NOTICE OF PRIVACY PRACTICES (HIPAA)
Counseling Resource Services, Inc.
Effective Date: January 2014
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.
If you have questions about this Notice, please contact:
Counseling Resource Services, Inc.
13350 W Colonial Drive Suite 340,
Winter Garden FL 34787
Phone: 407-654-4433
Email: Admin@CounselingResourceServices.com
WHO WILL ABIDE BY THIS NOTICE
This Notice applies to all services provided by Counseling Resource Services, Inc. (CRS). The following
individuals and groups follow the terms of this Notice and may share your information with each other for
treatment, payment, and healthcare operations: All licensed therapists, clinicians, and mental health
professionals providing services through CRS
All employees, administrative staff, billing personnel, interns, and trainees
Any volunteers authorized to assist in your care
Contractors or consultants providing services who have access to health information, including billing, EMR
vendors, IT support, and phone/communication systems.
OUR RESPONSIBILITIES
Counseling Resource Services is required by law to:
• Maintain the privacy and security of your protected health information (PHI)
• Provide you with this Notice describing our legal duties and privacy practices
• Follow the terms of the Notice currently in effect
• Notify you if a breach occurs that may compromise your privacy or security
• Consider and respond to your requests regarding your information
• Accommodate reasonable requests for confidential communication
• We will not use or disclose your information for reasons not described in this Notice unless you give
written authorization.
HOW WE MAY USE AND DISCLOSE YOUR INFORMATION
We may use and disclose your health information for the following purposes:
1. Treatment
We may use your information to provide, coordinate, or manage your mental health care. This may include
sharing information with other providers involved in your care when you give permission or when necessary
for your safety and continuity of care.
1. Treatment
We may use your information to provide, coordinate, or manage your mental health care. This may include
sharing information with other providers involved in your care when you give permission or when necessary
for your safety and continuity of care.
1. Treatment
We may use your information to provide, coordinate, or manage your mental health care. This may include
sharing information with other providers involved in your care when you give permission or when necessary
for your safety and continuity of care.
1. Treatment
We may use your information to provide, coordinate, or manage your mental health care. This may include
sharing information with other providers involved in your care when you give permission or when necessary
for your safety and continuity of care.
2. Payment
We may use and disclose your information to bill you, your insurance company, your Employee Assistance
Program (EAP), or other payers. This may include information needed for prior authorization or benefit
determination.
3. Healthcare Operations
We may use your information for quality improvement, supervision, auditing, accreditation, compliance,
training, and administrative purposes.
4. Appointment Reminders & Scheduling
We may contact you by phone, voicemail, text message, email, or mail to remind you of appointments or
communicate about services. (Texting is not a secure method; please avoid sharing personal health
information via text.)
5. Individuals Involved in Your Care
With your consent—or when permitted by law—we may disclose information to a family member, close
friend, or caregiver involved in your treatment or payment.
6. Safety Concerns
We may disclose information if necessary to prevent serious and imminent harm to you or others.
7. As Required by Law
We may disclose information for purposes including:
• Mandatory reporting of abuse, neglect, or exploitation
• Public health activities
• Court orders, subpoenas, or legal proceedings
• Law enforcement requests when required
• Health oversight activities (audits, investigations, licensure)
8. Business Associates
We work with external companies (billing services, electronic health record vendors, IT support, phone/texting
providers, consultants). When your information is shared with these partners, they are required by contract to
protect it under HIPAA.
OTHER USES REQUIRING YOUR AUTHORIZATION
Uses and disclosures not described in this Notice—such as:
• Most uses of psychotherapy notes
• Most marketing communications
• Sale of health information
—will only occur with your written authorization. You may revoke authorization at any time in writing.
YOUR RIGHTS REGARDING YOUR INFORMATION
You have the right to:
1. Access Your Records
Request to inspect or obtain a paper or electronic copy of your record. Reasonable fees may apply.
2. Request an Amendment
Ask us to correct or clarify information in your record if you believe it is incorrect or incomplete.
3. Request Confidential Communications
Ask us to contact you by an alternative method (different phone number, mailing address, etc.).
4. Request Restrictions
Ask us to limit what we share. Although we are not required to agree, we will consider all requests.
5. Accounting of Disclosures
Request a list of disclosures made in the past six years, excluding those for treatment, payment, and
operations.
6. Paper or Electronic Copy of This Notice
You may request one at any time.
7. Choose a Representative
A guardian or person with medical power of attorney may exercise your rights on your behalf.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time. Changes will apply to all information we maintain, past
and present. The most current version will always be posted on our website and available in our office.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with:
Counseling Resource Services, Inc.
13350 W Colonial Drive, Suite 340
Winter Garden, FL 34787
Email: Admin@CounselingResourceServices.com
or with the U.S. Department of Health & Human Services at:
https://ocrportal.hhs.gov/
We will not retaliate against you for filing a complaint.