Notice of Privacy Practices (HIPAA)

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.

Understanding Your Health Record

Each time you visit Journey Ahead Resources, LLC, a record of your visit is made. Typically, this record contains information about your symptoms, medical history, test results, diagnoses, treatment, and plans for future care or treatment.

This information, often referred to as your health or medical record, serves as a basis for planning your care and treatment, a means of communication among health professionals who contribute to your care, and a legal document describing the care you received.

How We May Use or Disclose Your Health Information

Treatment

We may use your health information to provide you with treatment and services. We may disclose your health information to other healthcare professionals involved in your care.

Payment

We may use and disclose your health information to bill and collect payment for services. This may include contacting your insurance company to verify coverage or submit claims.

Health Care Operations

We may use and disclose your health information to support our business activities, including quality assessment, licensing, and training.

Your Rights Regarding Your Health Information

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and obtain a copy of your health information.
Right to Amend: You may request that we amend your health information if you believe it is incorrect or incomplete.
Right to an Accounting: You have the right to request an accounting of disclosures of your health information.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your information.
Right to Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location.
Right to a Paper Copy: You have the right to obtain a paper copy of this notice upon request.

Our Responsibilities

We are required by law to:

Maintain the privacy of your health information
Provide you with this notice of our legal duties and privacy practices
Notify you if we cannot agree to a requested restriction
Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.

Questions and Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact:

Janet Mitchell, LCSW
Journey Ahead Resources, LLC
609 Airport North Office Park
Fort Wayne, IN 46825
(260) 255-5085

You will not be penalized for filing a complaint.

Acknowledgment

I acknowledge that I have received and reviewed the Notice of Privacy Practices for Journey Ahead Resources, LLC. I understand how my health information may be used and disclosed, and I understand my rights regarding my health information.

Electronic Signature

Full Legal Name *

Today's Date *

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