Notice of Privacy Practices
Your privacy is very important and we take it very seriously. At no point is your information shared, sold, or otherwise distributed unless noted below.
This notice describes how personal or medical information about you may be used and disclosed and how you can get access to it. Please review carefully.
1. Your medical records are used to provide treatment, may be used bill and receive payments from insurance, and conduct healthcare operations. Examples of these activities include but not limited to review of treatment records to ensure appropriate care, electronic or mail delivery of billing for treatment to you or other authorized payers, appointment reminder telephone calls, and records review to ensure completeness and quality of care. Use and disclosure of medical records is limited to the internal use outlined above except required by law or authorized by the patient or legal representative.
2. RISE Psychological Services uses Headway.co as a vendor to process and collect payments and retain electronic therapy notes. This means that Headway has access to limited patient information and maintain patient information securely on their servers. We do not share phone numbers, email addresses, or personal information with Headway, outside of what you provide to them when setting up your account through their web portal. For more information on how Headway works to protect this information you can visit <https://headway.co/legal/privacy-practices>
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3. Federal and State laws require abuse, neglect, domestic violence and threats to be reported to social services or other protective agencies. If such reports are made they will be disclosed to you or your legal representative unless disclosure increases risk of further abuse or harm.
4. Disclosed information will be limited to the absolute minimum necessary. You may request an account
for any uses or disclosures other than those described in Sections 1 and Sections 2.
5. You or your legal representative, may request your records to be disclosed to yourself or any other entity. Your request must be made in writing, clearly identify the person authorized to request the release, specify the information you want disclosed, the name and address of the entity you want the information released to, purpose and the expiration date of the authorization. Any authorization provided may be revoked in writing at any time. Psychotherapy notes are part of your medical records. We have 30 days to respond to a disclosure request and 60 days if the records is stored off site.
6. You may request corrections to your records in writing. Every reasonable action will be take to ensure continued accuracy of records.
7. A request for disclosure may be denied under the following circumstances: disclosure would likely endanger the life or physical safety of you or another person, requested information references other persons, except another healthcare provider, or if released to a legal representative would likely result in harm to you or another person. All disclosures must first be reviewed and authorized prior to release and your therapist will discuss the nature and potential ramification of disclosure with you.
8. If a request for disclosure is denied for reasons outlined in Section 6, you or your legal representative may request review of the denial. A review will be conducted by another licensed healthcare provider appointed by the original reviewer, who was not involved in the original decision to deny access. A review will be conducted within 30 days.
9. You may request that we restrict uses and disclosures outlined in Section 1. However, we are
not required to uphold the restrictions under certain circumstances. If an agreement is made to restrict use or disclosure, we will be bound by such restriction until revoked by you or your legal representative orally or in writing except when disclosure is required by law or in an emergency. We may also revoke such restrictions but information gathered while the restriction was in place will remain restricted by such an agreement.
10. Data collected using the "Contact Me" or other form, such as phone number, email, and name are not shared with third parties. This information is strictly used for the sole purpose of responding to your inquiry. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All other categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
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11. If you wish to submit a complaint regarding privacy related issues you may contact the Secretary of the
Department of Health and Human Services, Building, 200 Independence
Avenue SW, Washington DC, 20201. In any case there will not be any retaliation against you or
your legal representative for filing a complaint.
12. This agreement may be modified or amended as required by law or in the course of health care
operations.
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