PRIVACY PRACTICES

RIVER ROSE COUNSELING AND CONSULTING, LLC ("River Rose") is committed to protecting your privacy. River Rose is mandated by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. River Rose is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains River Rose's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.

YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to River Rose at the address noted below.

To inspect and copy PHI.
• You can ask for an electronic or paper copy of PHI. The fee for this service is $15 and is not covered by insurance.
• River Rose may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.

To amend PHI.
• You can ask to correct PHI you believe is incorrect or incomplete. River Rose may require you to make your request in writing and provide a reason for the request.
• River Rose may deny your request. River Rose will send a written explanation for the denial and allow you to submit a written statement of disagreement.

To request confidential communications.
• You can ask River Rose to contact you in a specific way. River Rose will say “yes” to all reasonable requests. Our therapists generally communicate via text message and email which is not a secure form of communication. IF YOU DO NOT WISH TO COMMUNICATE THIS WAY PLEASE LET US KNOW AND WE WILL ACCOMMODATE YOUR REQUEST.

To limit what is used or shared.
• You can ask River Rose not to use or share PHI for treatment, payment, or business operations. River Rose is not required to agree if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask River Rose not to share PHI with your health insurer.
• You can ask for River Rose not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.

To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.

To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.

To choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.

To file a complaint if you feel your rights are violated.
• You can file a complaint by contacting the Practice using the following information:
River Rose Counseling and Consulting, LLC
788 E Stuart Drive, Suite A, Galax, VA 24333
Catherine Burcham, Owner
276.233.1263
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• River Rose will not retaliate against you for filing a complaint.

OUR USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
River Rose is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. River Rose typically uses or shares your health information in the following ways:

To treat you.
• River Rose can use and share PHI with other professionals who are treating you.
• Example: Your primary care doctor asks about your mental health treatment.

To run the health care operations.
• River Rose can use and share PHI to run the business, improve your care, and contact you.
• Example: River Rose uses PHI to send you appointment reminders if you choose.

To bill for your services.
• River Rose can use and share PHI to bill and get payment from health plans or other entities.
• Example: River Rose gives PHI to your health insurance plan so it will pay for your services.

2. Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object
River Rose may use or disclose PHI without your authorization or an opportunity for you to object, including:

To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
• Serious threat to health or safety: To prevent a serious and imminent threat.
• Abuse or Neglect: To report abuse, neglect, or domestic violence.

To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law.
• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
• Law enforcement: For law to locate and identify you or disclose information about a victim of a crime.
• Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
• National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
• Workers' Compensation: To comply with workers' compensation laws or support claims.

To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized duties.
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional review board.
• Inmates: The Practice created or received your PHI in the course of providing care.
• Business Associates: To organizations that perform functions, activities or services on our behalf.

3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object
Unless you object, the Practice may disclose PHI:

To your family, friends, or others if PHI directly relates to that person's involvement in your care.

If it is in your best interest because you are unable to state your preference.

4. Uses and Disclosures of PHI Based Upon Your Written Authorization
River Rose must obtain your written authorization to use and/or disclose PHI for the following purposes:

Marketing, sale of PHI, and psychotherapy notes.

You may revoke your authorization, at any time, by contacting River Rose in writing, using the information above. River Rose will not use or share PHI other than as described in Notice unless you give your permission in writing.

OUR RESPONSIBILITIES
• River Rose is required by law to maintain the privacy and security of PHI.
• River Rose is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, River Rose will abide by the more stringent law.
• River Rose he right to amend Notice. All changes are applicable to PHI collected and maintained by River Rose. Should River Rose make changes, you may obtain a revised Notice by requesting a copy from River Rose.
• River Rose will notify you if PHI is compromised in a breach.