NOTICE OF PRIVACY PRACTICES
Revelation Counseling Center
1750 Hwy 160 W Ste 101 PMB 251, Fort Mill, SC 29708
Phone: 803-859-4496 | Fax: 803-266-6912
Email: service@revelationcounselingcenter.com
Privacy Officer: Amanda Cadwell
Effective Date: June 11, 2026 | Version: 3.0
Your Privacy Rights
Access: You can get a copy of your health and billing records.
Amend: You can ask us to correct your records.
Confidentiality: You can request private communications or alternate contact methods.
Limit Sharing: You can ask us not to share certain information.
Accounting: You can get a list of disclosures.
Paper Copy: You can request a paper copy of this notice at any time.
File a Complaint: If you feel your rights are violated.
Our Commitment to Your Privacy
We are required by law to protect your health information (Protected Health Information, or PHI) and to follow the practices described in this notice. We will not use or share your information other than as described here unless you give us written consent. If you change your mind, please tell us in writing.
How We May Use and Disclose Your Health Information
We may use or share your health information to:
Provide, coordinate, or manage your care (Treatment)
Bill and obtain payment for services (Payment)
Run our practice, improve quality, and train staff (Healthcare Operations)
Contact you about appointments or treatment options
Recommend treatment alternatives or health-related benefits
Psychotherapy Notes: These have special protections and require your written permission for most disclosures.
State-Specific Protections (SC, NC, MN, ID)
We follow the laws of the states where we are licensed.
Minnesota Residents: The Minnesota Health Records Act is more restrictive than HIPAA. We will generally obtain your specific written consent before disclosing your health records for any purpose, unless a legal exception applies.
Substance Use Disorder (SUD) Records Received from Other Providers
While Revelation Counseling Center does not provide SUD treatment or create SUD treatment records, we may receive SUD-related records from clients or other providers as part of your care. These records are protected by federal law (42 CFR Part 2) in addition to HIPAA. We will not disclose any SUD treatment records we receive without your specific written consent, except as allowed or required by law (such as in a medical emergency or with a qualifying court order). If you have questions about these protections, please ask.
Uses and Disclosures Without Your Consent
We may share your information without your authorization as allowed or required by law:
To prevent or control disease, injury, or disability; to report abuse, neglect, or domestic violence
In response to a court or administrative order, or valid subpoena
When required by law
For workers’ compensation claims
For audits or investigations by government agencies
Your Rights Regarding Your PHI
You have the right to:
Inspect and Copy: Obtain a copy of your medical record (electronic or paper) within 30 days. We may charge a reasonable, cost-based fee.
Amend: Request corrections to your record. We may deny requests but will respond in writing within 60 days.
Confidential Communications: Request that we contact you in a specific way or at a specific location.
Restrict Disclosures for Self-Pay: If you pay out-of-pocket in full, you may request that we do not share that information with your health insurer.
Accounting of Disclosures: Request a list of disclosures (except those for treatment, payment, and operations) for the past six years.
Paper Copy: Request a paper copy of this Notice at any time.
Choose a Representative: If you have a medical power of attorney or legal guardian, that person can exercise your rights.
Revoke Authorization: You may revoke your authorization for disclosure at any time in writing. Revocation does not affect disclosures already made.
Electronic Access: You may request your health information in electronic format. We will provide it securely and promptly.
Your Choices
For certain health information, you can tell us your preferences about what we share:
Family & Friends: You can ask us to share information with family, close friends, or others involved in your care.
Disaster Relief: You can tell us to share information in a disaster relief situation.
Marketing & Sale of PHI: We will never sell your information or use it for marketing purposes without your written permission.
Fundraising: If we contact you for fundraising, you have the right to opt out.
Training & Case Review: You may request that your PHI not be used for staff training or case review purposes.
Minors & Legal Guardians
For clients under 18, parents or legal guardians may exercise privacy rights on the client’s behalf, unless otherwise restricted by law.
How to Exercise Your Rights
To exercise any of your rights described in this Notice, please contact us in writing, by phone, or through our secure client portal. We will respond within the timeframes specified in this Notice.
Electronic Communications & Risks
If you choose to communicate with us by email, text, or client portal, please be aware that while we use reasonable safeguards and HIPAA-compliant platforms, these methods may carry some risk of unauthorized access. By using these methods, you acknowledge and accept those risks.
Additional Privacy Protections
Privacy Officer: Amanda Cadwell is our designated Privacy Officer. For privacy-related questions, concerns, or requests, contact her at the information listed above.
Data Retention: We retain your health records as required by law and professional standards. After the required retention period, records are securely destroyed.
Business Associates: We may share your PHI with trusted business associates (such as billing services or electronic health record vendors) who assist us in providing care. All business associates are required by law to safeguard your information.
De-identified Data: We may use or share de-identified information (which cannot be used to identify you) for research, quality improvement, or statistical purposes.
Client Portal Security: Our client portal uses encryption and other safeguards to protect your information. Access requires a secure login and password.
Telehealth Privacy: Telehealth sessions are conducted using secure, HIPAA-compliant platforms to protect your privacy.
Social Media & Website: We do not collect, use, or disclose PHI via our website or social media platforms. Please do not share sensitive information through these channels.
Emergency Contact: We may use your designated emergency contact only in urgent situations or as required by law.
Non-Discrimination: We do not discriminate in our privacy practices or provision of care based on race, color, national origin, age, disability, sex, gender identity, sexual orientation, or religion.
Annual Review: Our privacy practices are reviewed annually. We will notify you of any significant changes.
Feedback: We welcome your feedback about our privacy practices. Please contact us with any suggestions or concerns.
Our Responsibilities
Breach Notification: We will notify you promptly in writing if a breach occurs that may have compromised the privacy or security of your information and will explain steps you should take to protect yourself.
State Law Compliance: Where state law provides greater privacy protections than federal law, we will comply with the more stringent requirements.
No Condition of Care: You are not required to sign the acknowledgment form to receive care. Your signature simply confirms receipt of this Notice.
Notice Availability: The current Notice of Privacy Practices is always available electronically and upon request.
Changes to This Notice
We reserve the right to change the terms of this Notice at any time. Changes will apply to all information we have about you. The new notice will be available upon request and electronically.
Complaints & Privacy Questions
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
To file a complaint or ask privacy questions:
Contact Amanda Cadwell at the address/phone listed above.
To file a complaint with the U.S. Department of Health and Human Services:
200 Independence Avenue, S.W., Washington, D.C. 20201
1-877-696-6775 | www.hhs.gov/ocr/privacy/hipaa/complaints/
State Board Contact Information
South Carolina: (803) 896-4300; llr.sc.gov
North Carolina: (844) 622-3572; ncblcmhc.org
Minnesota: (651) 201-2756; mn.gov/boards/bbht
Idaho: (208) 334-3233; dopl.idaho.gov
Version 3.0 / Revelation Counseling Center / Effective June 11, 2026 / Supersedes all prior versions