Legal
Notice of Privacy Practices
Draft — not yet in effect
This is an unreviewed draft
It was written as a starting point for Eddie C. Walker to review and correct. It has not been checked by an attorney or a compliance reviewer, it is not in effect, and it is excluded from search engines until it is.
2 items still to decide:
- NAME OF PRIVACY OFFICER — confirm whether this is Eddie C. Walker or Robert L. Turner
- PRACTICE CONTACT EMAIL — not yet recorded in any reference doc
This notice describes how information about your mental health care may be used and disclosed, and how you can get access to that information. Please read it carefully.
Family Resource Center Tribe of Judah LLC, doing business as Tribe of Judah Family Resource Center, is required by law to protect the privacy of your health information, to give you this notice explaining our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
What this notice covers
Protected health information — PHI — is information that identifies you and relates to your mental or physical health, the care you receive here, or payment for that care. It includes your record of sessions, your diagnosis, your treatment plan, and your billing records.
Psychotherapy notes are treated separately and more protectively than the rest of your record. These are notes documenting or analysing the contents of a session, kept apart from your medical record. In almost every case, they will not be shared without your specific written authorization.
How we may use and disclose your information without your authorization
Federal and Georgia law permit certain uses of your information without asking you first. Those are limited to the following:
- Treatment — coordinating your care, including consultation with the licensed clinician who supervises this practice.
- Payment — billing you or your insurance plan, verifying coverage, and obtaining authorization for services.
- Health care operations — quality review, staff training, and the clinical supervision described below.
- Clinical supervision — this practice operates under the supervision of a licensed clinician, and your care is discussed with that supervisor as part of providing it. This is a routine and required part of supervised practice, not an exception to it.
Disclosures we are required or permitted to make by law
In specific circumstances, Georgia and federal law require or permit disclosure without your authorization. These are the limits of confidentiality, and they are explained again at the start of treatment:
- Suspected abuse or neglect of a child, an elderly person, or a disabled adult, which we are legally required to report.
- A serious and imminent threat of harm to yourself or to an identifiable other person.
- A court order, subpoena, or other lawful legal process.
- Public health activities and health oversight investigations required by law.
- Coroners, medical examiners, and funeral directors, as permitted by law.
- Workers' compensation claims, to the extent required by Georgia law.
Uses that always require your written authorization
Any use of your information that is not described above requires your written authorization. That specifically includes marketing, the sale of your information, and any use of psychotherapy notes beyond the narrow exceptions the law allows.
It also includes testimonials. If you choose to submit a review through this website, you are voluntarily disclosing your own information, and we will not publish it without the explicit consent you give on that form. You may withdraw that consent at any time by contacting us, and we will remove the review.
You may revoke any authorization in writing at any time. Revoking it stops future disclosures but does not undo disclosures already made in reliance on it.
Your rights over your health information
You have the following rights. To exercise any of them, contact us using the details at the end of this notice.
- To inspect and receive a copy of your record, in paper or electronic form.
- To request a correction if you believe something in your record is wrong or incomplete. We may deny the request, and you may then file a statement of disagreement that becomes part of your record.
- To request that we limit how your information is used or disclosed. We are not required to agree, except that we must agree to withhold information from a health plan for a service you paid for entirely out of pocket.
- To request that we contact you in a specific way or at a specific address.
- To receive a list of certain disclosures we have made in the previous six years.
- To receive a paper copy of this notice, even if you agreed to receive it electronically.
- To be notified promptly if a breach occurs that compromises the privacy of your information.
How to make a complaint
If you believe your privacy rights have been violated, you may complain to us using the contact details below, or directly to the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201.
You will not be retaliated against, penalised, or refused care for filing a complaint.
Changes to this notice
We may change this notice and apply the revised terms to information we already hold as well as information we receive in future. The current version will always be available on this page, and a paper copy is available on request.
Contact
Privacy Officer: [NAME OF PRIVACY OFFICER — confirm whether this is Eddie C. Walker or Robert L. Turner]
Family Resource Center Tribe of Judah LLC, doing business as Tribe of Judah Family Resource Center
8317 Office Park Drive #1E, Douglasville, GA 30134
Telephone: 334.349.2962
Email: [PRACTICE CONTACT EMAIL — not yet recorded in any reference doc]
Questions about this document? Call 334.349.2962.