Notice of Privacy Practices (HIPAA)

Overview

This Notice of Privacy Practices describes how your health information may be used and disclosed and how you can access this information.

This notice is provided in accordance with the HIPAA Privacy Rule.

Please review it carefully.

How Your Health Information May Be Used and Disclosed

The practice may use or disclose your protected health information (PHI) for the following purposes:

Treatment

Your PHI may be used to provide, coordinate, or manage your care. This may include communication with other health care providers involved in your treatment, when appropriate.

Payment

Your PHI may be used to obtain payment for services, when applicable. This may include disclosures to third parties responsible for payment.

Health Care Operations

Your PHI may be used for operations necessary to run the practice, including quality assessment, supervision, and administrative activities.

Other Permitted or Required Uses and Disclosures

Your PHI may also be used or disclosed as permitted or required by federal and applicable state law, including:

To comply with legal obligations such as court orders or subpoenas
To report suspected abuse or neglect
To prevent or reduce a serious threat to health or safety
For public health activities as required by law
For health oversight activities authorized by law

The practice may disclose the minimum necessary information to business associates who perform services on behalf of the practice. These parties are required to safeguard your information in accordance with applicable law.

Your Rights

You have the following rights regarding your protected health information:

Right to Access

You have the right to inspect or obtain a copy of your health records, subject to limited exceptions.

Right to Request Amendment

You may request that your records be amended if you believe information is incorrect or incomplete.

Right to Request Restrictions

You may request restrictions on certain uses or disclosures of your PHI. The practice is not required to agree to all requested restrictions.

Right to Request Confidential Communications

You may request that communications be made through alternative means or at alternative locations.

Right to an Accounting of Disclosures

You may request a list of certain disclosures of your PHI made by the practice.

Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this notice upon request.

Right to Be Notified of a Breach

You have the right to be notified if a breach of your unsecured PHI occurs.

Right to Designate a Personal Representative

You may designate a person to act on your behalf with respect to your health information, subject to verification of that person’s legal authority.

How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with the practice or with the U.S. Department of Health and Human Services.

To file a complaint with the practice, contact:

Pattern Shift Counseling, PLLC
Email: jason@patternshiftcounseling.com
Phone: 214 600 4830

To file a complaint with the U.S. Department of Health and Human Services, contact:

U.S. Department of Health and Human Services
Office for Civil Rights

Online complaint form:
https://www.hhs.gov/hipaa/filing-a-complaint/index.html

Complaints must be submitted within the timeframes required by law.

You will not be penalized or retaliated against for filing a complaint.

Practice Information

Pattern Shift Counseling, PLLC
Jason Joseph, LPC (TX), LPC (OR), LMHC (WA), CPC (NV), Registered for Telehealth in Florida (FL)
Telehealth counseling services
Email: jason@patternshiftcounseling.com
Phone: 214 600 4830

Legal References