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.

Sage Path Counseling Center is required by law to protect the privacy of your protected health information, to give you this notice describing our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your information without your authorization

For treatment. We may use your health information to provide, coordinate or manage your care, and to consult with or refer you to other providers involved in your treatment.

For payment. We may use and disclose your health information to bill and collect payment for services, including verifying benefits, obtaining authorization, and providing superbills or claims to your insurer.

For health care operations. We may use your health information for quality assessment, clinical supervision, training, licensing, business planning and administrative activities.

Uses and disclosures that require your written authorization

Most uses and disclosures of psychotherapy notes, any use or disclosure for marketing purposes, and any sale of your health information require your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Uses and disclosures permitted or required by law

We may use or disclose your health information without your authorization in limited circumstances, including:

• When required by federal, state or local law
• To prevent a serious and imminent threat to the health or safety of you or another person
• To report suspected abuse, neglect or exploitation of a child, an elderly person or a vulnerable adult, as required by New Jersey law
• For public health activities and health oversight activities
• In response to a court order, subpoena or other lawful process
• For workers' compensation claims, coroners, medical examiners and funeral directors as permitted by law
• For specialized government functions, including certain military, national security and correctional purposes

Special protection for psychotherapy notes

Psychotherapy notes are notes recorded by a clinician documenting or analyzing a counseling session, kept separate from the rest of your record. They receive greater protection than other health information, and we will not disclose them without your specific written authorization except in the narrow circumstances the law allows.

Your rights

You have the right to:

• Inspect and obtain a copy of the health information we maintain about you, in a paper or electronic format, subject to limited exceptions
• Request an amendment to information you believe is incorrect or incomplete
• Receive an accounting of certain disclosures we have made of your information
• Request restrictions on how we use or disclose your information. We are not required to agree to every request, but if you pay for a service in full out of pocket, you may require that we not share information about that service with your health plan
• Request confidential communications, for example asking us to contact you only at a particular phone number or address
• Receive a paper copy of this notice, even if you agreed to receive it electronically
• Be notified if a breach occurs that may have compromised the privacy or security of your information
• Choose someone to act for you, such as a legal guardian or someone with medical power of attorney

Our responsibilities

We are required by law to maintain the privacy and security of your health information, to notify you promptly if a breach occurs that may have compromised it, and to follow the duties and privacy practices described in this notice. We will not use or share your information other than as described here unless you tell us in writing that we may.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting hhs.gov/ocr/privacy/hipaa/complaints.

We will not retaliate against you for filing a complaint.

Changes to this notice

We may change the terms of this notice at any time. Any change will apply to information we already hold as well as information we receive in the future. The current notice will always be posted on this page with its effective date.

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