Your Health Information Rights

You have several rights with regard to your health information. If you wish to exercise any of the following rights, please contact Kelly Munier with Growing Light Counseling, LLC at 2005 Venture Park, Kingsport, TN 37660.

Specifically, you have the right to:

INSPECT AND COPY YOUR HEALTH INFORMATION:

You have the right to inspect and obtain a copy of your personal health information by making a specific request to do so in writing. However, therapists are permitted to deny access for specified reasons. For instance, this right of access does not include psychotherapy notes or information gathered for judicial proceedings. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Kelly Munier at Growing Light Counseling, LLC at 2005 Venture Park, Kingsport, TN 37660. In addition, we may charge you a reasonable fee if you want a copy of your health information.

REQUEST TO AMEND YOUR HEALTH INFORMATION:

If you believe your health information is incorrect, you may ask us to correct the information for as long as it is kept by Growing Light Counseling, LLC. To request an amendment, you must make your request in writing to Kelly Munier at Growing Light Counseling, LLC at 2005 Venture Park, Kingsport, TN 37660. You must also give a reason as to why your health information should be changed. Growing Light Counseling, LLC may deny your request for an amendment if it is not in writing or if it does not include a reason to support the request. Growing Light Counseling, LLC may also deny your request if Growing Light Counseling, LLC did not create the health information that you believe is incorrect; if Growing Light Counseling, LLC disagrees with you and believes your health information is correct; if the information is not part of the information which you would be permitted to inspect or copy (i.e., psychotherapy notes); or, if the information is not kept by or for Growing Light Counseling, LLC.

REQUEST RESTRICTIONS ON CERTAIN USES AND DISCLOSURES:

You have the right to ask for restrictions on the medical information Growing Light Counseling, LLC uses or discloses about you for treatment, payment or health care operations. You also have the right to limit the health information provided to family or friends involved in your care or payment of medical bills. For example, you could ask that Growing Light Counseling, LLC not use or disclose information about a particular procedure you underwent. You may also want to limit the health information provided to authorities involved with disaster relief efforts. To request a restriction, you must make your request in writing to Kelly Munier at Growing Light Counseling, LLC at 2005 Venture Park, Kingsport, TN 37660. However, Growing Light Counseling, LLC is not required to agree in all circumstances to your requested restriction. If Growing Light Counseling, LLC does agree, Growing Light Counseling, LLC will comply with your request unless the information is needed to provide you with emergency treatment.

AS APPLICABLE, RECEIVE CONFIDENTIAL COMMUNICATION OF HEALTH INFORMATION:

You have the right to ask that Growing Light Counseling, LLC communicate your health information to you indifferent ways or places. For example, you may wish to receive information about yourhealth status in a special, private room or through a written letter sent to a private address.Growing Light Counseling, LLC must accommodate reasonable requests.

RECEIVE AN ACCOUNTING OF DISCLOSURES OF YOUR HEALTH INFORMATION:

In some limited instances, you have the right to ask for a list of the disclosures of your health information Growing Light Counseling, LLC has made during the previous six years, but the request cannot include dates before April 14, 2003. This list must include the date of each disclosure, who received the disclosed health information, a brief description of the health information disclosed, and why the disclosure was made. Growing Light Counseling, LLC must comply with your request for a list within 30 days, unless you agree to a 30-day extension, and Growing Light Counseling, LLC may not charge you for the list, unless you request such list more than once per year. Growing Light Counseling, LLC may deny your request if the disclosures made by Growing Light Counseling, LLC pertain only to: (a) treatment, payment and health care operations; (b) individuals who request their own health information; (c) include in the facility’s directory or to those involved in the patient’s care; (d) comply with national security or intelligence purposes; (e) correctional institutions or law enforcement officials; or (e) have only disclosures made prior to April 14, 2003.

OBTAIN A PAPER COPY OF THIS NOTICE:

Upon your request, you may at any time receive a paper copy of this notice from Kelly Munier at Growing Light Counseling, LLC.

COMPLAIN:

If you believe your privacy rights have been violated, you may file a complaint with Growing Light Counseling, LLC and with the federal Department of Health and Human Services. To file a complaint with either entity, please contact Kelly Munier, who will provide you with the necessary assistance and paperwork. The quality of your care will not be jeopardized nor will you be penalized for filing a complaint.

CHANGES TO THIS NOTICE

Growing Light Counseling, LLC reserves the right to change the privacy practices described in this notice, in accordance with the law. Changes to privacy practices would apply to all health information maintained.

IF YOU HAVE ANY QUESTIONS OR CONCERNS REGARDING YOUR PRIVACY RIGHTS OR THE INFORMATION IN THIS NOTICE, PLEASE CONTACT KELLY MUNIER AT GROWING LIGHT COUNSELING, LLC AT 2005 VENTURE PARK, KINGSPORT, TN 37660 FOR FURTHER INFORMATION AND RECEIPT OF COMPLAINTS.