Notice of Privacy Practices (HIPAA)

Your Information. Your Rights. Our Responsibilities. 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.

You have the right to:

Get a summary of your paper or electronic medical record.
Request to correct your paper or electronic medical record.
Request confidential communication at designated contact numbers.
Ask us to limit the information we share.
Get a list of those with whom we’ve shared your information.
Get a paper copy of this privacy notice.
Choose someone to act for you as legal guardian or power of attorney.
File a complaint if you believe your privacy rights have been violated.
Ethical treatment without discrimination.
Decide not to receive services.
Terminate therapeutic services at any time.

You have some choices in the way that we use and share information to:

Choose any family and friends to tell about your condition.
Provide relief in a disaster, if needed.
Provide mental health care.

If you have a clear preference for how we share your information in any situation, please tell us. We do not share your information in marketing or fundraising. Your information is not sold.

We may use and share your Information as we:

Treat you in collaboration with other professionals.
Train current employees.
Run our organization, improve care, and to contact you.
Bill for your services and get payments.
Help with public health and safety issues.
Do health research.
Comply with the law.
Work with a medical examiner or funeral director.
Address workers compensation, law enforcement, and other government requests.
Respond to lawsuits and legal actions.
Report suspected abuse and neglect of minors or the elderly.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. If there is a breach, notice will then be sent to the last known address in your chart.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticeapp.html.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775, visiting Health and Human Services – How To File a Complaint, or sending a letter to:

200 Independence Avenue, S.W., Washington, D.C. 20201

* We will not retaliate against you for filing a complaint.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website at www.couplescounselingcenter.online.

CCC’s Privacy Officer is Cheri Timko and can be contacted at ctimko@timkocounseling.com or (304) 534-8227.

Effective Date: May, 2013.
Updated: January 2024.
Couples Counseling Center
Timko Counseling Services, LLC

Notice of Privacy Practices:

I acknowledge that I have received and read the Couples Counseling Center HIPAA Notice of Privacy Practices.