Still Waters Counseling and Education Center

400 Office Park Drive, Suite 230

Mountain Brook, Alabama 35223

Hello@mystillwaters.org

205-825-1423

 

Effective Date: March 10, 2025

​

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

​

I. Our Pledge Regarding Health Information

At Still Waters Counseling and Education Center, we are committed to protecting your personal health information. We maintain a record of the care and services you receive from our team of licensed therapists, which helps us provide quality care and meet legal requirements.

This Notice applies to all health records created or maintained by our practice and explains how we may use and share your health information, as well as your rights regarding that information.

We are required by law to:

• Keep your protected health information (PHI) private

• Provide you with this Notice of our legal duties and privacy practices

• Follow the terms of this Notice currently in effect

We may revise this Notice at any time. Changes will apply to all information we have about you and will be available in our office, on our website, and upon request.

 

II. How We May Use and Disclose Your Health Information

For Treatment, Payment, and Health Care Operations

We may use or disclose your PHI for the following purposes without your written permission:

• Treatment: To provide, coordinate, or manage your care (e.g., consultation between providers).

• Payment: To bill and collect payment from you, an insurance company, or a third party.

• Health Care Operations: To run our practice efficiently (e.g., supervision, case review, audits).

Disclosures for treatment purposes may include access to your full record, as necessary to provide safe and effective care.

 

III. Uses and Disclosures That Require Your Written Authorization

We must obtain your written authorization for:

• Psychotherapy Notes: Except for use in treatment, supervision, legal defense, HHS compliance, or as required by law.

• Marketing purposes: We will not use your PHI for marketing without your written permission.

• Sale of PHI: We do not sell your PHI under any circumstances.

You may revoke your authorization in writing at any time, except to the extent that we have already relied on it.

 

IV. Other Permitted or Required Disclosures Without Authorization

Subject to certain limitations in the law, we may use and disclose your PHI without your written authorization for the following reasons:

• When required by state or federal law, and the disclosure complies with and is limited to the requirements of that law.

• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

• For health oversight activities, including audits, investigations, inspections, or licensing by government agencies.

• For judicial and administrative proceedings, including responding to a court or administrative order, though our preference is to obtain your authorization first when possible.

• For law enforcement purposes, such as reporting a crime on our premises or as required by law.

• To coroners or medical examiners, when such individuals are performing duties authorized by law (e.g., determining cause of death).

• For specialized government functions, such as military or national security activities, as required by law.

• For workers’ compensation purposes:
  If you are involved in a workers’ compensation claim and your mental health is deemed relevant to that claim, we may be required by law to disclose certain limited health information to your employer, the insurer, or their representatives. These disclosures are made strictly to comply with applicable Alabama workers’ compensation laws and are limited to the information necessary to support the claim. We will not release your records for workers’ compensation purposes unless it is legally required or you give written permission.

• For appointment reminders and health-related benefits or services, such as contacting you about an upcoming appointment or informing you of services we offer.

 

V. Disclosures to Others Involved in Your Care

We do not disclose your protected health information to family members, friends, or others involved in your care without your prior written authorization, except in emergency situations where you are unable to provide consent and disclosure is necessary to prevent serious harm. In such cases, we will use professional judgment and disclose only what is necessary. Otherwise, any communication with a third party requires a signed Release of Information.

 

VI. Your Rights Regarding Your Protected Health Information

You have the following rights regarding the PHI we maintain about you:

1. Right to Request Restrictions - You can ask us not to share certain information about your care. In most cases, we don’t have to agree. But if you pay in full out-of-pocket for a service and ask us not to tell your insurance company about it, we must agree and keep that information private from your insurance.

2. Right to Confidential Communications
   You may request that we contact you in a specific way (e.g., only by email or at work), and we will honor reasonable requests.

3. Right to Access
   You may inspect or receive an electronic or paper copy of your record (excluding psychotherapy notes) within 30 days of your written request. Reasonable, cost-based fees may apply.

4. Right to Amend
   If you believe your record is incorrect or incomplete, you may request an amendment. If we deny your request, we will explain why in writing within 60 days.

5. Right to an Accounting of Disclosures
   You may request a list of disclosures (not including treatment, payment, or operations) made in the past six years. The first request in a 12-month period is free; additional requests may incur a fee.

6. Right to a Paper or Electronic Copy of This Notice
   You may request a paper or electronic copy of this Notice at any time, even if you previously agreed to receive it electronically.

7. Right to Notification of a Breach
   If there is a breach of your unsecured PHI, we will notify you in accordance with federal and state laws.

 

VII. Business Associates

We may share your PHI with third-party service providers (e.g., billing services, electronic records systems) who assist in our operations. These business associates are contractually required to safeguard your information in compliance with HIPAA.

 

VIII. Complaints and Contact Information

If you believe your privacy rights have been violated, you have the right to file a complaint. We will never retaliate or take any adverse action against you for doing so.

You may file a complaint with:

Still Waters Counseling and Education Center
400 Office Park Drive, Suite 230
Mountain Brook, AL 35223
hello@mystillwaters.org | (205) 825-1423

or with:

U.S. Department of Health and Human Services – Office for Civil Rights
https://www.hhs.gov/hipaa/filing-a-complaint/index.html