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HIPPA Notice of Privacy Practices


This Notice of Privacy Practices describes how we may use and disclose your
protected health information (PHI) to carry out treatment, payment or health care
operations (TPO) and for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected health information.
“Protected health information” is information about you, including demographic
information, that may identify you and that relates to your past, present or future
physical or mental health or other condition and related health care services.

Uses and Disclosures of Protected Health Information:
Your PHI may be used and disclosed by your counselor, our office staff and others
outside our office that are involved in your care and treatment for the purpose of
providing health care services to you, to pay your mental health care bills, to support
the operation of the therapist’s practice, and any other use required by law.

We will use and disclose your PHI to provide, coordinate, or manage your
mental health care and any related services. This includes the coordination or
management of your care with a third party. For example we would disclose your PHI
as necessary to a physician to whom you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.

Mental Health Care Operations:
We may use or disclose, only on an as needed basis,
your PHI to support the business activities of your therapist’s practice. These
activities include, but are not limited to, quality assessment activities, employee
review activities, licensing, and conducting or arranging for other business activities.
We may also call you by your first name in the waiting room when your therapist is
ready to meet with you. We may use or disclose your PHI, as necessary, to contact
you regarding scheduled appointments, such as if an appointment time needs to be
changed due to an emergency.

We may use or disclose your PHI in the following situations without your
These situations include as required by law: abuse or neglect of a child,
mentally impaired individual, or senior citizen; when the therapist is concerned you
may be of harm to yourself or another individual; or when there is a valid court order
compelling us to release records or witness testimony. Also included under HIPAA is
the right to disclose without your authorization: Public Health issues – communicable
diseases, Food and Drug Administration requirements, Worker’s Compensation, and
when required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of Section 164.500.

Other Permitted and Required Uses and Disclosures will be made only with your
written consent, authorization or opportunity to object unless required by law.

You may revoke this authorization at any time in writing except to the extent that
your therapist or the therapist’s practice has taken an action in reliance on the use
or disclosure indicated in the authorization.

Your Rights:
The following is a statement of your rights with respect to your
protected health information (PHI)

You have the right to inspect and copy your protected health information. Under
federal law, however, you may not inspect or copy the following records: session
notes, information compiled in reasonable anticipation of or use in a civil, criminal,
or administrative-action or proceeding, and PHI that is subject to law that prohibits
access to protected health information.

You have the right to request a restriction of your protected health information. This
means you may ask us not to use or disclose any part of your PHI for the purposes of
treatment, payment or mental health care operations. You may also request that any
part of your PHI not be disclosed to family members or friends who may be involved in
your care for notification purposes as described in this Notice of Privacy Practices.
Your request must state the specific restriction requested and to whom you want the
restriction to apply.

Your therapist is not required to agree to a restriction you may request. If the
therapist believes it is in your best interest to permit use and disclosure of your PHI,
it will not be restricted. You then have the right to choose another mental health care

You have the right to request to receive confidential communications for us by
alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request.

You have the right to have your therapist amend your protected health information.
If we deny your request for amendment, you have the right to file a statement of
disagreement with us and we may prepare a rebuttal to your statement and we will
provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if
any, of your PHI.

We reserve the right to change the terms of this notice and will inform you by mail
of any changes. You then have the right to object or withdraw as provided in this

You may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint with us
by notifying our privacy contact, the Office Manager of Battlefield Ministries, Inc., of
your complaint by using the address of our office in Rome Georgia. We will not
retaliate against you for filing a complaint. The address for the Office of Civil Rights,
US Department of Health and Human Services is: 200 Independence Ave., SW., Room
509F, HHH Building, Washington, DC 20201. OCR Hotline-Voicemail: 1-800-368-1019.

These policies and procedures are effective as of June 1, 2006.

We are required by law to maintain the privacy of, and provide individuals with, this
notice of our legal duties and privacy practices with respect to protected health
information (PHI).

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