This notice describes how your health information may be used and disclosed, and how you can access it. Please review it carefully.
OUR COMMITMENT TO YOU
Sullivan & Sullivan is required by law to maintain the privacy of your protected health information (PHI), provide you this notice of our legal duties and privacy practices, and follow the terms currently in effect.
HOW WE MAY USE & DISCLOSE YOUR INFORMATION
For treatment. To provide, coordinate, or manage your care, including consultation with our clinical supervisor.
For payment.To bill you directly or provide documentation you may submit to your insurer for reimbursement.
For healthcare operations.Quality assessment, supervision, and administrative purposes necessary to run our practice.
As required by law.Including mandatory reporting of suspected child or elder abuse, and situations involving serious, credible threats of harm to yourself or others.
With your written authorization.Any other use or disclosure requires your written consent, which you may revoke at any time.
YOUR RIGHTS
You have the right to: request restrictions on certain uses and disclosures; request confidential communications; inspect and obtain a copy of your records; request an amendment to your records; receive an accounting of certain disclosures; obtain a paper copy of this notice; and file a complaint if you believe your privacy rights have been violated, without fear of retaliation.
If you've paid for a service in full out of pocket, you have the right to request that we not disclose that information to your health plan, and we will honor that request. Psychotherapy notes (our private process notes, kept separate from your file) require your separate written authorization before release, as does any use of your information for marketing or sale to a third party — which we would never do without asking you directly.
If a breach of your unsecured health information ever occurs, we are required to notify you within 60 days, describing what happened and what we're doing about it.
To exercise any of these rights, contact us at hello@sullivanmft.com. You may also file a complaint with the U.S. Department of Health & Human Services Office for Civil Rights: hhs.gov/ocr or 1-800-368-1019.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and to make the revised notice effective for information we already have as well as information we receive in the future. An updated notice will always be available on our website and in our office.
CONTACT & SUPERVISION
Kristie Sullivan, MA, LMFTA, and Keith Sullivan, MA, LMFTA, are supervised by [ Supervisor Name, Credentials, License # ]. Questions about this notice or our privacy practices can be directed to hello@sullivanmft.com.
