HIPAA information

YOUR INDIVIDUAL RIGHTS

1. Right to Inspect and Copy. You have the right to look at or get copies of your health information, with limited exceptions. Your request must be in writing. If you request a copy of the information, a reasonable charge may be made for the costs incurred.
2. Right to Amend. You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We have the right to deny your request under certain circumstances.
3. Right to an Accounting of Disclosures. You have the right to receive a list of instances in which we have disclosed your health information for a purpose other than treatment, payment, or health care operations. To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer. Such accountings remain available for six years after the last date of service at the Practice.
4. Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you. While you are in treatment, a written request should be made with your therapist. To request a restriction after therapy is completed, you must make your written request to the Privacy Officer. Please note that we are not required to agree to your request, except when a restriction is requested regarding a disclosure to a health plan in situations where the patient has paid for services in full and where the purpose of the disclosure is for payment. If we do agree, we will abide by the restriction unless the information is needed in an emergency or we are required to disclose it by law.
5. Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we contact you only by mail or at work. You must make this request in writing and it must specify the alternative means or location that you would like us to use to provide you information about your health care. We will make every attempt to accommodate reasonable requests.
6. Right to File Complaints. You may complain to us and to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by contacting the Privacy Officer at compliance@headway.co or via phone at (833) 384-1044

My license as an LPCS #64076 is governed by the Texas Behavioral Health Executive Council and the Board Of Professional Examiners of Licensed Professional Counselors. 

Their contact information is:
BHEC
1801 Congress Avenue, Ste 7300
Austin, TX 78701
512-305-7000
Investigations and Complaints 24 Hr 1-800-821-3205

My South Dakota License as an LPC20874 is governed by the South Dakota Board of Examiners for Counselors and Marriage and Family Therapists

Their contact information is:
PO Box 340
Pierre, SD 57501
605-224-1721
dss.sd.gov
sdbce@midwestsolutionssd.com
Hours of Operation
8:30am - 5:00pm (CT), Monday - Friday

My Georgia License as an LPC013858 is governed by the Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists.

Their contact information is:
Georgia State Board of Professional licensiing
237 Coliseum Drive
Macon GA 31217
404-424-9966
www.sos.ga.gov/plb