This notice describes how medical/mental health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Jonah's Place Counseling, LLC will only release information in accordance with state and federal laws and the ethics of the counseling profession.

This notice describes Jonah's Place Counseling, LLC's policies related to the used and disclosure of client's healthcare information.

Use and disclosure of protected health information for the purposes of providing services: Providing treatment services, collecting payment and conducting healthcare operations are necessary activities for quality care. State and federal laws allow us to use and disclose your health information for these purposes.

FOR TREATMENT

We may use or disclose your protected health information (PHI) to provide and coordinate your health care and related services. This may include communications with other healthcare professionals regarding your healthcare, including your referral to another healthcare provider.

FOR PAYMENT

We may use or disclose your PHI to obtain payment or be reimbursed for the healthcare services we provide for you. Such disclosures may be made to billing services or collection departments. Before you receive services, we may disclose your PHI with your insurance company to determine eligibility.

FOR HEALTH CARE OPERATIONS

We may use or disclose PHI in connection with certain administrative, financial, and legal activities that are necessary for us to run our practice and to support our functions of treatment and payment.  

INCIDENTAL USE OR DISCLOSURE

An "incidental use or disclosure" is a use or disclosure that cannot reasonably be prevented, is limited in nature and occurs as a result of another permissible or required use or disclosure. We have set up reasonable safeguards that protect against permissible uses and disclosures and limits incidental uses or disclosures. We also have policies and procedures that set limits to ensure that, as applicable, only the reasonable minimum necessary amount of your PHI is used, disclosed and requested for certain purposes.

YOU CAN OBJECT TO CERTAIN USES OR DISCLOSURES

Each of the uses or disclosures of your PHI listed below, if you are present and able, we will either obtain oral permission, give you the opportunity to object, or reasonably infer from the circumstances, based on our professional judgment, that you do not object. If you are unable to object, we will use our professional judgment to disclose only such PHI as is directly related to such person's involvement in your healthcare. For uses or disclosures:

to a relative, friend or other person identified by you only your PHI that is directly relevant to the person's involvement in your healthcare or payment for your healthcare;

to a family member, personal representative, or other person responsible for your care only your PHI necessary to notify such individuals of your location, general condition, or death; or

to a private or public agency for disaster relief purposes. (Even if you object, we are still permitted to share your PHI as necessary for emergency circumstances.)

REQUIRED USES OR DISCLOSURES

We are required by law to disclose your PHI to you pursuant to your patient right of access and accounting as described below. We are also required to disclose your PHI to the Secretary of the Department of Health and Human Services when required for their investigation of our compliance with privacy laws.

OUR CONTACT WITH YOU

We may use or disclose your PHI to provide you with appointment reminders such as leaving voicemail messages, emails or texts.

BUSINESS ASSOCIATES

We may use and disclose your PHI with our business associates. A "business associate" is a person or entity that provides certain functions, activities, or services on our behalf pursuant to a written agreement that  contains terms regarding protection of your PHI.

OTHER USES OR DISCLOSURES

required by law or used for law enforcement purposes

necessary for public health activities

necessary to report abuse, neglect or domestic violence

for health oversight activities

for judicial and administrative proceedings

for medical research

to coroners, medical examiners, or funeral directors

to avert a serious threat to the health or safety of a person or the public

for specialized governmental functions

for workers compensation

ALL OTHER USES AND DISCLOSURES OF YOUR PHI REQUIRES YOUR WRITTEN AUTHORIZATION

You my authorize us to use or disclose your PHI for other purposes. You may revoke this authorization at any time in writing; however, your revocation will not apply to any uses or disclosures that were being processed before we received your revocation.

YOUR PATIENT RIGHTS

Restrictions

You have the right to ask us to restrict our uses or disclosures of part or all of your PHI treatment, payment, healthcare operations or to individuals involved in your care. However, we are not required to agree to your requested restriction. If we do agree to your restriction, we will only use and disclose your PHI in accordance  with such restriction, unless otherwise permitted or required by law. You may request restriction by completing written notification. Therapist can provide a form for your convenience.

Confidential Communications

You have the right to request that communications about your PHI be delivered by an alternative means or at alternative locations. If you desire your communication with Jonah's Place Counseling to take a form other than your contact information on intake documents, we will accommodate reasonable requests, however, the request must be in writing. A form is available to make that request.

Access

You have the right to inspect and obtain a copy of your PHI contained in clinical, billing and certain other records used to make decisions about you, except in certain limited situations. Your request must be made in writing, and you will be charged reasonable cost-based fees for expenses tot his organization. Instead of copies, we may provide you with a summary of your PHI, if you agree to the form and cost of such summary. We may, in some cases deny your request and will notify you in writing of the reasons for denial, provide you with information regarding your rights to submit a written statement disagreeing with such denial and provide information on how to file such a statement. You may request to see and receive a copy of your PHI by sending a request to P.O. Box 760, Blountsville, AL 35031.

Amendments

You have the right to request an amendment to your PHI contained in clinical, billing and certain other records used to make decisions about you, except in limited certain situations. Your request must be in writing and to provide a reason to support the requested amendment. We may, in some cases, deny your request for amendment and will notify you in writing of the reasons for our denial, provide you with information regarding your rights to submit a written statement disagreeing with such denial and provide information on how to file such a statement. You may request an amendment of your PHI by sending a request to P.O. Box 760, Blountsville, AL 35031.

Accounting

You have a right to receive a listing of disclosures of your PHI made for purposes other than treatment, payment, healthcare operations, upon your request, your authorization, to individuals involved in your care or as allowed by law. You may requests all disclosure made during the last 6 years. If you request this list more than once in a 12 month period, you will be charged reasonable cost based expenses to provide the additional listing. You may request a listing of your disclosures by calling 205-625-3701.

QUESTIONS AND COMPLAINTS

If you have questions or feel your privacy rights have been violated, or want to discuss privacy practices, you can contact Privacy Officer/therapist at P.P. Box 760, Blountsville, AL  35031,  205-625-3701.

You may also submit a written complaint to the U.S. Department of Health and Human Services. We will not retaliate in any way against you if you choose to file a complaint with us or the U.S. Department of Health and Human services.