Notice of Privacy Practices

Athena Counseling
84 Park Avenue Suite E106
Flemington, NJ 08822

Effective Date of This Notice

This notice went into effect on [INSERT DATE]

Notice of Privacy Practices

This notice describes how health information may be used and disclosed and how you can get access to this information. Please review it carefully.

I. My Pledge Regarding Health Information

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice.

This notice will tell you about the ways in which I may use and disclose health information about you. It also describes your rights to the health information I keep about you and my obligations regarding its protection.

I am required by law to:

  • Make sure that protected health information ("PHI") that identifies you is kept private.
  • Give you this notice of my legal duties and privacy practices with respect to health information.
  • Follow the terms of the notice that is currently in effect.
  • Update this Notice as required; changes will apply to all information I have about you.

II. How I May Use and Disclose Health Information

Health information may be used or disclosed for treatment, payment, and health care operations. This includes coordination with other providers, consultations, and referrals.

Other disclosures may include:

  • Lawsuits and disputes (court orders, subpoenas, or legal processes)

III. Uses and Disclosures Requiring Authorization

Psychotherapy notes, marketing purposes, and sale of PHI require your authorization. Exceptions include treatment, supervision, legal defense, and compliance with federal law.

IV. Uses and Disclosures Not Requiring Authorization

PHI may be used or disclosed without authorization for public health, oversight, legal proceedings, law enforcement, research, government functions, and workers' compensation.

V. Uses and Disclosures With Opportunity to Object

Information may be shared with family or others involved in your care unless you object.

VI. Your Rights Regarding PHI

  • Request restrictions on use or disclosure
  • Request limits for out-of-pocket paid services
  • Choose how you receive communications
  • Access or copy your records
  • Request accounting of disclosures
  • Request corrections to your records
  • Receive a copy of this notice

Acknowledgement of Receipt

By signing below, you acknowledge receipt of this HIPAA Notice of Privacy Practices and confirm you understand its contents.