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 to keep your protected health information (PHI) private and confidential, and to provide you with a notice of our privacy practices. 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 your 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:
While you are a client at Peavy Counseling Services, LLC your protected health information may be used by members of our staff or may be disclosed to other health care professionals for the purpose of providing you appropriate levels of care. For example, disclosing your information to a mental health professional after your treatment with us has been completed, provided that you have given us written permission to do so.
Your health information may be used to pay for mental health services you have received at Peavy Counseling Services , LLC. Such information such as dates of service, diagnoses and demographic information may be shared with third party payers such as your insurance company for the purpose of payment.
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.
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.
Confidentiality of Alcohol and Drug Abuse Records.
By federal law and regulations Peavy Counseling Services, LLC will not disclose your protected health information and will keep information shared in counseling sessions private and confidential. There are certain limitations to the above including:
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. 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.
Uses of your Information:
Appointment reminders, and follow-up.
Peavy Counseling Services, LLC may use your health information 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.
As a client of Peavy Counseling Services, LLC you are entitled to certain rights under federal privacy standards. There rights include:
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 detailing the problem to the following:
Gregory R. Peavy MS, LPC
7526 Coopers Landing Road
Foley, Alabama 36535
Director, Office of Civil Rights
U.S. Department of Health & Human Services
61 Forsyth St., SW – Suite 31370
Atlanta, GA 30323
(404) 562-7858 or 562-7884
In this letter 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 or after May 14th, 2013.
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