HIPAA Notice of Privacy Practices

Introduction

Adult Therapy Alliance, PLLC is committed to protecting the privacy of your health information. This Notice of Privacy Practices explains how we may use and disclose your protected health information (PHI), your rights regarding your PHI, and our responsibilities under applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).

1. Our Responsibilities

Adult Therapy Alliance, PLLC is required by law to:

Maintain the privacy of your protected health information
Provide you with this Notice describing our privacy practices and legal responsibilities
Follow the terms of the Notice currently in effect
Notify you as required by law if a breach occurs that may compromise the privacy or security of your protected health information

We reserve the right to change this Notice and make the revised Notice applicable to health information we already maintain, as permitted by law.

2. How We May Use and Disclose Your Health Information

We may use or disclose your protected health information without your written authorization when permitted or required by applicable law.

Treatment

We may use or disclose your health information to provide, coordinate, or manage your therapy and other healthcare services.

For example, information may be used to support your individual or couples therapy and coordinate care when appropriate.

Payment

We may use or disclose your health information to obtain payment for services provided to you, when applicable.

This may include activities related to billing, payment processing, eligibility, or other payment related matters.

Healthcare Operations

We may use or disclose your health information for healthcare operations necessary to operate our practice and maintain the quality and effectiveness of our services.

These activities may include quality assessment, administrative activities, compliance, and practice management.

3. Other Permitted or Required Uses and Disclosures

We may also use or disclose protected health information when permitted or required by law, including for certain circumstances such as:

Public health activities
Reporting certain types of abuse, neglect, or domestic violence when required or permitted by law
Health oversight activities
Judicial and administrative proceedings
Law enforcement purposes when authorized by law
Coroners, medical examiners, or funeral directors when legally permitted
Organ, eye, or tissue donation purposes when applicable
Research when applicable legal requirements are satisfied
Preventing or reducing a serious and imminent threat to health or safety
Workers’ compensation purposes when permitted by law
Other uses or disclosures required by law

4. Uses and Disclosures Requiring Your Authorization

Certain uses and disclosures of your protected health information require your written authorization.

Except as otherwise permitted or required by law, we will obtain your authorization before using or disclosing your PHI for purposes that require authorization.

You may revoke an authorization in writing at any time, except to the extent that we have already relied on the authorization.

5. Your Rights Regarding Your Health Information

You have certain rights regarding your protected health information.

Right to Inspect and Obtain a Copy

You generally have the right to inspect and obtain a copy of your protected health information maintained by Adult Therapy Alliance, PLLC, subject to applicable legal limitations.

Right to Request an Amendment

You may request that we amend protected health information that you believe is incorrect or incomplete.

Your request must be made in writing and may be subject to applicable legal requirements.

Right to an Accounting of Disclosures

You generally have the right to request a list of certain disclosures of your protected health information made by us, subject to limitations provided by law.

Right to Request Restrictions

You may request restrictions on how we use or disclose your protected health information.

We are not required to agree to every restriction request, except where applicable law requires otherwise.

Right to Request Confidential Communications

You may request that we communicate with you about your health information by alternative means or at an alternative location.

We will consider reasonable requests as required by applicable law.

Right to Receive a Paper Copy

You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

6. Psychotherapy Notes

Psychotherapy notes receive special protection under HIPAA. In circumstances where psychotherapy notes are maintained separately from the rest of your medical record, certain uses and disclosures may require your written authorization unless an exception under federal law applies.

7. Your Right to Receive Notice of a Breach

If Adult Therapy Alliance, PLLC determines that your unsecured protected health information has been affected by a breach requiring notification under applicable law, you will be notified as required by law.

8. Complaints

If you believe your privacy rights have been violated, you may file a complaint with Adult Therapy Alliance, PLLC.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

You will not be retaliated against for filing a privacy complaint.

9. Contact Information

For questions about this Notice, to exercise your privacy rights, or to submit a privacy related request or complaint, please contact:

Adult Therapy Alliance, PLLC
Contact: Vincent Dhan
Email: vincentdhan@adulttherapyalliance.com
Phone: 630-386-5001
Service Area: Aurora, Batavia, Elgin, Wheaton, Illinois

10. Changes to This Notice

Adult Therapy Alliance, PLLC reserves the right to change this Notice of Privacy Practices.

Any revised Notice will be made available as required by law, and the revised Notice will apply to protected health information maintained by the practice as permitted by applicable law.