Autumn Leaf Counseling Notice of Privacy Practices / Terms & Conditions

 This notice describes how medical information about you may be used and disclosed and how you can get  access to it. Please review carefully.  

1. Autumn Leaf Counseling respects your privacy by opting into our SMS messaging service you agree to the following terms regarding how we handle you data.

• Data Collection: We will collect your name, email address, mailing address, and mobile phone number when you sign up for SMS updates.
• The information will be collected via the website contact form.
• Data Usage: We use your data solely for sending appointment reminders, scheduling requests, appointment cancellations, or billing inquiries.
• Data Security: We protect your data with secure storage measures to prevent unauthorized access.
  
• Data Retention: We retain your information as long as you are subscribed to out SMS service.  You may request deletion at any time.
• MESSAGE AND DATA RATES MAY APPLY.  Your mobile carrier may charge fees for sending or receiving text messages, especially if you do not have an unlimited texting or data plan.
  
• Messages are recurring, and message frequency varies.
  
• Contact Autumn Leaf Counseling at 630-228-6011 or [email protected] for HELP or to STOP receiving messages.
  
• Opt-Out: You can Opt-Out of the SMS list at any time by texting, emailing, or replying STOP or UNSUBSCRIBE to Autumn Leaf Counseling or 630-228-6011 or [email protected].  After unsubscribing, you will receive a final SMS to confirm you have unsubscribed and we will remove your number from our list within 24 hours.
  
• You can send HELP for additional assistance, and you will receive a text including our phone number, email, and website.  We are here to help you.
• Non-Sharing Clause: We do not share your data for marketing purposes.  Autumn Leaf Counseling will not sell, rent, or share the collected mobile numbers.

2. Your medical records are used to provide treatment, bill and receive payments, and conduct  healthcare operations. Examples of these activities include but not limited to review of treatment  records to ensure appropriate care, electronic or mail delivery of billing for treatment to you or  other authorized payers, appointment reminder telephone calls/texts, and records review to ensure  completeness and quality of care. Use and disclosure of medical records is limited to the internal  used outlined above except required by law or authorized by the patient or legal guardian.  

3. Federal and State laws require abuse, neglect, domestic violence and threats to be reported to  social services or other protective agencies. If such reports are made they will be disclosed to you  or your legal representative unless disclosure increases risk of further.  

4. Disclosed information will be limited to the minimum necessary. You may request an account for  any uses or disclosures other than those described in Sections 1 and Sections 2.  

5. You, or your legal representative, may request your records to be disclosed to yourself or any  other entity. Your request must be made in writing, clearly identify the person authorized to  request the release, specify the information you want disclosed, the name and address of the entity  you want the information released to, purpose and the expiration date of the authorization. Any  authorization provided may be revoked in writing at anytime. Psychotherapy notes are part of  your medical records. We have 30 days to respond to a disclosure request and 60 days if the  records is stored off site.  

6. You may request corrections to your records.  

7. A request for disclosure may be denied under the following circumstances: disclosure would  likely endanger the life or physical safety of you or another person, requested information  references other persons, except another healthcare provider, or if released to a legal  representative would likely result in harm. 

8. If a request for disclosure is denied for reasons outlined in Section 6, you or your legal  representative may request review of the denial. A review will be conducted by another licensed 
healthcare provider appointed by the original reviewer, who was not involved in the original  decision to deny access. A review will be concluded within 30 days.  

9. You may request that we restrict uses and disclosures outlined in Section 1. However, we are not  required to agree to the restrictions. If an agreement is made to restrict use or disclosure, we will  be bound by such restriction until revoked by you or your legal representative orally or in writing  except when disclosure is required by law or in an emergency. We may also revoke such  restrictions but information gathered while required by law or in an emergency. We may also  revoke such restrictions but information gathered while the restriction was in place will remain  restricted by such an agreement.  

10. If you wish to complain about privacy related issues you may contact the Secretary of the  Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence  Avenue SW, Washington DC, 20201. In any case there will not be any retaliation against you or  your legal representative for filing a complaint.  

11. This agreement may be modified or amended as required by law or in the course of health care operations.