Privacy Practices
NOTICE OF PRIVACY PRACTICES
Last Updated: Feb 02, 2025
THIS NOTICE DESCRIBES HOW MEDICAL 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
Van Otto Counseling is committed to maintaining the privacy of your protected health information (PHI). We are required by law to maintain the confidentiality of your health information. This Notice describes our legal duties and privacy practices regarding your PHI.
How We May Use and Disclose Your PHI
We may use and disclose your PHI for the following purposes:
- Treatment: To provide, coordinate, or manage your health care.
- Payment: To bill and collect payment for services provided.
- Health Care Operations: For our internal operations, including quality assessment and improvement activities.
We may also use or disclose your PHI without your authorization in the following situations:
- As required by law
- For public health activities
- To report abuse, neglect, or domestic violence
- For health oversight activities
- For judicial and administrative proceedings
- For law enforcement purposes
- To coroners, medical examiners, and funeral directors
- For organ and tissue donation purposes
- For research, under certain conditions
- To avert a serious threat to health or safety
- For specialized government functions
- For workers' compensation
Your Rights Regarding Your PHI
You have the following rights regarding your PHI:
- Right to inspect and copy your PHI
- Right to request amendments to your PHI
- Right to receive an accounting of certain disclosures of your PHI
- Right to request restrictions on certain uses and disclosures of your PHI
- Right to request confidential communications
- Right to receive a paper copy of this Notice
Changes to This Notice
We reserve the right to change this Notice. We will post a copy of the current Notice in our facility and on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact:
Van Otto
vanottocounseling@gmail.com
[Practice Address]
[Phone Number]
You will not be penalized for filing a complaint.
Contact Information
For further information about our privacy practices, please contact:
Van Otto
vanottocounseling@gmail.com
[Practice Address]
[Phone Number]
By signing below, I acknowledge that I have received a copy of this Notice of Privacy Practices.
Signature of Patient or Representative
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