center, PLLC
Health Insurance Portability and Accountability Act (HIPAA) NOTICE OF PRIVATE PRACTICES
Effective November 1, 2011
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. YOU WILL SIGN THIS DOCUMENT AT YOUR FIRST VISIT.
When you receive treatment or benefits from San Antonio Compassionate Counseling and Behavioral Center, PLLC, create and maintain information about your health, treatment, and payment for services. We will not use or disclose your information without your written authorization (permission) except as described in this notice.
How We May Use and Disclose Your Health Information
We may use and disclose your health information without your authorization for treatment, payment, and health care operation purposes. Examples include but are not limited to:
We may share your health information with our business associates who need the information to perform services on our behalf and agree to protect the privacy and security of your health information according to agency standards.
We may use or share your health information without your authorization as authorized by law for our patient directory, to family or friends involved in your care, or to a disaster relief agency for purposes of notifying your family or friends of your location and status in an emergency situation.
We may use and disclose your health information without your authorization to contact you for the following activities, as permitted by law and agency policy: providing appointment reminders; describing or recommending treatment alternatives; providing information about health-related benefits and services that may be of interest to you; or fundraising.
We may also use and disclose your health information without your authorization for the following purposes:
We will always obtain your authorization to use or share your information for marketing purposes, to use or share a summary of your psychotherapy notes, if there is payment from a third party, or for any other disclosure not described in this notice or required by law. You have the right to cancel your authorization, except to the extent that we have taken action based on your authorization. You may cancel your authorization by writing to the privacy officer per below.
Your Privacy Rights
Although your health record is the property of San Antonio Compassionate Counseling and Behavioral Center, PLLC, you have the right to:
We are required to provide you with notice of our legal duties and our privacy practices with respect to your health information.
We must maintain the privacy of information that identifies you and notify you in the event your health information is used or disclosed in a manner that compromises the privacy of your health information.
We are required to abide by the terms of this notice. We reserve the right to change the terms of this notice and to make the revised notice effective for all health information that we maintain. We will post revised notices on our public website at www.dshs.texas.gov and in waiting room areas. You may request a copy of the revised notice at the time of your next visit.
If you believe your HIPAA privacy rights have been violated please submit your complaint in writing. To report an offense allegedly occurring in Texas, file the complaint with the Region VI office located in Dallas.
Region IV Office for Civil Rights
1301 Young Street, Suite 1169
Dallas, Texas 75202
San Antonio Compassionate Counseling and Behavioral Center, PLLC will not retaliate against you for filing a complaint.
Written Acknowledgement of receipt and understanding of HIPAA Rights
NOTICE: YOU WILL SIGN THIS DOCUMENT DURING YOUR FIRST VISIT WITH YOUR COUNSELOR. YOUR SIGNATURE ON THIS DOCUMENT INDICATES YOU HAVE READ IT AND ALSO SERVES AS AN ACKNOWLEDGEMENT YOU HAVE RECEIVED THE HIPAA NOTICE DESCRIBED ABOVE.