Karuna Counseling
1945 Mason Mill Road • Suite 100 • Decatur, Georgia 30033
404.321.4307
www.KarunaCounseling.com
Health Insurance Portability and Accountability Act (HIPAA)
NOTICE OF PRIVACY PRACTICES
Effective 4/14/03
I. COMMITMENT TO YOUR PRIVACY: Karuna Counseling, Inc. is dedicated to maintaining the privacy of your protected health information (PHI). PHI is information that may identify you and that relates to your past, present or future physical or mental health condition and related health care services either in paper or electronic format. This Notice of Privacy Practices (“Notice”) is required by law to provide you with the legal duties and the privacy practices that Karuna maintains concerning your PHI. It also describes how medical and mental health information may be used and disclosed, as well as your rights regarding your PHI. Please read carefully and discuss any questions or concerns with your therapist.
II. LEGAL DUTY TO SAFEGUARD YOUR PHI: By federal and state law, Karuna is required to ensure that your PHI is kept private. This Notice explains when, why, and how Karuna would use and/or disclose your PHI. Use of PHI means when Karuna shares, applies, utilizes, examines, or analyzes information within its practice; PHI is disclosed when Karuna releases, transfers, gives, or otherwise reveals it to a third party outside of Karuna. With some exceptions, Karuna may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, Karuna is always legally required to follow the privacy practices described in this Notice.
III. CHANGES TO THIS NOTICE: The terms of this notice apply to all records containing your PHI that are created or retained by Karuna. Please note that Karuna reserves the right to revise or amend this Notice of Privacy Practices. Any revision or amendment will be effective for all of your records that Karuna has created or maintained in the past and for any of your records that Karuna may create or maintain in the future. Karuna will have a copy of the current Notice in the office in a visible location at all times, and you may request a copy of the most current Notice at any time. The date of the latest revision will always be listed at the end of Karuna ’s Notice of Privacy Practices.
IV. HOW KARUNA MAY USE AND DISCLOSE YOUR PHI: Karuna will not use or disclose your PHI without your written authorization, except as described in this Notice or as described in the “Information, Authorization and Consent to Treatment” document. Below you will find the different categories of possible uses and disclosures with some examples.
1. For Treatment: Karuna may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are; otherwise involved in your care. Example: If you are also seeing a psychiatrist for medica