Guyton Counseling Services Privacy Policy

Nathan Guyton, M.Ed., LCDC, LPC-Associate

Supervised By Dr. Kelly Guidry, LPC-S

The Woodlands, Texas

(281) 584-3145

NOTICE OF PRIVACY POLICIES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Anything in you or your childʼs healthcare record is personal information about you and your health. Information that identifies anything about you from the past, present, or future regarding physical or mental health care is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how Guyton Counseling Services, LLC may use or disclose any PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”). This notice also details your rights and how you may gain access to your PHI.

By law, Guyton Counseling Services is required to maintain privacy of any and all PHI and to provide you notice of our legal duties with respect to your PHI. While we take this commitment seriously, should there be a breach of privacy I may be required to inform you of what happened and what you can do to protect yourself. Changes to this notice may be made at any time. Any updated Notice of Privacy Practices will apply to all PHI that we maintain at that time. A new copy of the Notice of Privacy Practice will be made available to all clients upon request by email or mail.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: After reading this notice, you will be asked to sign a consent form that allows for treatment to proceed and allows for the sharing of PHI in certain circumstances. PHI is intended to be shared with organizations that provide treatment to you, arrange for payment for services, or other business functions that are a part of health care operations. Together these are treatment, payment, and health care operations and they are detailed below.

For Treatment: PHI may be used and disclosed with individuals involved in your care in an effort to provide, coordinate, and manage your health care treatment. This may include clinical consultation with supervisors and other clinical team members.

For Payment: PHI may be used and disclosed in order to receive payment for the treatment services provided to you. This will be done with your authorization and may include: Guyton Counseling Services staff (with appropriate HIPAA training) reviewing relevant information. processing claims with insurance companies, reviewing services to determine medical necessity, or undertaking utilization review activities with an insurance company.

For Health Care Operations: PHI may be used or disclosed to support business activities, including but not limited to, quality assessment activities, employee review activities, etc. An example of this could include sharing PHI with a third party that is responsible for performing various business activities (e.g., billing insurance) provided a written contract exists with that business that requires them to safeguard the privacy of your PHI.

III. USE AND DISCLOSURE OF YOUR HEALTH INFORMATION WITHOUT AUTHORIZATION:

Below is a list of categories of uses and disclosures permitted by HIPAA without your authorization. There is a limited number of situations in which applicable law does permit the disclosure of PHI without your authorization and these may made electronically [Texas 181.154].

Child Abuse or Neglect: PHI may be disclosed to state or local authorities regarding suspicion or reported child abuse or neglect. We are mandated to report this within 48 hours of receiving the information.

Elder Abuse or Neglect: PHI may be disclosed to state or local authorities regarding suspicion or reported elderly abuse or neglect. We are mandated to report this information to the appropriate authorities.

Sexual Misconduct by a therapist: We are required to inform the appropriate licensing authority and / or appropriate authorities if you report any behavior by a previous therapist that is sexually inappropriate.

Judicial and Administrative Proceedings: PHI may be disclosed pursuant to a subpoena (with written consent), court order, administrative order, or other legal proceeding.

Threat to Public Health or Safety: During the course of treatment if it is determined there is a probability of imminent physical danger by you to yourself to someone else, or a probability of mental injury to yourself, PHI may be disclosed to appropriate medical or law enforcement personnel.

Regulatory Oversight: PHI may be disclosed to licensing authorities relevant to a complaint filed against a therapist, pursuant to a subpoena.

Verbal Permission: With your verbal permission, PHI may be disclosed to family members whom you identified and are directly involved in your treatment.

IV. USES AND DISCLOSURES OF PHI WITH AUTHORIZATION:

PHI will not be used or disclosed for reasons not specifically permitted by applicable law without your written authorization, which you have the right to revoke at any time. This excludes disclosures that have been made previous to the revocation with your written permission. These disclosures may be made electronically [Texas 181.154]

V. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask not to use or disclose certain PHI for treatment, payment, or health care operations purposes. Please note that we are not required to agree to your request, and should this be the case, we believe it would affect your health care.

Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

Right to Request Confidential Communication: You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.

Right to See and Get Copies of Your PHI: PHI may be requested, inspected, and copied by you, with the rare exception of special circumstances from the “designated record set”. Additionally, if your information was compiled in reasonable anticipation of, or for use in a civil, criminal, or administrative action or proceeding then it may not be released to you for inspection. A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where a licensed professional believes it is reasonably likely that access would endanger the life or physical safety of, or cause substantial harm to, the individual or another person. A reasonable fee may be charged for copies of the record. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person.

Right to an Accounting of Disclosures: You have the right to request a list of instances in which your PHI for purposes other than treatment, payment, or health care operations, or for which you provided an Authorization. A reasonable fee may be charged if more than one accounting of this is made in a 12-month period.

Right to Amend: If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request a correction to the existing information or add the missing information. Should your request for amendment be denied, you will be notified in writing and you have the right to file a statement of disagreement.

Right to Get a Paper or Electronic Copy of this Notice: You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

VI. QUESTIONS AND COMPLAINTS If you have questions about this notice, or would like to make a complaint about a privacy violation you may contact:

Nate Guyton, (281) 584-3145;

Dr. Kelly Guidry, (281) 317-2310;

or Texas Behavioral Health Executive Council, (512) 305-7700.

A written complaint to the Secretary of the U.S. Department of Health and Human Services may also be made at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202) 619-0257. I will not retaliate against you for filing a complaint.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on February 19, 2024.