Notice of Privacy Practices (HIPAA)
BLACK SWAN COUNSELING SERVICES, LLC
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
Black Swan Counseling Services, LLC is dedicated to maintaining the privacy of your Protected Health Information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI.
How We May Use and Disclose Your PHI
The following categories describe the different ways we may use and disclose your PHI without your specific written authorization:
Treatment: We may use your PHI to provide, coordinate, or manage your mental health care and any related services. For example, we may disclose your PHI to another psychologist, psychiatrist, or physician who becomes involved in your care to coordinate treatment.
Payment: We may use and disclose your PHI so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about clinical sessions you received so they will pay us or reimburse you.
Health Care Operations: We may use and disclose your PHI to run our practice, improve your care, and contact you when necessary. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff.
Disclosures Requiring Your Specific Written Authorization
For any use or disclosure not covered by the categories above, we must obtain your written Authorization for Release of Information. Furthermore, the following require your explicit authorization:
Psychotherapy Notes: Most uses and disclosures of psychotherapy notes (notes recorded by your clinician documenting or analyzing the contents of conversation during a private counseling session) require your written authorization. These notes are kept separate from your official medical record.
Marketing & Sale of PHI: We will never sell your PHI or use it for marketing purposes without your express written consent.
Permitted or Required Disclosures Without Your Authorization
We may use or disclose your PHI without your consent or authorization under specific situations, heavily dictated by Florida Law and Federal regulations:
Child Abuse Reporting: If we have reason to suspect that a child is abused, abandoned, or neglected, we are required by Florida law to report that information to the Florida Department of Children and Families (DCF).
Vulnerable Adult Abuse: We are required to report suspected abuse, neglect, or exploitation of a vulnerable adult or elderly individual to the DCF abuse hotline.
Imminent Threat to Health or Safety / Duty to Warn: Under Florida Statutes, if a client communicates a specific, serious threat of physical violence against an identifiable victim, or if the client presents an imminent threat of suicide or serious bodily harm to themselves, we may disclose PHI to law enforcement and the intended victim to prevent the threat.
Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court order. Disclosures in response to a subpoena are governed by strict Florida mental health privilege laws, which generally protect your records unless a judge orders their release or you waive privilege.
Your Rights Regarding Your PHI
You have the following rights regarding the PHI we maintain about you:
Right to Inspect and Copy: You have the right to inspect and obtain a copy of your health and billing records. You must submit your request in writing. We may charge a reasonable fee for copying and mailing costs as permitted by Florida law.
Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. Your request must be made in writing and provide a reason.
Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations.
Out-of-Pocket Payment Restriction: If you pay for a service completely out-of-pocket and ask us not to bill or share this information with your health insurance plan, we must honor this restriction unless a law requires us to disclose that information.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or operations.
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location (e.g., only calling your cell phone, or mailing items to a specific P.O. Box).
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Black Swan Counseling Services, LLC or with the Secretary of the U.S. Department of Health and Human Services (HHS). You will not be penalized or retaliated against for filing a complaint.