Who we are
Our website address is: creativefoxcounseling.org, our leader is Alexis Bierman, LPC-Associate supervised by Vicki Williams-Patterson.
PRIVACY PRACTICES
RIGHTS WITH RESPECT TO YOUR PHI:
- The Right to Request Limits on Uses and Disclosures of Your PHI. You can ask me not to use or share certain PHI for treatment, payment, or healthcare operations. I may deny your request if I believe it would affect your health care.
- The Right to Request Restrictions for Out-of-Pocket Expenses Paid in Full. You can request that I don’t share PHI with your health plan if it relates to a service or item you’ve paid for completely out-of-pocket.
- The Right to Choose How I Send PHI to You. You can ask me to contact you in a specific way (e.g., home or office phone) or send mail to a different address. I will accommodate reasonable requests.
- The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you can request an electronic or paper copy of your medical record. I will provide it within 30 days of receiving your written request and may charge a reasonable fee.
- The Right to Get a List of the Disclosures I Have Made. You can request a list of times I’ve shared your PHI for purposes other than treatment, payment, or healthcare operations. I will respond within 60 days and provide records from the past six years. The first request each year is free; additional requests may have a reasonable fee.
- The Right to Correct or Update Your PHI. If you believe there’s an error in your PHI or important information is missing, you can request a correction. I may deny the request, but I will explain why in writing within 60 days.
- The Right to Get a Paper or Electronic Copy of This Notice. You can request a paper copy of this notice at any time, even if you agree to receive it electronically.
ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have rights regarding the use and disclosure of your protected health information. By signing this document, you acknowledge that you have received a copy of the HIPAA Notice of Privacy Practices.
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