Rosewood Therapy
Terms and Conditions
NOTICE OF PRIVACY PRACTICES
Rosewood Therapy LLC
Effective Date: [Insert Date]
This Notice describes how medical and mental health information about you may be used and disclosed and how you can access this information. Please review it carefully.
1. Our Commitment to Your Privacy
Rosewood Therapy LLC is committed to protecting the privacy of your Protected Health Information (PHI). We are required by law to:
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Maintain the privacy of your health information
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Provide you with this Notice of our legal duties and privacy practices
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Follow the terms of this Notice
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Notify you following a breach of unsecured health information
2. How We May Use and Disclose Your Health Information
We may use or disclose your PHI without your written authorization for the following purposes:
A. Treatment
We may use your information to provide, coordinate, or manage your mental health care. This may include sharing information with other healthcare providers involved in your care.
B. Payment
We may use and disclose information to bill and collect payment for services, including:
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Insurance claims
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Eligibility verification
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Co-pay and deductible collection
C. Health Care Operations
We may use your information for internal operations, including:
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Quality improvement
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Staff training
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Licensing compliance
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Administrative activities
3. Uses and Disclosures Requiring Your Authorization
We will obtain your written authorization before using or disclosing your information for purposes not described in this Notice, including:
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Most marketing communications
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Sale of health information
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Any other disclosures not permitted by law
You may revoke an authorization in writing at any time, except to the extent action has already been taken.
4. Special Situations Where Disclosure May Be Required or Permitted by Law
We may disclose your information without your authorization in the following situations:
A. Risk of Harm
If there is a serious risk of harm to yourself or others, we may disclose information as required to prevent harm.
B. Abuse or Neglect
We may report suspected abuse or neglect of children, elders, or vulnerable individuals as required by law.
C. Legal Proceedings
We may disclose information in response to a court order, subpoena, or other legal process.
D. Law Enforcement
We may disclose limited information if required by law enforcement authorities.
E. Public Health & Safety
We may disclose information when required for public health activities or safety concerns.
5. Your Rights Regarding Your Health Information
You have the following rights:
A. Right to Inspect and Copy
You may request access to your medical records. Requests must be submitted in writing. Fees may apply as allowed by law.
B. Right to Request Amendments
You may request corrections to your records if you believe information is inaccurate.
C. Right to an Accounting of Disclosures
You may request a list of certain disclosures made of your health information.
D. Right to Request Restrictions
You may request limits on how we use or disclose your information. We are not required to agree to all requests but will consider them.
E. Right to Request Confidential Communications
You may request that we contact you in a specific way (for example, only by phone or at a specific address).
F. Right to a Paper Copy of This Notice
You may request a paper copy of this Notice at any time.
6. Safeguards
We implement reasonable administrative, technical, and physical safeguards to protect your health information, including secure record systems and confidentiality protocols.
7. Changes to This Notice
We reserve the right to change this Notice. Any revisions will apply to all information we maintain. Updated versions will be posted on our website and available upon request.
8. Complaints
If you believe your privacy rights have been violated, you may:
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Contact us directly using the information below
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File a complaint with the U.S. Department of Health and Human Services
You will not be penalized for filing a complaint.
9. Contact Information
Rosewood Therapy LLC
223 Addison Road, Suite 303
Glastonbury, CT 06033
Phone: 860-681-4681
Email: EricaM@RosewoodTherapyCT.com