NOTICE OF PRIVACY PRACTICES

This document describes how information about you may be used, disclosed, and how you can get access to this information.  Please review this document carefully, and download a copy for your records if you so desire.


Your rights regarding your health information

You may request a copy of your medical record

You have the right to inspect or have a copy made of your medical record for you (fees apply).  

You may ask us to correct or amend your medical record

If you feel something was misquoted or documented incorrectly, you may make a written request to have our medical record amended.  We reserve the right to deny your request, but will respond to this in written form.

You may ask to only be contacted in specific ways

While it is imperative that we be able to contact you in some way, you may request that we can only contact you using a certain phone number, email address, or mailing address.  

You can ask us to limit what we share with others.

Most information is protected under state and federal guidelines, and the information that we can disclose without your consent is still on a minimum basis.  You have the right to ask us to limit certain information be shared with third parties.  You also can request a list of entities that we have shared your information with subject to federal or state regulations.  

You can appoint someone to act on your behalf

If someone you trust have power of attorney that designates that they can make decisions regarding your mental health, then we can respect that person’s authority.  If you have a guardian, then we must allow them to make decisions for you and share information with them.  

Records Retention

Applicable state and federal law dictate how long we store your information before it is destroyed.  For individuals initiating services after the age of majority in Virginia (18 years old), that will be seven years after the date of last contact or formal termination, whichever is greater.  For individuals initiating services under the age of majority, we are obligated to keep that information for ten years after the age of majority, plus the date of formal termination or last contact, whichever is greater.  


How and When we share your information

Generally we are required by law to keep all of your information private unless there is a written release of information.  The exceptions to this are as follows

  1. We can use your information to refer you to another professional or physician in order to treat you.  
  2. We can use your information to run our practice, consult amongst those that work within the organization, or within a supervisor/supervisee relationship.  
  3. We can use your information for billing purposes to seek payment from third parties for the care we provide to you.  

Legal Disclosures

To a certain extent, our responsibility to keep your information confidential do not apply in the following circumstances:

  1. There is reasonable suspicion that you have become a danger to yourself, to others, or your mental health symptoms are impairing your ability to care for yourself in a reasonable manner.  
  2. There is a suspicion of physical, sexual, emotional, or fiscal abuse of a minor, elderly, or disabled adult.  
  3. You initiate a legal proceeding against us.  


Electronic Dissemination of Information

Business Associate Agreements (BAA)

We are required by law to have a BAA with any third party applications that we may use in the course of our practice which guarantees your privacy.  The following is a current list of companies that we have such an agreement, and their corresponding application:

Company

Application

Google, Inc

  • Gmail
  • Google Calendar
  • Google Drive (including Docs, Sheets, Slides, and Forms)
  • Google Hangouts (chat messaging feature only)
  • Hangouts Meet (video chat and all other features)
  • Google Keep
  • Google Tasks
  • Jamboard
  • Google Vault services
  • Google Cloud Identity Management        

Square, Inc

Personal Billing Information including Name, Address, Phone Number, Email Address, and Payment Method

Doxy.me

Two-Way Video Chat and all applicable information obtained

Phone.com

All telephonic communication including voice, fax, and SMS Messaging

 

To our knowledge, none of the above applications used for simultaneous two way audio and video chat record or keep any type of record of the communication after it is terminated.  

Social Media

We cannot and will not guarantee your right to privacy protection should you as a client choose to interact with us via social media.  

Other Third Party Apps

Any other third party apps that you use to receive services from us such as BetterHelp, TalkSpace, or Live Coach, you will be subject to their privacy and terms of service.  Progress notes may be kept separately and subject to any of the aforementioned information.  


Complaints

We would like the opportunity to address any complaints or questions you may have regarding our services or how your information is used.  Should you choose to not afford us the opportunity, complaints can be submitted to the following entities:

Virginia Board of Counseling

Perimeter Center

9960 Mayland Drive.  Suite 300.

Henrico, VA 23233

PH:  800-533-1560

https://www.dhp.virginia.gov/counseling/

Virginia Attorney General

202 North Ninth Street

Richmond, VA 23219

PH:  804-786-2071

https://www.oag.state.va.us/consumer-protection/index.php/file-a-complaint

US Department of Health and Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201

PH:  800-368-1019

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

Revised 12/2018