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.

This notice applies to all records of your care created or kept by Avenue Counseling, PLLC and every clinician who provides services through the practice.

1. Our duties to you

We understand that information about you and your care is personal. We are required by law to:

• Keep the privacy of your protected health information (PHI).
• Give you this notice of our legal duties and privacy practices.
• Follow the terms of the notice currently in effect.
• Notify you if a breach of your unsecured PHI occurs.

2. How we use and disclose your information without your written permission

Treatment. We use and share your information to provide and coordinate your care. Example: your therapist consults with their clinical supervisor about your treatment plan, or, with your agreement, coordinates with your physician or psychiatrist.

Payment. We use and share your information to bill and get paid for services. Example: we send your insurance plan your diagnosis, dates of service and the type of service so the claim can be paid, or we request prior authorization.

Health care operations. We use your information to run the practice and improve care. Example: we review records for quality and documentation compliance, train and supervise clinicians, or respond to an insurance or licensing audit.

Business associates. We work with companies that support the practice, such as our electronic health record and billing platform (SimplePractice). They must sign agreements to protect your information.

Appointment reminders. We may contact you to remind you of appointments, or tell you about other services we offer that may help you.

3. Other uses and disclosures allowed or required by law

Subject to the limits in federal and Virginia law, we may use or disclose your information without your authorization:

• When required by federal, state or local law.
• To report suspected abuse or neglect of a child, elderly person or incapacitated adult.
• To prevent or lessen a serious and imminent threat to the health or safety of you or others.
• For health oversight, such as audits, investigations and licensing reviews.
• In response to a court or administrative order. For a subpoena or other legal request without a court order, we will only respond after efforts are made to tell you or to obtain a protective order.
• For law enforcement purposes, as limited by law.
• To coroners or medical examiners performing duties authorized by law.
• For workers' compensation, as required by law.
• For specialized government functions, such as military, national security or correctional settings.
• For research that has been approved under privacy safeguards.

Where Virginia law gives you more protection than HIPAA, we follow Virginia law.

4. Uses that require your written authorization

• Psychotherapy notes. We may keep separate psychotherapy notes. Most uses or disclosures of these notes require your authorization, except to treat you, to train or supervise clinicians, to defend ourselves in a legal action you bring, or when required by law or for HHS oversight.
• Marketing. We will not use or disclose your information for marketing.
• Sale of information. We will not sell your information.
• Substance use disorder records. If we receive records from a federally assisted substance use disorder program (42 CFR Part 2), we will not use or disclose them in any civil, criminal, administrative or legislative proceeding against you without your written consent or a court order, after you are given notice and a chance to be heard. Records received with your consent for treatment, payment or health care operations may be used and redisclosed as HIPAA allows.
• Fundraising. We do not fundraise. If that ever changes, you will have the chance to opt out before you receive any fundraising communication.
• All other uses. Any use or disclosure not described in this notice requires your written authorization. You may revoke an authorization in writing at any time, except to the extent we already acted on it.

5. Your opportunity to agree or object

Unless you object, we may share information with a family member, friend or other person you identify who is involved in your care or in paying for it. In an emergency, we may share what is needed and ask your permission afterward.

6. Your rights

• Get a copy of your records. You may ask, in writing, to see or get a paper or electronic copy of your record (other than psychotherapy notes). We will respond within 30 days and may charge a reasonable, cost-based fee.
• Ask us to correct your records. If you believe information is wrong or missing, you may ask us to change it. If we say no, we will explain why in writing within 60 days.
• Request confidential communication. You may ask us to contact you in a specific way or at a specific address. We will agree to all reasonable requests.
• Ask us to limit what we use or share. We are not required to agree, except: if you pay for a service in full out of pocket, you may ask us not to share that information with your health plan, and we will agree unless the law requires us to share it.
• Get a list of disclosures. You may ask for a list of times we shared your information in the six years before your request, other than for treatment, payment, operations and certain other purposes. One list per year is free; additional requests may have a reasonable fee.
• Get a copy of this notice. You may ask for a paper copy at any time, even if you received it electronically.
• Choose someone to act for you. If someone is your legal guardian or has a valid power of attorney, that person can exercise your rights.
• Be notified of a breach. We will notify you if your unsecured information is involved in a breach.

7. Children and adolescents

Under Virginia law, a parent or legal guardian generally has the right to access a minor child's health records, unless a court order or other legal exception applies, or unless a clinician determines that access is reasonably likely to cause substantial harm to the child or another person. Psychotherapy notes, including what a child shares in session, are not released except as required by law or when we believe sharing is in the child's best interest. Some services a minor may consent to on their own under Virginia law may have additional confidentiality protections.

8. Changes to this notice

We may change this notice, and the changes will apply to all information we have about you. The current notice will be posted in our office and on our website, and is available from us on request.

9. Questions and complaints

If you have questions about this notice, or believe your privacy rights have been violated, contact our Privacy Officer: Dominique Black, LCSW, (540) 530-3341, dblack@avenueculpeper.com, 39 Garrett Street, Suite 104, Warrenton, VA 20186. We ask that complaints be made in writing.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201; 1-877-696-6775; or online at www.hhs.gov/ocr/complaints.

We will not retaliate against you for filing a complaint.