Notice of Privacy Practices

Notice Effective Date: 8/6/2023

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Fidanexa Counseling PLLC (hereby referred to as the “Practice”) presents you with this notice in accordance with HIPAA regulations. This notice describes how the Practice may use and disclose your healthcare information and how you can get access to your healthcare information.

If the Practice has provided you with any information that contradicts this notice, then this Notice of Privacy Practices will supersede that other information. Please review this notice carefully.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of the Practice’s responsibilities to help you.

Get an electronic or paper copy of your medical record

•        You can ask to see or get an electronic or paper copy of your medical record and other health information that the Practice has about you, other than psychotherapy notes, which are personal notes regarding conversations with your therapist during counseling sessions.

•        To see or obtain a copy of your medical records or other health information, you must provide the Practice with a written request specifying the specific information you would like to receive.  Please ask for a request form you may use.

•        The Practice will provide a copy or a summary of your health information, usually within 30 days of your request. The Practice will charge $0.10 per printed page of information, whether the Practice copies your records or provides a summary of your health information in lieu of actual records.

Ask to correct your medical record

•        You can ask the Practice to correct health information about you that you think is incorrect or incomplete. To do this, you must provide the Practice with a written request specifying the specific information that is incorrect or incomplete, as well as what changes you would like to be made. Please ask for a request form you may use.

•        The Practice may say “no” to your request, but will tell you why in writing, usually within 60 days.

Request confidential communications

•        You can ask the Practice to contact you in a specific way (for example, home or office phone) or to send mail to a different address.  You must request a change in the way the Practice contacts you in writing. Please ask for a request form you may use.

•        The Practice will say “yes” to all reasonable requests.

•        If you do not specify how the Practice may contact you, the Practice may communicate with you by any means, and may contact you at any address, telephone number or email address you provide.

Ask to limit what the Practice uses or shares

•        You can ask the Practice not to use or share certain health information for treatment, payment, or operations. The Practice is not required to agree to your request, and may say “no” if it would affect your care. The Practice prefers that you make your request in writing. Please ask for a request form you can use.

•        If you pay for a service or health care item out-of-pocket in full, the Practice will not share that information for the purpose of payment or operations with your health insurer, unless a law requires the Practice to share that information.

Get a list of those with whom the Practice shared information

•        You can ask for a list (accounting) of the times the Practice shared your health information for six years prior to the date you ask, who the Practice shared it with, and why.

•        The Practice will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked the Practice to make). The Practice will provide one accounting a year for free but will charge $0.10 per printed page of information if you ask for another one within 12 months.

Get a copy of this privacy notice

•   You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. The Practice will provide you with a paper copy promptly.

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 and make choices about your health information.

•        The Practice will make sure the person has this authority and can act for you before taking any action.

File a complaint if you feel your rights are violated

•        If you feel The Practice has violated your rights, you can complain by contacting your privacy contact, Viktor Jakab, LPC, at 203-208-6282, or by email at clients@fidanexa.com.

•        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/.

•        The Practice will not retaliate against you for filing a complaint.

Uses and Disclosures

How does the Practice typically use or share your health information?

The Practice cares about your privacy and strives to protect the confidentiality of your health information. The following categories describe different ways that the Practice may typically use your health information.

For treatment

The Practice can use your health information to provide you with treatment or services.

Example: The Practice will use health information you provide to diagnose your mental health condition and provide you with appropriate counseling services.

To run the Practice

The Practice can use your health information to run its business, improve your care, and contact you when necessary.

Example: The Practice uses health information to manage your treatment and services and evaluate its performance in caring for you.

Other uses or disclosures that can be made without your authorization

Under Connecticut law, communications between a licensed professional counselor and a client or a client’s family member related to the diagnosis and treatment of the client are confidential and, in general, may not be shared with anyone else without authorization.  There are, however, limited exceptions to this general rule that permit the Practice to disclose your health information without your consent.  The Practice may disclose certain health information if:

  • It is required by Connecticut law

  • Child abuse, or abuse of an elderly or disabled individual, is known or suspected

  • To prevent a clear and present danger to the health or safety of an individual

  • To avert a risk of imminent personal injury to you or others or a risk of imminent injury to the property of others

  • The information is disclosed to The Practice during the course of a mental health assessment ordered by a court and you have been informed that the information will not be privileged

  • Your mental health condition is introduced in a civil proceeding in court

  • The Practice use a third party to collect fees you owe, for services rendered

Under HIPAA regulations, psychotherapy notes (personal notes regarding conversations with your therapist during counseling sessions) may generally not be shared with anyone else without authorization. Only a few of the exceptions specified above permit the Practice to disclose psychotherapy notes without your authorization.

My Responsibilities

•        The Practice is required by law to maintain the privacy and security of your protected health information.

•        The Practice will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

•        The Practice must follow the duties and privacy practices described in this notice and give you a copy of it.

•        The Practice will not use or share your information other than as described here unless you indicate otherwise in writing.  Specific information must be included in written authorizations required by HIPAA.  Please ask for an authorization form you may use.

•        If you authorize the Practice to use or disclose your information in a way not provided in this notice, you may change your mind (revoke your authorization) at any time. Let the Practice know in writing if you change your mind.

•        The Practice will never share your information for marketing purposes, sell your personal information or list your personal information in a directory, unless required by Federal or State law.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

The Practice can change the terms of this notice, and the changes will apply to all information the Practice has about you.  The new notice will be available upon request.

Privacy Contact

Viktor Jakab, LPC, is your privacy contact.  If you have questions, concerns or complaints about these privacy practices, you can email him at clients@fidanexa.com or call 203-208-6282.