LifeGate Counseling Center @ Peachtree is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you.

Your Health Information Rights:

 

The health and billing records we maintain are the physical property of LifeGate Counseling Center @ Peachtree.  The information in it, however, belongs to you.  You have the right to:

 

• Request a restriction on certain uses and disclosures of your health information by delivering the request to our office. We will consider all requests, though we are not required to grant request.

• Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information (“Notice”) by making the request at our office.

• Request that you be allowed to inspect and copy your health record and billing record.

• Request that your health care record be amended to correct incomplete or incorrect information.  We may deny your request if you ask us to amend information that:

- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment

                  - Is not part of the health information kept by or for the office

                  - Is not part of the information that you would be permitted to inspect and

                     copy

                        - Is accurate and complete

- If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records

• Request that communication of your health information be made by alternative means or at an alternative location

• Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a request to our office.  An accounting will not include uses and disclosures of information for treatment, payment, or operations; disclosures or uses made to you or made at your request; or uses or disclosures to notify family or others responsible for your care of your location, condition, or your death.

• Revoke authorizations that you made previously to use or disclose information by delivering a written revocation to our office, except to the extent information or action has already been taken.

 

If you want to exercise any of the above rights, please contact us at 404-842-3150 or

3434 Roswell Road NW Atlanta, GA 30305 in person or in writing, during regular business hours.  We will inform you of the steps that need to be taken to exercise your rights.

 

Our Responsibilities:

 

LifeGate Counseling Center @ Peachtree is required to:

• Maintain the privacy of your health information required by law

• Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you, and abide by the terms of this Notice

• Notify you if we cannot accommodate a requested restriction or request, and accommodate your reasonable requests regarding methods to communicate health information with you

 

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain.  If our information practices change, we will amend our Notice.  You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.

 

To Request Information or File a Complaint:

 

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact our office at 404-842-3150.

 

Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to the office. You may also file a complaint with the U.S. Department of Health and Human Services using a form available online at http://cms.hhs.gov/hippa/hippa2/default.asp .

• We cannot and will not require you to waive the right to file a complaint with the Secretary of Health and Human Service (HHS) as a condition of receiving treatment from the office.

• We cannot and will not retaliate against you for filing a complaint with the Secretary of Health and Human Services.

 

Other Disclosures and Uses:

 

The confidentiality of the counseling relationship is strictly maintained.  Other disclosures and uses of protected health information occur only if the client/patient signs a Release of Information Form authorizing the terms of such use or disclosure.

           

There are certain situations in which your therapist or psychiatrist may be required by law to disclose information without your permission.  These include:

 

• If ordered by a judge, your therapist or psychiatrist may be required by law to provide the information specifically ordered, except for matters privileged under the law of the state of Georgia.

• If a client is in therapy by order of a court of law, the court may require reporting of the results of the therapy to the court.

• If a client reveals information implying or indicating abuse or neglect of a child, or abuse or neglect of an elderly person, the therapist or psychiatrist is required by law to report this to the Department of Family and Children Services or other appropriate state agencies.

• If a client threatens bodily harm or death to another person, the therapist is required by law to inform the intended victim and appropriate law enforcement agencies.

• If a client threatens to commit suicide, the therapist or psychiatrist will inform a family member and assist in the mobilization of appropriate mental health services.

 

Effective Date:  April 16, 2003          

Revised:  January 3, 2019