THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

Our Commitment to Your Privacy
At Jade Healing Therapy, PLLC, we are dedicated to protecting your health information. We create a record of the care and services you receive to provide quality care and comply with legal requirements. This notice applies to all records of your care generated by our practice.

Our Legal Duties
We are required by law to:

• Ensure that protected health information (“PHI”) that identifies you is kept private.

• Provide you with this notice of our legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• Notify you if there is a breach of your unsecured protected health information, which requires notification under the Privacy Rule.

Jade Healing Therapy, PLLC may revise this Notice at any time. Any revisions will apply to all information we maintain. Any updates to the Notice will be provided to you. 

I. How We May Use and Disclose Health Information About You

The following categories describe different ways that Jade Healing Therapy, PLLC may use and disclose your health information. While not every use or disclosure is listed, all permitted uses fall within one of these categories. 

• For Treatment, Payment, and Health Care Operations: As permitted by federal regulations, we may disclose your PHI without written authorization for:

  • Treatment: To share information with other providers involved in your care, including for diagnosis, treatment planning, coordination, or consultation.

  • Payment: To bill and receive payment for services rendered.

  • Health Care Operations: To support administrative functions such as care management, quality improvement, evaluating performance, internal auditing, and care coordination.

• Lawsuits and Disputes: If you are involved in a lawsuit or legal dispute, we may disclose health information in response to a court or administrative order. We may also disclose health information about you or your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only after efforts have been made to notify you or to obtain an order protecting the information requested. 

II. Certain Uses and Disclosures Require Your Authorization
We will not use or disclose your health information without your written authorization except as described below.

• Psychotherapy Notes. Jade Healing Therapy, PLLC does keep “psychotherapy notes” as defined in 45 CFR § 164.501. These are maintained separately from your standard record and will only be used or disclosed under the following circumstances:

• Used by Jade Healing Therapy, PLLC for your treatment.

• Training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

• For Jade Healing Therapy, PLLC use in defending this mental health care practice and clinicians in legal proceedings instituted by you.

• For use by the Secretary of Health and Human Services to investigate Jade Healing Therapy, PLLC compliance with HIPAA.

• Disclosures required by law, including:

• Health oversight activities pertaining to the originator of the psychotherapy notes.

• Coroner investigations authorized by law.

• Prevention of serious threats to the health and safety of others.

• Marketing Purposes. We will not use or disclose your PHI for marketing purposes without your prior written authorization, as required by HIPAA. 

• Sale of PHI. As a psychotherapist, Jade Healing Therapy, PLLC will not sell your PHI in the regular course of its business.
  

III. Other Uses and Disclosures That Do Not Require Your Authorization
We may use or disclose your PHI without your authorization in the following circumstances:

• Required by Law: When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to relevant requirements of such law.

• Public Health Activities: Including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

• Health Oversight Activities: including audits and investigations.

• Judicial and Administrative Proceedings: including responding to a court or administrative order, although Jade Healing Therapy, PLLC’s preference is to obtain an Authorization from you before doing so.

• Law enforcement: Including reporting crimes occurring on the premises.

• Coroners or Medical Examiners: When such individuals are performing duties authorized by law.

• Research: For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

• Specialized Government Functions: For military, national security, or correctional purposes.

• Workers’ Compensation: To comply with applicable laws, although Jade Healing Therapy, PLLC’s preference is to obtain your authorization first.

• Appointment Reminders and Health-Related Services: To remind you of appointments or inform you about alternative treatments or benefits.

• Collections: We may provide your minimum necessary PHI to a collections agency to recover unpaid service fees. We will make all reasonable efforts to work with you prior to taking this step. You will be notified in advance if your account is referred to a collections agency.

• Incidental Disclosures: Incidental uses and disclosures of your PHI may occur as a byproduct of otherwise permitted actions. These are not considered violations if reasonable safeguards are in place.

IV. Certain Uses and Disclosures Require You to Have the Opportunity to Object:

• Disclosures to Family, Friends or Others: We may disclose your PHI to a family member, friend, or other person involved in your care or payment for your care, unless you object in whole or in part. In emergency situations, your opportunity to consent may be obtained retroactively.

V. Your Rights Regarding Your PHI:
You have the right to:

• Request Limits on Use and Disclosure of your PHI: You have the right to ask Jade Healing Therapy, PLLC not to use or disclose certain PHI for treatment, payment or health care operations purposes. Jade Healing Therapy, PLLC is not required to agree to your request, and Jade Healing Therapy, PLLC may say “no” if Jade Healing Therapy, PLLC believes it would affect your health care.

• Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payments or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

• Request Confidential Communication: You may request how Jade Healing Therapy, PLLC sends PHI to you. You have the right to ask Jade Healing Therapy, PLLC to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and Jade Healing Therapy, PLLC will agree to all reasonable requests.

• See or Get Copies of Your PHI: Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that Jade Healing Therapy, PLLC has about you. Jade Healing Therapy, PLLC will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request. Jade Healing Therapy, PLLC will charge a reasonable, cost-based fee for copying or providing your PHI.

• Receive a List of Disclosures: You have the right to request a list of instances in which Jade Healing Therapy, PLLC has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided Jade Healing Therapy, PLLC with an Authorization. Jade Healing Therapy, PLLC will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list Jade Healing Therapy, PLLC will give you will include disclosures made in the last six years unless you request a shorter time. Jade Healing Therapy, PLLC will provide the list to you at no charge, but if you make more than one request in the same year, Jade Healing Therapy, PLLC will charge you a reasonable cost-based fee for each additional request.

• Request Corrections: If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that Jade Healing Therapy, PLLC correct the existing information or add the missing information. Jade Healing Therapy, PLLC may say “no” to your request but Jade Healing Therapy, PLLC will update you within 60 days of receiving your request.

• Receive Breach Notification: You have the right to receive a notification, in the event that there is a breach of your unsecured health information, which requires notification under the Privacy Rule.

• Receive a Copy of This Notice: You may request this Notice in paper or electronic form at any time.
  

VI. Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:

• Jade Healing Therapy, PLLC
  Phone: (336) 252-4393
  Email: deanna@jadehealingtherapy.com

• You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.
  

VII. Acknowledgement of Receipt
I acknowledge that I have received a copy of the Notice of Privacy Practices for Jade Healing Therapy, PLLC. I understand that this acknowledgment does not authorize the use or disclosure of my health information — it simply confirms receipt of the document.