This document explains how your mental health and medical information may be used, disclosed, and how you can access it. Please read it carefully.
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
We may use or disclose your protected health information (PHI) for treatment, payment, and health care operations with your consent. Here are key definitions to clarify these terms:
- PHI: Information in your health record that can identify you.
- Treatment: Providing, coordinating, or managing your health care. For example, consulting with your family physician or another psychologist.
- Payment: Assisting in obtaining reimbursement for your health care, such as disclosing PHI to your insurer to determine eligibility or coverage.
- Health Care Operations: Activities related to the performance and management of our practice, such as quality assessments, audits, administrative services, and care coordination.
- Use: Activities within our practice, such as examining or analyzing your information.
- Disclosure: Activities outside our practice, such as sharing your information with other parties.
- For Reminders: We may use your health information to send you reminders about your care, such as appointment reminders or notifications about prescribed medications.
- For Communications: We may use the contact information (like phone numbers or email addresses) you provide to send you messages regarding treatment, payment, or healthcare operations.
II. Uses and Disclosures Requiring Authorization
We will obtain your written authorization for uses or disclosures of PHI beyond treatment, payment, and health care operations.
You may revoke any authorization at any time by submitting a written request. However, revocations do not apply to information already disclosed or if the authorization was a condition of insurance coverage and the insurer has the legal right to contest the claim.
III. Uses and Disclosures Without Consent or Authorization
We may use or disclose PHI without your consent in the following situations:
- Child Abuse: If we suspect child abuse or neglect, we must report it to the Virginia Department of Social Services.
- Adult and Domestic Abuse: If we suspect abuse, neglect, or exploitation of an adult, we must report it to the Virginia Department of Social Services.
- Health Oversight: The Virginia Department of Health Professions may subpoena relevant records during an inquiry.
- Judicial or Administrative Proceedings: We will not release information without your authorization or a subpoena unless required by law. If you contest the subpoena or file a motion to quash, we may be required to provide the records to the clerk of court so the court can determine whether or not the records should be released.
- Serious Threats to Health or Safety: If you communicate a specific, immediate threat of serious bodily harm or death to an identified person, we may notify potential victims or parent/guardian of the potential victim (if under 18) or law enforcement.
- Worker’s Compensation: If you file a worker’s compensation claim we are required by law to submit relevant mental health information to you, your employer, and/or the insurer, if requested.
- To Business Associates
We may share your health information with business associates and to third party service providers who perform services on our behalf. These associates are required to maintain the confidentiality of your information and can only use it as specified in our contracts and as allowed by law.
IV. Client Rights
- Request Restrictions: You can request limitations on how your PHI is used or disclosed for
treatment, payment, or healthcare operations. You can also request restrictions on disclosures to family members or others involved in your healthcare or payment. While we will try to accommodate these requests, we are not required to agree to restrictions except for specific disclosures to health plans, as described in this notice. - Confidential Communications: You can request to receive your health information in a
different manner or location. We will accommodate reasonable requests. In some cases,
we may accept your verbal request, but we may require written confirmation. - Inspect and Copy: You may request to inspect or obtain copies of your PHI. In certain situations, we may deny your request to inspect or copy your information. If that happens,
you may have the right to appeal the denial. We may charge a reasonable fee for providing copies. - Amend: You have the right to request that we amend certain health information we hold
about you, such as medical and billing records, if you believe the information is incorrect or incomplete. Your request must be submitted in writing, explaining why you believe the
information should be amended. - Accounting of Disclosures: You can request an accounting of certain disclosures of your
PHI made by us within the past six years. However, this accounting will not include
disclosures for: (i) treatment, payment, and healthcare operations; (ii) disclosures made to you or with your authorization; (iii) disclosures to law enforcement or correctional institutions; and (iv) other disclosures that federal law does not require us to account for. - Paper Copy: You can request a paper copy of this notice at any time, even if you’ve agreed
to receive it electronically. We will post any revised notices on our website.
V. SMS Messaging
Information We Collect
When you opt-in to receive SMS messages, we collect:
- Your phone number
- Consent to send SMS messages
- Your email address
- Your basic contact information
How We Collect Your Information
We may collect your information directly from you, such as when you complete a form or contact us; automatically, such as when you interact with our website; or from others, such as when we receive information about you from third parties.
How We Use Your Information
We use your information to:
- Send you the SMS messages you’ve opted in to receive
- Provide updates, promotions, or other relevant content based on your preferences
- Choices and Controls
- To operate our business
Disclosures of Your Information
We may disclose your information to our affiliated companies; to third party service providers, business advisors, or consultants who provide services to us; in connection with a merger, acquisition, reorganization, restructuring, financing transaction, or sale of assets; as required by law or administrative order; to assert claims or rights or to defend against claims; and [other disclosures you make]
Protection of Information
We take steps to protect your information against unauthorized use or disclosure. We do not share your personal information, phone number, or SMS consent opt-in data with third parties or affiliates for marketing or promotional purposes.
How to Contact Us
You can reach us by texting the word HELP for support to 804-796-0790. You may also contact us directly at (804) 796-0790.
Complaints
If you believe your privacy rights have been violated, you may:
- Contact your provider
- Contact the practice owner
- File a written complaint with the Secretary of the U.S. Department of Health and Human
Services. We can provide the appropriate address upon request.
VI. Effective Date & Policy Changes
This notice is effective as of January 1, 2025.
We respect your privacy and strive to protect your information. In cases where consent is not
required, we still make every effort to avoid sharing your information without your knowledge. If there are changes to our privacy practices or the law, the updated notice will be posted in our office, on our website, and made available upon request.