GUIDING PATH, PLLC
JAMES B. LEWIS, LCSW, CSAT II

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Notice of Privacy Practices

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

Why I am providing you with this notice:
I am required by a federal law known as the Health Insurance Portability and Accountability Act (HIPPA) to give you this notice. This notice will tell you about the ways I may use and disclose health information about you and will describe your rights and my obligations regarding the use and disclosure of that information.

Your health information:
This notice applies to the information and records I have about your health, health status, and the health care services you receive from Guiding Path. This information relates primarily to counseling services you have received from Guiding Path.

How I may use and disclose health information about you:
For treatment. I may use or disclose health information about you to facilitate counseling and other treatment within this company.
For payment. I may use and disclose health information about you so that I can be paid by you, an insurance company, or another party, for the services I provide you. For example, I may need to give your health insurance company information about my services to you so the company will pay me for these services.
For professional operations. I may use and disclose health information about you in order to run this office and make sure that you and other clients receive quality care. For example, I may use your health information to evaluate my performance or to contact you to remind you of your appointments or to cancel an appointment.

Please notify me in writing if you do not want me to contact you to remind you of an appointment or where you prefer me to contact you to cancel an appointment.

Special situations.  I may use or disclose your health information without your permission for several reasons. These reasons include:

• Disclosing your health information when I believe that disclosure is necessary to prevent a serious threat to your health and safety or the health and safety of another person.
  Disclosing your health information as required by federal, state, or local law.
  Disclosing your health information as required by law to prevent injury or suspected abuse or neglect.
  Disclosing your health information in response to a court order, subpoena, warrant, summons or similar process.

Other uses and disclosures of health information.
Except where otherwise required or authorized by law, I will not use or disclose your health information for any purpose without your written authorization. If you authorize me to use or disclose health information about you, you may revoke your authorization, in writing, at any time. If you revoke your authorization, I will no longer use or disclose your health information for the reasons covered by your written authorization, but I cannot take back any uses or disclosures I have already made with your permission.

Your rights regarding your health information.  You have the following rights with regard to your health information:  

• You may inspect and copy your health information, with certain exceptions.
  If you believe that the health information I have about you is incorrect or incomplete, you may ask me to amend the information.
  You may obtain and account of my disclosures of your health information. This is a list of all of my disclosures of your health information for purposes other than treatment, payment and health care operations.
  You have the right to request that I restrict or limit my use or disclosure of your health information to only treatment, payment or health care operations. I am not required to comply with your request.
  You may request that I communicate with you about your health matters in a certain way or at a certain location. For example, you can ask that I only contact you at work or by mail.
• You have the right to receive a paper copy of this notice.  

If you want to exercise any of these rights, please contact me, in writing at my office where you are receiving counseling.  

Changes to this notice.  I have the right to change this notice. If I do so, the new notice will apply to the health information I may already have about you and the health information that I receive in the future. I am required to abide by the most current notice that is in effect. I will post a summary of the most current notice in my office. You are entitled to receive a copy of the most current notice.  

Complaints.  If you believe your privacy rights have been violated, you may file a complaint with my office or with the Secretary of the U. S. Department of Health and Human Services. To file a complaint with Guiding Path, please contact me at (801) 673-1447.  

This Notice is effective as of October 3, 2005  

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