Privacy Policy

NOTICE OF PRIVACY PRACTICES

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

OUR COMMITTMENT REGARDING YOUR HEALTH INFORMATION: 

Infinity Counseling is committed to protecting your health information.  As part of treatment, a file is created that contains identifiable information about you and your health care. This information is called Protected Health Information (PHI). It may also be referred to as your medical record. Maintaining a medical record helps ensure a quality of care and is required by many insurance carriers. I am required by law to:

· Make sure that protected health information that identifies you is kept private.

· Give you this notice of my legal duties and privacy practices with respect to health information.

· Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: 

Information about you is obtained throughout the course of treatment. Protected Health Information may include demographic information, family history, reasons for seeking psychotherapy, diagnoses, billing and payment information, as well as notes or evaluations by other providers. We will not disclose any personal health information without your written authorization, unless such disclosure is permitted or required by law.

The ways we are permitted to use and disclose PHI fall within the following categories. Please note, this is not an exhaustive list.

Permitted Uses and Disclosures Without Your Authorization--For Treatment, Payment, or Health Care Operations: Providing treatment services, collecting payment and conducting healthcare operations are necessary activities for quality care. State and Federal laws allow us to use and disclose your health information for these purposes. Federal privacy rules (regulations) allow health care providers, such as therapists at Infinity Counseling, who have a direct treatment relationship with the client (you) to use or disclose the client’s personal health information without written authorization, to carry out the health care provider’s treatment, payment or health care operations. We may also disclose your protected health information for consultation with other health care providers who abide by the same privacy practices. 

The following circumstances are other examples when such disclosures may or will be made without written authorization:

1) For judicial and administrative proceedings, including responding to a court or administrative order

2) If disclosure is compelled by a board, commission, or administrative agency for purposes of adjudication pursuant to its lawful authority

3) If disclosure is compelled by the patient or the patient’s representative pursuant to federal statutes or regulations (e.g., the federal “Privacy Rule,” which requires this Notice). 

4) For public health activities, including reporting suspected child, elder, or dependent adult abuse or neglect

5) If it is deemed that you are in such a mental or emotional condition as to be dangerous to yourself or to the person or property of others, and if we determine that disclosure is necessary to prevent the threatened danger.

6) If it is determined that you report a serious threat (imminent) of physical violence to be committed by you against a reasonably identifiable victim or victims.

7) If disclosure is compelled or permitted, in the event of your death, to the coroner in order to determine the cause of your death.

8) We may disclose your information to companies and professionals such as our accountants, bookkeepers, attorneys and information technology associates that assist us in running our operations. Contracts with these associates assure that the privacy of your health information is protected. 

Certain Uses and Disclosures Require You To Have The Opportunity To Object-- Others Involved in Your Healthcare: If you agree or do not object, we may disclose to a member of your family, a relative, a close personal friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care or payment for your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We also may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Uses and Disclosures that Require your Authorization: In other situations that may not be described above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we haven’t taken any action relying on the authorization). Additionally, your authorization is required for the following: 

1. Marketing Purposes. As a therapist, I will not use or disclose your PHI for marketing purposes. This includes the use of phone numbers. If you would like to receive or generate SMS or text messages from or with your therapist at Infinity Counseling, your written consent is necessary. SMS opt-in and phone numbers collected for SMS purposes will not be shared with third parties or affiliates for marketing purposes.

Do you agree to receive SMS/Text Messages from Infinity Counseling LLC? You may reply Stop to opt-out at any time.  YES NO

2. Sale of PHI. As a therapist, I will not sell your PHI in the regular course of my business.

YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

· The Right to Request Limits on Uses and Disclosures of Your PHI.  You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operation purposes. I will consider your request; however, I am not legally required to agree to it if it could negatively affect your health care. If I agree to your request, I will put any limits in writing and abide by them except in emergency situations. 

· The 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.

· The Right to Choose How I Send PHI to You.  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.

· The Right to See and Get Copies of Your PHI.  You have the right to inspect and copy protected health information about you by making a specific request in writing.  If you request paper copies of your PHI, we may charge you a reasonable fee for each page. For electronic health records (EHR), you may be charged the cost of labor to produce the electronic copy or make the electronic transmission. The right to inspect and copy your PHI is not absolute. At times, we may provide you with a summary or explanation of the PHI as long as you agree to that and to the cost in advance.

· The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last seven years unless you request a shorter time. 

· The Right to Correct or Update Your PHI. 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, in writing, that the existing information be corrected or the missing information be added. We may deny your request in writing for specific reasons. Our written denial will state the reasons for the denial. If we approve your request, we will make the change to your PHI, tell you that we have done it, and notify others that need to know about the change to your PHI.

· The Right to Get a Paper Copy of this Notice.  You have the right to obtain a paper copy of this notice upon request.

COMPLAINTS 

If you need or desire further information related to this Notice or its contents, or if you have any questions about this Notice or its contents, please contact Allison Doyle at Infinity Counseling. If you believe your privacy rights have been violated, you may file a complaint with us by sending an email to adoyle@infinitycounselingpllc.com. We will not retaliate against you for filing a complaint. You may also contact the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. 

Mailing Address:

Infinity Counseling, PLLC

84 Bay St, Ste 1R

Manchester, NH 03104

The effective date of this notice is 9/1/2024.

I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.