NOTICE OF PRIVACY PRACTICES

Your Privacy is Important to Us

This Notice of Privacy Practices describes how Revelation Counseling Center may use and disclose your protected health information (PHI) to provide treatment, obtain payment, and conduct healthcare operations. It also outlines your rights regarding your PHI.

I. Uses and Disclosures of Health Information

  1. Treatment: We may use your health information to provide, coordinate, or manage your healthcare and any related services.

  2. Payment: Your health information may be used to obtain payment for services provided to you, including billing and collections.

  3. Healthcare Operations: We may use your information for administrative purposes related to the operation of our practice, including quality assessment and improvement activities, training, and accreditation.

  4. Other Uses and Disclosures: We may use or disclose your PHI without your consent for the following:

    • As Required by Law: When required by federal, state, or local law.

    • Public Health Activities: To prevent or control disease, injury, or disability.

    • Research: To assist in health research.

    • Health Oversight Activities: To assist in audits, investigations, or inspections.

    • Worker’s Compensation: For workers’ compensation claims.

    • Judicial and Administrative Proceedings: In response to a court or administrative order, or subpoena.

II. Your Rights

You have the following rights regarding your protected health information:

  1. Right to Inspect and Copy: You have the right to inspect and request copies of your health information, subject to certain exceptions.  We will provide a copy or summary of your health information, usually within 30 days of your requests.  We may charge a reasonable, cost-based fee.

  2. Right to Amend: If you believe your health information is incorrect or incomplete, you have the right to request an amendment.  We may deny your request and we will inform you in writing within 60 days.

  3. Right to Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location (ex. home or office phone).  We will comply with all reasonable requests.

  4. Right to Request Restrictions: You may request restrictions on certain uses and disclosures of your health information, although we are not required to agree to your request.  If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.  We will comply unless a law requires us to share that information.

  5. Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures of your health information made by us in the past six years.  We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).  We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

  6. Get a Copy of this Privacy Notice: You can ask for a paper copy of this notices at any time, even if you have agreed to receive the notice electronically.  We will provide you with a paper copy promptly.

  7. Choose Someone to Act for You: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.  We will make sure that the person has this authority and can act for you before we take action.

  8. Right to File a Complaint: If you believe your privacy rights have been violated, you have the right to file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services.  To file a complaint with us, please refer to our contact information at the top of this page.  To file a complaint with the U.S. Department of Health and Human Services, please send a letter to 200 Independence Ave., S.W., Washington, D.C. 20201, call 1-877-696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints/.  Please know that we will not retaliate against you for filing a complaint.

III. Your Choices

  1. The Right and Choice to Share Information: You can ask that we share information with your family, close friends, or others involved in your care; share information in a disaster relief situation, include your information in a practice directory, or contact you for fundraising efforts.  If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest.  We may also share your information when needed to lessen a serious and imminent threat to health or safety.

  2. The Choice to share Information with Written Permission: In cases such as marketing purposes, sale of information, and most sharing of psychotherapy notes we will require your written permission to share.

  3. The Choice to Engage in Fundraising Efforts: We may contact you for fundraising efforts, but you can tell us not to contact you again.

IV. Our Responsibilities:

  1. We are required by law to maintain the privacy and security of your protected health information

  2. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  3. We must follow the duties and privacy practices described in this notice and give you a copy of it.

  4. We will not use or share your information other than as described here unless you tell us we can in writing.  IF you tell us we can, you may change your mind at any time.  Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 V. Changes to This Notice

We reserve the right to change the terms of this Notice at any time and the changes will apply to all information we have about you.  We will notify you of any significant changes in the way we treat your health information, and the new notice will be available upon request, in our office, and on our website.

 IV. Contact Information

If you have questions about this Notice or would like to exercise any of your rights, please contact:

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