PRIVACY POLICY

This Notice describes how medical information about you may be used, disclosed, and how you can access this information. Please read it carefully. Maintaining privacy of your information is of the highest importance for Goal Driven Counseling (GDC). We are required by applicable federal and state law to maintain the privacy of your personal health information (PHI). We are also required to give you this notice about privacy practices, legal obligations, and your rights concerning your PHI. We must follow the privacy practices that are described in this Notice (which may be amended periodically). For more information about privacy practices, or for additional copies of this Notice, please speak with your clinician directly or contact a member of our team via the information in Section II G of this Notice.

I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION (PHI)

A. Permissible uses and disclosures without your written authorizationUnchanged:

GDC may use and disclose PHI without your written authorization, excluding psychotherapy notes as described in Section II, for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.

1. Treatment: GDC may use and disclose PHI to provide treatment to you. For example, your clinician may provide information to any family members or significant others that you voluntarily decide to bring to and include in a counseling session. Your clinician may disclose your PHI, except for identifying information, during professional clinical supervision and/or consultation, to ethically provide you the highest quality services.

2. Health Care Operations: GDC may use and disclose PHI in connection with health care operations such as quality improvement activities, certifications, licensing or credentialing activities.

3. Required or Permitted by Law: GDC may use or disclose PHI when it is required or permitted to do so by law. For example, your clinician may disclose PHI to appropriate authorities if I reasonably believe that you or a child are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. In addition, your clinician may disclose PHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

Other disclosures permitted or required by law include the following: disclosures for public health activities; health oversight activities including disclosures to state or federal agencies authorized to access PHI; disclosures to judicial and law enforcement officials in response to a court order or other lawful process; disclosures for research when approved by an institutional review board; and disclosures to military or national security agencies, coroners, medical examiners, and correctional institutions or otherwise as authorized by law.

B. Uses and disclosures requiring your written authorizationUnchanged:

1. Psychotherapy Notes: Notes your clinician records to document the contents of a counseling session with you will be used only by your clinician and will not otherwise be used or disclosed without your written authorization.

2. Marketing Communications: GDC will not use your health information for marketing or fundraising communications without your written authorization. You have the right to opt out of any marketing or fundraising communications that you choose not to receive.

3. Other Uses and Disclosures: Uses and disclosures other than those described in Section I.A. above will only be made with your written authorization. For example, you will need to sign an authorization form before GDC can send PHI to your school, attorney, doctor, etc. You may revoke any such authorization at any time.

II. YOUR INDIVIDUAL RIGHTS

A. Right to Inspect and Copy: You may request access to your medical record and billing records maintained by GDC to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, GDC may deny access to your records. GDC may charge a fee for the costs of copying and sending you any records requested. If you are a parent or legal guardian of a minor, please note that certain portions of the minor's medical record may not be accessible to you, in accordance with state law. You have the right to an electronic communication of any records that GDC keeps electronically.

B. Right to Alternative Communications: You may request, and GDC will accommodate, any reasonable written request for you to receive PHI by alternative means of communication or at alternative locations.

C. Right to Request Restrictions. You have the right to request a restriction on PHI used for disclosure for treatment, payment or health care operations. You must request any such restriction in writing addressed to the Clinical Director as indicated below. GDC is not required to agree to any such restriction you may request.

D. Right to Disclosure of Breach. You have the right to be notified by GDC if a privacy breach of your PHI has occurred. If such a breach occurred, you would be notified within a reasonable time.

F. Right to Obtain Notice. You have the right to obtain a paper copy of this Notice by submitting a request at any time.

G. Questions and Complaints. If you desire further information about your privacy rights, or are concerned that GDC has violated your privacy rights, you may contact our Clinical Director, Melissa Douglass, at (855) 524-5222 ext 4. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201 or calling 1-877-696-6775. GDC will not retaliate against you for filing a complaint.

III. EFFECTIVE DATE AND CHANGES TO THIS NOTICE

A. Effective Date: This Notice is effective on September 24, 2017

B. Changes to this Notice: GDC may change the terms of this Notice at any time. If GDC changes this Notice, it may make the new notice terms effective for all PHI that it maintains, including any information created or received prior to issuing the new notice. If GDC changes this Notice, you can obtain a copy by contacting our team or printing it here.