River Rocks Counseling

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4301 Hillsboro Pike, Suite 101, Nashville, TN 37215

615-682-8674 | admin@riverrockscounseling.com

www.riverrockscounseling.com

Effective Date: July 1, 2021

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I. Uses and Disclosures for Treatment, Payment, and Health Care Operations

River Rocks Counseling (“the practice”) may use or disclose your protected health information (PHI) for treatment, payment, and health care operations with your consent.

Definitions:
• PHI refers to information in your health record that could identify you.
• Treatment includes the provision, coordination, or management of your mental health care and related services. For example, this may involve consultation between your clinician and another health care provider, such as your primary care physician or psychiatrist.
• Payment involves activities related to obtaining reimbursement for your care, such as submitting information to your insurance company for payment or verifying coverage.
• Health Care Operations refers to business functions that support the operation of River Rocks Counseling, including quality assessment, improvement activities, administrative services, audits, and case management.
• Use applies to internal activities within River Rocks Counseling such as sharing, analyzing, or employing information that identifies you.
• Disclosure applies to activities outside the practice, such as providing access to your information to other parties.
• Consent means you give prior permission for these standard activities when you sign the Client Acknowledgment of Counseling Policies and HIPAA Notice form.

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II. Uses and Disclosures Requiring Authorization

River Rocks Counseling may use or disclose your PHI for purposes other than treatment, payment, or health care operations only when your written authorization is obtained.

An authorization is specific written permission that allows only the described disclosure. Authorization is also required for the release of psychotherapy notes, which are maintained separately from your clinical record and receive additional protection under HIPAA.

You may revoke an authorization at any time in writing, except to the extent that:
1. River Rocks Counseling has already relied on that authorization; or
2. The authorization was obtained as a condition of insurance coverage, and the law provides the insurer the right to contest a claim.

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III. Uses and Disclosures Without Consent or Authorization

River Rocks Counseling may use or disclose PHI without your consent or authorization in certain situations required or permitted by law, including:
• Child Abuse: Clinicians are mandated to report suspected child abuse or neglect to the appropriate authorities.
• Adult or Domestic Abuse: Suspected abuse, neglect, or exploitation of a vulnerable adult must be reported to the Tennessee Department of Human Services.
• Health Oversight: If a complaint is filed with a professional licensing board, the board may subpoena relevant confidential information.
• Judicial or Administrative Proceedings: Information may be disclosed only with your written authorization or a valid court order, except in cases where evaluation is court-ordered or for a third-party assessment.
• Serious Threat to Health or Safety: If a client communicates a credible threat of serious harm to an identifiable person, the clinician must take reasonable steps to protect potential victims.
• Workers’ Compensation: If you file a workers’ compensation claim, relevant treatment information must be provided to your employer or insurer upon request.

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IV. Client Rights and River Rocks Counseling’s Duties

Client Rights:
• Right to Request Restrictions: You may request limitations on how your PHI is used or disclosed. The practice is not obligated to agree to requested restrictions.
• Right to Receive Confidential Communications: You may request communications through alternate means or at alternate locations (for example, receiving bills at a different address).
• Right to Inspect and Copy: You may inspect or obtain a copy of your health and billing records used to make decisions about your care.
• Right to Amend: You may request an amendment to your records. If denied, you will be informed of the reason and how to appeal.
• 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: You may request a paper copy of this notice, even if you received it electronically.

Practice Duties:
River Rocks Counseling is required by law to maintain the privacy of your PHI, provide you with notice of its legal duties and privacy practices, and abide by the terms of this notice currently in effect.

River Rocks Counseling reserves the right to revise these privacy policies and practices. If significant changes occur, clients will be notified by mail, phone, or email.

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V. Questions and Complaints

If you have questions about this notice or concerns about your privacy rights, please contact:
River Rocks Counseling
Phone: 615-682-8674
Address: 4301 Hillsboro Pike, Suite 101, Nashville, TN 37215

If you believe your privacy rights have been violated, you may file a complaint with River Rocks Counseling or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

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VI. Effective Date and Future Changes

This notice is effective as of July 1, 2021.

River Rocks Counseling may revise this notice and make the new provisions applicable to all PHI maintained by the practice. Updated notices will be available at our office and on our website (www.riverrockscounseling.com).