Notice of Privacy Practices

Effective Date: 7-13-2013

Greenleaf Professional Counseling is committed to protecting your privacy. This Notice describes how medical and mental health information about you may be used and disclosed, and how you can access this information. Please review it carefully.

Your Protected Health Information (PHI)

We create and maintain records of the care and services you receive. These records include information about your symptoms, diagnosis, treatment, and billing. We are required by law to keep this information private and to provide you with this Notice.

How We May Use and Share Information

We may use and share your PHI for purposes of:

  • Treatment – coordinating your care with other professionals at your request.

  • Payment – billing your insurance or you directly.

  • Health Care Operations – improving our services and ensuring quality care.

We will not use or share your information for marketing or fundraising without your written permission.

Other Disclosures

We may also disclose your PHI when required by law, such as to:

  • Prevent or lessen a serious threat to health or safety.

  • Report suspected abuse or neglect.

  • Comply with court orders or legal processes.

Any other disclosures will only be made with your written authorization. You may revoke your authorization at any time.

Your Rights

You have the right to:

  • See and get a copy of your records.

  • Ask us to correct information you believe is inaccurate.

  • Request confidential communications or restrictions on certain uses or disclosures.

  • Get a list of who we’ve shared your information with.

  • Receive a paper copy of this Notice at any time.

Questions or Complaints

If you have questions or believe your privacy rights have been violated, you may contact us at:

Greenleaf Professional Counseling, LLC
Mailing Address:
P.O. Box 21
Roland, OK 74948
Email: info@greenleafprocounseling.com
Phone: 479-208-6464

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be retaliated against for filing a complaint.