Wiseman Counseling & Therapy
Jill Wiseman, MA, LPC-S

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

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Your health record contains personal information about you and your health. In order to provide you care, Jill Wiseman, MA, LPC-S (your “Provider”) and Wiseman Counseling & Therapy must collect, create and maintain health information about you, which includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. Your Provider is required by law to maintain the privacy of this information. This Notice of Privacy Practices (this “Notice”) describes how your health information may be used and disclosed, and explains certain rights you have regarding this information. Your Provider is required by law to provide you with this Notice, and will comply with the terms as stated.

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How Provider Uses and Discloses Your Health Information

Your Provider protects your health information from inappropriate use and disclosure, and will use and disclose your health information for only the purposes listed below:

Uses and Disclosures for Treatment, Payment, and Health Care Operations. Your Provider may use and disclose your protected health information in order to provide your care or treatment, obtain payment for services provided to you and in order to conduct our health care operations as detailed below.

• Treatment and Care Management. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultants only with your authorization. 

• Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your authorization. Our payment activities include, without limitation, making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection. 

• Health Care Operations. We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, resolving any complaints or grievances you may have, and conducting or arranging for other business activities . For example, we may share your PHI with third parties that perform various business activities (e.g., billing or administrative services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization. 

• ​Required by Law. Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule. We may use and disclose your health information as required by state, federal and local law. 

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Uses and Disclosures Without Your Consent or Authorization. Following is a list of the circumstances where disclosures are required and/or permitted by HIPAA without an authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations. 

• Abuse or neglect. Your provider may disclose your PHI to a state or local agency that is authorized by law to receive reports of suspected abuse or neglect of vulnerable populations such as children, the elderly or individuals with disabilities.

• Judicial and administrative proceedings. We may disclose your health information in the course of any judicial or administrative proceeding in response to an appropriate order of a court or administrative body, including a subpoena, Court Order, Administrative Order, or similar process. Many court-ordered services necessitate a report to the Court; therefore, your PHI would be included in such reports.

• Law enforcement purposes. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena, court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises. 

• Medical Emergencies. We may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency. 

• Individuals involved in your care. We may disclose your health information to a family member or close personal friend involved in your treatment based on your consent or as necessary to prevent serious harm. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, taking into account the circumstances and based upon our professional judgment. We may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission. 

• Deceased individuals. We may disclose PHI regarding deceased clients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate or the person identified as next-of-kin. PHI of persons who have been deceased for more than fifty (50) years is not protected under HIPAA. 

• Public Health. If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority. 

• Public safety. We may disclose your PHI, if necessary, to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat. 

• Health oversight activities. We may disclose your health information to federal or state health oversight agencies for activities authorized by law such as audits, investigations, inspections and licensing surveys.

• Specialized government functions. We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm. 

• Research. PHI may only be disclosed after a special approval process or with your authorization.

• Fundraising and Marketing. Your Provider will never use your PHI for fundraising or marketing purposes.

• Appointments, Information and Services. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related services that may be of interest to you.

• Incidental Uses and Disclosures. Incidental uses and disclosures of your health information sometimes occur and are not considered to be a violation of your rights. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.

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Special Treatment of Certain Records. HIV related information, genetic information, alcohol and/or substance abuse records, and other specially protected health information may enjoy certain special confidentiality protections (that are more restrictive than those outlined above) under applicable state and federal law. Any disclosures of these types of records will be subject to these special protections.

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Obtaining Your Authorization for Other Uses and Disclosures. Certain uses and disclosures of your health information will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; and (c) that constitute a sale of health information under the Privacy Rule. Your Provider will not use or disclose your health information for any purpose not specified in this Notice unless we obtain your express written authorization or the authorization of your legally appointed representative. If you give us your authorization, you may revoke it at any time, in which case we will no longer use or disclose your health information for the purpose you authorized, except to the extent we have relied on your authorization to provide your care.

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Your Rights Regarding Your Health Information

You have the following rights regarding your health information. To exercise any of these rights, please submit your request in writing to our Privacy Officer, Jill Wiseman, MA, LPC-S at 22720 Morton Ranch Rd. Suite # 160-174, Katy, Texas 77449.

• Right to Inspect or Get a Copy of Your Medical Record. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a “Designated record set.” A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is contained in separately maintained psychotherapy notes. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person. We may charge a reasonable, cost-based fee for providing copies of records, which may include the cost of labor for copying the requested PHI; supplies for creating the copy (e.g., paper, electronic media); postage for mailing the copy to the individual, where applicable; and, if agreed to by the individual, preparation of an explanation or summary of the PHI. We may impose a labor fee of up to one hour of your treatment services fee. 

• Right to Request Changes to Your Medical Record. You have the right to request changes to any health information we maintain about you if you state a reason why this information is incorrect or incomplete. Your Provider might not agree to make the changes you request. If we do not agree with the requested changes we will notify you in writing and inform you how to have your objection included in our records.

• Right to an Accounting of Disclosures. You have the right to receive a list of all disclosures we have made of your health information. The list will not include disclosures made for certain purposes including, without limitation, disclosures for treatment, payment or health care operations or disclosures you authorized in writing. Your request should specify the time period covered by your request, which cannot exceed six years. The first time you request a list of disclosures in any 12-month period, it will be provided at no cost. If you request additional lists within the 12-month period, we may charge you a nominal fee.

• Right to Request Restrictions. You have the right to request restrictions on the ways which we use and disclose your health information for treatment, payment and health care operations. We are required to comply with your request if it relates to a disclosure to your health plan regarding health care items or services for which you have paid the bill in full, though in other instances, we may not agree to the restrictions you request.

• Right to Request Confidential Communications. You have the right to ask us to send health information to you in a different way or at a different location. Your request for an alternate form of communication should also specify where and/or how we should contact you.

• Right to Receive Notification of Breach. You have the right to receive a notification, in the event that there is a breach of your unsecured health information, which requires notification under the Privacy Rule.

• Right to Paper Copy of Notice. You have the right to receive a paper copy of this Notice of Privacy Practices at any time. To make a request as described in any of the above, please contact your Provider.

• Right to File Complaints. If you believe your privacy rights have been violated you may file a complaint with your Provider or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against by your Provider for filing a complaint.

 

Changes to this Notice

Your Provider may change the terms of this Notice of Privacy Practices at any time. If the terms of the Notice are changed, the new terms will apply to all of your health information, whether created or received by your Provider before or after the date on which the Notice is changed. Any updates to the Notice will be provided to you.

The effective date of this notice is January 1, 2024.