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HIPAA Notice of Privacy Practices


This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) for treatment, payment, or health care operations (TPO), as well as for other purposes that are permitted or required by law. It also outlines your rights to access and control your protected health information.Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services. The Employee Assistance Program (EAP) does not release any information to insurance companies or collect medical information on you; we are a separate individual service provided to you by your company. All information obtained by the EAP remains in our offices.

Uses and Disclosures of Protected Health Information

Your therapist, our office staff, and other persons involved in your care and treatment may use and disclose your protected health information for the purposes of providing health care services to you, paying for your EAP sessions, supporting the operation of the EAP, or for any other use that is required by law.

Treatment: We will use and share your protected health information to offer, organize, and manage your counseling and any associated services. This includes arranging or managing your health care with a third party. For instance, we may share details about your current therapy with a drug and alcohol treatment center if you are referred there for additional care under the guidance of the EAP.

Payment:  Your therapist may use your protected health information, such as your demographics, as needed to receive payment for your EAP sessions.

EAP Operations: We may use or disclose your protected health information, as necessary, to support the business activities of your EAP, such as quality assessment, review, training of staff, and other related activities. For example, we may disclose your protected health information to the EAP for payment, or contact the therapist to confirm the EAP referral and appointment dates.

Without your authorization, we may disclose your protected health information in the following situations: as required by law, public health issues, communicable diseases, health oversight, abuse or neglect, Food and Drug Administration requirements, legal proceedings, law enforcement, coroners, funeral directors, and organ donation, research, criminal activity, military activity and national security, workers compensation, inmates, and required uses and disclosures for investigation or determining our compliance with the Department of Health and Human Services. (Note that some of the above do not apply to EAP services)

Other Permitted and Required Uses and Disclosures Only with your consent, authorization, or opportunity to object (unless required by law) will changes be made. For instance, if a supervisor refers you, we will ask you to sign an authorization form granting the therapist permission to disclose information about your progress in treatment, recommendation, and attendance to the EAP. This authorization will then permit the EAP to report your attendance and compliance with the recommendations to your supervisor.

You may revoke this authorization, at any time, in writing, except to the extent that your EAP or therapist has taken an action in reliance on the use or disclosure indicated in the authorization.

You’re Rights

Following is a statement of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information.  Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

You have the right to request a restriction of your protected health information.  This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Under normal practice of the EAP we only discuss protected health information with the therapist and you, the client, unless an authorization has been signed.

Your EAP is not required to agree to a restriction that you may request. If the EAP believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to not use the EAP.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically.

You may have the right to have your EAP amend your protected health information.  If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.


You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on/or before September 14, 2003.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our Main Phone Number.

For more information, contact Employee Business Solutions, Inc.


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