HIPPA Notice Of Privacy Practices
The following statements are to explain your rights as a therapy client under HIPAA.
The primary goal of this law was to make it easier for people to keep health insurance, and help the industry control administrative costs. This statement of your rights covers Title II of the act and was put into effect on April 14, 2003. The goal for the privacy rule under HIPAA provides protection for all clients.
Your rights are as follows:
Origins Holistic Psychotherapy is a covered entity and must follow all guidelines under HIPAA. All files and other documentation containing any of your private and confidential information will be maintained in a secure location at all times.
All office and staff members with Origins Holistic Psychotherapy have confidentiality agreements that maintain that all information regarding clients will be held in confidence and that the individual is personally liable for any violation of this agreement.
You have the right to review your file at any time.
Your identifiable information may not be released without your prior written consent. Identifiable information includes: your name, your social security number, Medicaid number, insurance information, address, phone number, dates of service, or treatment records.
Permitted disclosures that may not require written consent include:
To you, the individual
For payment, treatment, and health care operations
For public policy
As required by law
For public health
About victims of abuse, neglect, or domestic violence
For judicial and administrative proceedings
For law enforcement excluding substance abuse treatment notes
Information about decedents
To avert a serious threat to health and/or safety
Authorization is required for disclosures not permitted by the Privacy Rule. Authorization must have an expiration and statement that is revocable.
You may request a copy of your file at any time. Requests must be made in writing. Copies will be made within thirty days after receipt of written request. Copies are charged at $0.75 per page payable upon delivery. Upon reviewing copies of your record, you may request, in writing, to an amendment to your file. Requests are to be submitted to the staff person assigned your case. Perspective Center for Holistic Therapy has sixty days from the receipt of the request to respond in writing to your amendment request. Amendment may be made or you will receive a denial to your request with an explanation.
You have a right to an accounting of all disclosures made by Perspectives Center for Holistic Therapy of your private health information in the six years or less prior to the date requested.
Complaints with regard to your privacy rights may be made to the following:
Michelle Shlafman
(404) 500-6125
Complaints will be reviewed and submitted to the Continuous Quality Improvement committee. A response to all complaints will be made within sixty days of receipt. Complaints may also be made to:
Department of Health and Human Services
Office of Civil Rights
200 Independence Ave., SW
Washington, DC 20201
Toll free (877) 696-6775
You have the right to confidential communications between yourself and Origins Holistic Psychotherapy.