Your Privacy Is Important To Us
Spark Counseling & Consulting LLC is committed to maintaining client confidentiality. At your first visit to our practice, you will be asked to read the Notice of Privacy Practices and sign a HIPAA Consent form. Below you will find a copy of the notice we distribute.
Notice of Privacy Practices for Spark Counseling & Consulting LLC
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.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, rights to understand and control how your health information is used. We are required to abide by the terms of this notice. HIPAA provides penalties for misuse of personal health information.
HIPAA COMPLIANT USES AND DISCLOSURES:
Providing, Coordinating, or Managing Your Treatment: For example, details of your treatment may be shared with another mental health professional during state mandated case review.
Billing for Services and Collecting Payments: For example, personal health information may be shared with your insurance company when attempting to collect payment for services that have been rendered.
Health Care Operations: Your information may be shared with other professionals involved in running our practices, for example, staff members.
Other Allowable Disclosures Not Requiring Your Consent: Reporting child abuse or neglect, complying with a court order or subpoena, state-mandated disclosure of deceased patients, medical emergencies that may necessitate disclosure to prevent serious harm, disclosure to legally authorized overseeing agencies for audits, investigations, or inspections, disclosure to authorized officials in government for national security and intelligence reasons, disclosure to legally authorized public health officials for the purpose of preventing and controlling disease and disclosure to prevent a serious imminent threat to the health or safety of a person or the public.
Any other disclosures will be made only with your written authorization via our Release of Information form. You may revoke such authorizations in writing and we are required to honor and abide by that written request. If a breach of privacy occurs, you will be notified in writing.
WE MAY CONTACT YOU TO:
Provide you with appointment information or information about your treatment.
Provide you with information about treatment alternatives or services that may be of interest to you.
Collect payment for services that were provided.
YOUR INDIVIDUAL RIGHTS:
The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. If we agree to a restriction, we must abide by it unless you submit a written request to remove it.
You have the right to have disclosures of psychotherapy notes as well as sale of your information or marketing disclosures only on the basis of an authorization signed by you, the patient.
The right to reasonable request to receive confidential communications of protected health information from us by alternative means or at alternative locations.
The right to inspect a copy of your protected health information.
The right to request that your file must be amended if you believe information is incorrect or missing. This request must be made in writing.
The right to receive an accounting of your disclosed protected health information.
The right to restrict disclosures of your information for services of which you have self-paid.
The right to obtain an additional copy of this notice upon request.
We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions immediately effective for all protected health information that we maintain. We will post any amendments to this notice and you may request a written copy of any revisions from our office at any time.
If you feel that your privacy protections have been violated you have the right to file a written complaint with our office:
(Attention Bre Carr 2700 Corporate Drive Ste 200, Birmingham, AL 35242 or call 205-291-8686)
or with the Dept. of Health and Human Services
(Office of Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201 or call 202-619-0257).
We will not retaliate against you for filing a complaint.
Effective Date of Notice: 02/01/2019
Click here to download PDF copy –> Spark Counseling & Consulting LLC Privacy Notice