“Good Faith Estimate"

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 HIPPA NOTICE OF PRIVACY PRACTICES for MARBLE COUNSELING & CONSULTING, LLC  

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

EFFECTIVE DATE OF THIS NOTICE: 1/1/2022.

The terms of this Notice can be changed, and such changes will apply to all information I have about you. The new Notice will be available upon request, in our office, and on Marble Counseling & Consulting, LLC's website.

What is protected?

Protected Health Information (PHI), which consists of any medical information containing your name or containing other publicly available information from which your identity can be determined.

Your PHI:

Is kept in written charts, or stored electronically (i.e., in a computer system.)

Includes records of evaluations, treatments, tests, visits, counseling sessions, and any other health care services you have received.

Protecting your privacy:

· By law, we must keep your PHI confidential, except in certain situations.

· We must give you a copy of this Notice.

· All Marble Counseling & Consulting, LLC Employees and Providers must follow applicable privacy rules.

· If there is a privacy breach that involves your PHI we will notify you.

· The personal health information (PHI) may include past, present and future medical information as well as information outlined in the Privacy Rules.

· The information, to the extent disclosed, will be disclosed consistent with the Privacy Rules or any other applicable law as amended from time to time.

· You have the right to change your mind and withdraw your consent, however, the information may have already been provided as allowed by you.

· The opportunity to consent may be obtained retroactively in emergency situations.

· This consent will remain in effect until revoked by you in writing.

· When requested in writing, you will be provided a list of entities to which your information has been disclosed.

IN MANY CASES, WE NEED YOUR WRITTEN AUTHORIZATION BEFORE WE CAN SHARE YOUR PHI WITH ANY PERSON. However, we can share PHI without your written authorization in certain circumstances, such as:

· Providing you with medical treatment or assisting another healthcare provider to treat you.

· Running our organization.

· Billing or obtaining payment for services.

· Helping with public health and safety issues.

· Conducting research.

· As part of an organized healthcare arrangement.

· As part of a community health information exchange.

· Complying with the law.

· Responding to lawsuits and legal actions.

· For law enforcement purposes.

· Working with a medical examiner or funeral director.

· Worker’s compensation purposes.

· Scheduling an interpreter for you.

· In the event of a disaster.

· Preventing or controlling outbreaks of disease.

· Reporting births or deaths.

· In the event of a healthcare emergency.

· In the event of an eminent threat to self or others.

· Complying with court or administrative orders, or in response to a subpoena, although my preference is to obtain an Authorization from you before doing so.

· Reporting suspected abuse, neglect, or domestic violence, although my preference is to obtain an Authorization from you before doing so.

· Responding to an investigation or audit conducted by a health oversight agency.

· To correctional facilities as necessary for your care, although my preference is to obtain an Authorization from you before doing so.

· For national security or to protect the President.

· Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us.

Your privacy rights

· You can ask us to limit how we use or share your information. You must ask in writing. We can agree if law allows.

· You can ask us to contact you in a certain way or in a certain place. We will follow any realistic request.

· In most cases, you can look at or get copies of your records. You must ask in writing.

· You can ask to amend health information in your medical or billing records. This must be in writing. We may not agree to these changes in certain situations.

· You can usually revoke your written authorization if you ask us in writing. However, we can’t take back any PHI or other information we have already shared.

· You can ask for a list of those with whom we have shared your PHI in the past 6 years. You must ask in writing. This list will not include disclosures of PHI made for treatment, payment, or health care operations, or those that were made pursuant to your written authorization.

· Your PHI will not be sold.

· Genetic information cannot be disclosed to health plans to determine eligibility.

· We will not disclose information to your health plan if you pay for services out of pocket.

· You can ask for a paper copy of this Notice at any time.

· You can choose to designate someone as your authorized representative for purposes of deciding whether your PHI should be shared. Any such designation must be in writing and otherwise legally valid

Your Choices

You have some choices in the way we use and share your PHI in the following circumstances:
• To tell family or friends about your condition.
• To provide disaster relief.
• To market our services or sell your information (we do not sell your information).

If you have a preference as to how we share PHI in any of these circumstances, please tell us and we will follow your instructions to the extent we are legally able to do so.