THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
Peavy Counseling Services, LLC Responsibilities and Rights:
Peavy Counseling Services, LLC is required by law, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 (HIPPA), including the HIPPA Privacy Rule, and 42 C.F.R. Part 2, to keep your protected health information (PHI), and substance use disorder (SUD) information private and confidential, and to provide you with a notice of our privacy practices. Peavy Counseling Services, LLC will comply with all applicable federal, and state laws. We are also required to abide by these policies that are outlined below.
Rights to Revise Privacy Practices:
We are permitted by law to make changes to our privacy policies and practices. Such modifications may be required by changes in federal and/or state laws and regulations. You may upon request receive an updated copy of our privacy practices during an office visit.
Uses and Disclosures:
Treatment.
While you are a client at Peavy Counseling Services, LLC your protected health information (PHI), and/or substance use disorder (SUD) information may be used by members of our staff, or may be disclosed to other health care, or behavioral health care professionals for the purpose of providing you appropriate levels of care. For example, disclosing your information to a mental health, or substance use disorder treatment professional after your treatment with us has been completed, provided that you have given us written consent to do so.
Payment.
Your protected health information (PHI), and/or substance use disorder (SUD) information may be used to pay for mental health, or substance use disorder treatment services you have received at Peavy Counseling Services, LLC. Such information such as dates of service, diagnoses, demographic information, etc., may be shared with third party payers such as your insurance company, or other applicable entities for the purpose of payment. A written release is required to be signed and dated by you prior to release of this information to third party payers.
Office Operation.
Your health information may be used to support the day-to-day operations of Peavy Counseling Services, LLC. For example, your information may be used to evaluate the quality of services offered by Peavy Counseling Services, LLC.
Appointment reminders, and follow-up.
Your health information may be used to notify you of your upcoming appointments, or notify you in the event you did not meet your scheduled appointment. We also may contact you for a follow-up after your treatment with us has concluded.
Law enforcement.
Your health information may be disclosed to law enforcement, and other government agencies for the purpose of possible inspections, government audits, and mandated reporting in certain instances.
Public Health Reporting.
Your health information may be disclosed to certain health agencies as required by the law, such as in the case that you have certain communicable diseases that must be reported to the health department.
Fundraising.
Peavy Counseling Services, LLC, will not use your health information for the purposes of fundraising as of the writing of this document.
Redisclosure of information.
Once health information is disclosed to a recipient, it may be subject to further redisclosure, and is no longer protected at that point in time.
Confidentiality of Alcohol and Drug Abuse/ Substance Use Disorder (SUD) Records:
Under federal law and regulations, and other applicable laws including 42 C.F.R. Part 2, which is more stringent than the HIPPA Privacy Rule, Peavy Counseling Services, LLC, will not disclose your protected health information (PHI), and or substance use disorder (SUD) information, and will keep information shared in counseling sessions private and confidential. There are certain limitations to the above including:
· You as the client have signed and dated a “Consent of Release of Confidential Information Form”, or other applicable release forms, which allows us to disclose your protected health information (PHI) and/or substance use disorder (SUD) information, to an identified party or parties. A release clearly specifying the disclosure of substance use disorder (SUD) information – such as assessment reports, and counseling/progress notes, etc. – containing substance use disorder (SUD) information, is required prior release of information.
· A court order mandates the release of your information.
· You are believed of being an imminent danger to yourself, or others.
· The mandatory reporting of suspected abuse or neglect of minors, elderly, or handicap persons.
· In the event of a medical emergency. Only a minimum amount of protected health information (PHI) will be disclosed in the event of an emergency.
· For program/treatment evaluation, and operation purposes, and only by appropriate personnel.
Peavy Counseling Services, LLC will not disclose Part 2 substance use disorder (SUD) information that may be used in civil, criminal, administrative or legislative proceedings against you unless you have given us a written consent, or in the event that we receive a court order.
Miscellaneous uses and disclosures require your authorization:
Any additional disclosure or use of your health information for other purposes not listed above require that you sign and date a “Consent for the Release of Confidential Information Form”, or other applicable release forms. You may revoke this release at any time, but such revocation must be done in writing. Any disclosure of information prior to your revocation will not be effected or undone.
Note: Any crime committed against Peavy Counseling Services, LLC, our staff, or on the premises of the office, is not considered protected information.
Individual Rights:
As a client of Peavy Counseling Services, LLC you are entitled to certain rights under federal privacy standards. There rights include:
· You have the right to request restrictions on the use and disclosure of your protected health information.
· You have the right to receive communications which are confidential that deal with your treatment and diagnoses if applicable.
· You have the right to inspect and have a copy of your protected health information.
· You have the right to change or request corrections be made to your protected health information.
· You have the right to be informed of how and with whom your protected health information has been disclosed.
· You have the right of an accounting of disclosures for substance use disorder (SUD) records made through an intermediary over the past 3 years.
· You have the right to receive a printed copy of this notice. If you choose not to receive a copy of this notice, you may request one at any time for no fee.
Requests to Inspect Protected Health Information:
You as a client of Peavy Counseling Services, LLC have the right to inspect and copy your protected health information. As is afforded to us by federal regulations, we require that you submit in writing your request to inspect or copy your protected health information. Your request will be reviewed, and unless there are legal or medical reasons to deny your request, you will be permitted access to your information.
Complaints and Violations:
If you believe that your rights have been violated in regard to your protected health information, or you would like to level a complaint against Peavy Counseling Services, LLC, please send a letter or email detailing the problem to the following:
Gregory R. Peavy II, MS, LPC
7526 Coopers Landing Road
Foley, Alabama 36535
Phone: (251) 949-6429
OR
Office of Civil Rights
U.S. Department of Health and Human Services
61 Forsyth St., S.W.
Atlanta, GA 30323-8909
Phone: (800) 368-1019
Email: ocrmail@hhs.gov
In this letter or email include your name, address, telephone number, and a description of your grievance. Leveling a complaint or notifying us of a violation will not result in any retaliation or repercussions.
Revised and effective on and after February 1st 2026.