HIPAA Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
ATL Marriage Counseling, operated by Symmetricly LLC, is committed to maintaining the privacy of your Protected Health Information (PHI). We are required by law to maintain the privacy of your health information, provide you with this notice of our legal duties and privacy practices, and notify you following a breach of unsecured PHI.
What Is Protected Health Information (PHI)?
PHI is individually identifiable health information that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or the past, present, or future payment for the provision of health care to you.
How We May Use and Disclose Your PHI
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your mental health treatment. For example, we may share information with other treating clinicians, your supervising therapist, or referring providers involved in your care.
Payment
We may use and disclose your PHI to obtain payment for services rendered. For example, we may submit claims to your insurance company including relevant diagnosis and treatment information.
Healthcare Operations
We may use and disclose your PHI for practice operations such as quality assessment, clinical supervision, staff training, and compliance activities.
Uses and Disclosures Required by Law
We may disclose your PHI when required to do so by federal, state, or local law, including but not limited to:
- Mandatory reporting of suspected child abuse or neglect
- Mandatory reporting of suspected abuse of a vulnerable adult
- When you present a serious and imminent threat to yourself or others (Duty to Warn)
- Court orders or lawful subpoenas
- Public health activities as required by law
Uses and Disclosures Requiring Your Authorization
Other uses and disclosures of your PHI not described above will be made only with your written authorization, including:
- Most disclosures of psychotherapy notes
- Marketing communications
- Sale of your PHI
- Disclosures to family members, friends, or employers unless required by law
You may revoke any authorization in writing at any time, except to the extent that we have already acted in reliance upon it.
Confidentiality in Couples Therapy
In couples and marriage counseling, both partners are considered clients. Information shared by one partner during a joint session is generally not kept confidential from the other partner. If individual sessions are conducted as part of couples treatment, your therapist will discuss the confidentiality policy for those sessions with you at the outset of treatment.
Your Rights Regarding Your PHI
- Right to Access: You have the right to inspect and obtain a copy of your PHI, with limited exceptions.
- Right to Amend: You may request an amendment to your PHI if you believe it is inaccurate or incomplete.
- Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your PHI.
- Right to Request Restrictions: You may request restrictions on certain uses and disclosures of your PHI.
- Right to Confidential Communications: You may request that we communicate with you about your PHI in a certain way or at a certain location.
- Right to a Paper Copy of This Notice: You may request a paper copy of this Notice at any time.
- Right to be Notified of a Breach: You have the right to be notified in the event of a breach of your unsecured PHI.
Our Duties
We are required by law to maintain the privacy of your PHI and to abide by the terms of this Notice. We reserve the right to change our privacy practices and the terms of this Notice and to make the new Notice effective for all PHI we maintain. Revised notices will be posted on our website and available in our office.
Complaints
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. You will not be retaliated against for filing a complaint.
Contact Our Privacy Officer
ATL Marriage Counseling · Powered by Symmetricly LLC
Attn: Privacy Officer
1246C Concord Rd, Smyrna, GA 30080
Phone: (770) 670-6879
Email: [email protected]
To file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: www.hhs.gov/ocr/privacy/hipaa/complaints