Notice of Privacy Practices

Restoring Harbor Counseling, LLC
Effective Date: 06/01/2015

This Notice of Privacy Practices (“Notice”) describes how medical and mental health information about you may be used and disclosed and how you may access this information. Please review it carefully.

I. Legal Duty to Safeguard Your Protected Health Information (PHI)

Restoring Harbor Counseling, LLC (“Provider”) is required by law to maintain the privacy and security of your Protected Health Information (PHI) and to provide you with notice of our legal duties and privacy practices with respect to such information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the HIPAA Privacy Rule, and applicable state law.

We are required to:

• Maintain the confidentiality of your PHI;

• Provide you with this Notice;

• Follow the terms of this Notice currently in effect; and

• Notify you in the event of a breach of unsecured PHI.

II. Use and Disclosure of PHI

The following categories describe the ways in which we may use and disclose your PHI without your written authorization:

A. For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. For example, we may consult with another provider regarding your care.

B. For Payment

We may use and disclose your PHI for billing and payment purposes, including submitting claims to your health plan or insurance company.

C. For Healthcare Operations

We may use and disclose your PHI for healthcare operations including quality assurance, credentialing, auditing, and administrative activities.

III. Other Permitted or Required Uses and Disclosures

We may also use and disclose your PHI without your written authorization in the following situations, as permitted or required by law:

• To report abuse, neglect, or domestic violence.

• To comply with legal proceedings such as court orders or subpoenas.

• For law enforcement purposes.

• When necessary to prevent or lessen a serious threat to health or safety.

• For health oversight activities authorized by law.

• To comply with workers’ compensation or other similar programs.

• To comply with public health reporting requirements.

IV. Uses and Disclosures Requiring Your Authorization

Certain uses and disclosures of PHI require your written authorization, including but not limited to:

• The use or disclosure of psychotherapy notes (except as permitted by law).

• The use or disclosure of PHI for marketing purposes.

• The sale of PHI.

You may revoke your authorization at any time in writing, except to the extent that we have already acted in reliance upon it.

V. Your Rights Regarding PHI

You have the following rights under HIPAA regarding your PHI:

1. Right to Access – You have the right to inspect and obtain a copy of your PHI, subject to certain limitations.

2. Right to Amend – You may request an amendment to your PHI if you believe the information is inaccurate or incomplete.

3. Right to an Accounting of Disclosures – You may request a list of disclosures of your PHI made in the past six (6) years, excluding those made for treatment, payment, or healthcare operations.

4. Right to Request Restrictions – You have the right to request restrictions on how we use and disclose your PHI. While we are not required to agree to all requests, we will comply with legally required ones.

5. Right to Request Confidential Communications – You may request that we communicate with you in a specific manner or at a specific location.

6. Right to a Paper Copy of This Notice – You are entitled to receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

VI. State-Specific Legal Requirements – Colorado

Under Colorado law, mental health information is confidential and may only be disclosed as permitted by law or with your written consent. Colorado law may provide additional confidentiality protections not outlined in this Notice. If state law is more stringent than federal law, we will follow state law.

VII. Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer at Restoring Harbor Counseling, LLC or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

To file a complaint, contact:
Privacy Officer
Restoring Harbor Counseling, LLC
Jessica Gutierrez Gaytan
4542 Teller Pl. Loveland, Co 80538

(970)6912415
contact@restoringharbor.com

Or file with:
U.S. Department of Health & Human Services
Office for Civil Rights
www.hhs.gov/ocr/privacy/hipaa/complaints/

VIII. Changes to This Notice

We reserve the right to change the terms of this Notice at any time. The revised Notice will be effective for all PHI we maintain at that time and will be available in our office and on our website upon request.

IX. Contact Information

If you have any questions about this Notice or how your information may be used or disclosed, please contact:

Restoring Harbor Counseling, LLC
Jessica Gutierrez Gaytan, SWC
(970)691-2415
contact@restoringharbor.com