Notice of Privacy Practices

WILLIAM MARSHALL CSW THERAPIST LLCWilliam S. Marshall IV, LMSW
850 Windy Hill Road SE, Unit 7, Smyrna, GA 30081-3000
Telephone: 770-333-4531 • Email: [email protected]NOTICE OF PRIVACY PRACTICESTHIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.Effective date of this notice: September 4, 2026I. My Pledge Regarding Health InformationHealth information about you and your health care is personal, and I am committed to protecting it. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to meet certain legal requirements. This notice applies to all of the records of your care that this practice generates. It describes the ways I may use and disclose health information about you, your rights regarding that information, and my obligations concerning its use and disclosure.I am required by law to:- Keep protected health information ("PHI") that identifies you private.- Give you this notice of my legal duties and privacy practices with respect to your health information.- Follow the terms of the notice currently in effect.- Notify you if a breach occurs that may have compromised the privacy or security of your health information.I may change the terms of this notice, and any changes will apply to all information I hold about you. A revised notice will be made available to you on request and through the secure client portal.II. How I May Use and Disclose Health Information About YouThe categories below describe the different ways I use and disclose health information, with examples. Not every use or disclosure is listed, but every use or disclosure I am permitted to make falls within one of these categories.For Treatment, Payment, or Health Care Operations. Federal privacy rules allow health care providers who have a direct treatment relationship with a client to use or disclose that client's personal health information, without written authorization, to carry out their own treatment, payment, or health care operations. I may also disclose your protected health information for the treatment activities of another health care provider without your written authorization. For example, if I were to consult with another licensed health care provider about your care, I would be permitted to use and disclose otherwise confidential information in order to assist in the assessment and treatment of your condition.Disclosures for treatment purposes are not limited by the "minimum necessary" standard, because health care providers may need access to the full record in order to provide quality care. "Treatment" includes, among other things, coordination and management of care among providers and referral of a client from one provider to another.Clinical Supervision. I hold an associate-level license and practice under the clinical supervision of Melanie Storrusten, LCSW, as Georgia law requires for licensure at my level. I discuss my cases with her, including information about you. Your information is protected within that relationship in the same way it is protected by me directly.Lawsuits and Disputes. If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.III. Certain Uses and Disclosures Require Your Authorization1. Marketing Purposes. I will not use or disclose your PHI for marketing purposes.2. Sale of PHI. I will not sell your PHI.Any other use or disclosure not described in this notice will be made only with your written authorization. You may revoke that authorization at any time, in writing, except to the extent I have already acted on it.IV. Certain Uses and Disclosures Do Not Require Your AuthorizationSubject to limitations in the law, I may use and disclose your PHI without your authorization for the following reasons:1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the requirements of that law.2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone's health or safety.3. For health oversight activities, including audits and investigations.4. For judicial and administrative proceedings, including responding to a court or administrative order, though my preference is to obtain your authorization first.5. For law enforcement purposes.6. To coroners or medical examiners performing duties authorized by law.7. For specialized government functions, including military missions, protective services, intelligence operations, and the safety of those working within or housed in correctional institutions.8. For workers' compensation purposes. My preference is to obtain your authorization, but I may provide your PHI in order to comply with workers' compensation laws.9. For appointment reminders and information about health-related services. I may use and disclose your PHI to remind you of an appointment, or to tell you about treatment alternatives or other services I offer.V. Certain Uses and Disclosures Require You to Have the Opportunity to ObjectDisclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person you indicate is involved in your care or in payment for your care, unless you object in whole or in part. In an emergency, your agreement may be obtained afterward.VI. Your Rights With Respect to Your PHI1. The right to request limits on uses and disclosures of your PHI. You may ask me not to use or disclose certain PHI for treatment, payment, or health care operations. I am not required to agree, and I may decline if I believe it would affect your care.2. The right to request restrictions for out-of-pocket expenses paid in full. You may request restrictions on disclosure of your PHI to a health plan for payment or health care operations purposes if the information pertains solely to an item or service you have paid for out of pocket in full.3. The right to choose how I send PHI to you. You may ask me to contact you in a specific way, or to send mail to a different address, and I will agree to all reasonable requests.4. The right to see and get copies of your PHI. You have the right to get an electronic or paper copy of your record and other information I hold about you. I will provide a copy of your record, or a summary if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee.5. The right to get a list of the disclosures I have made. You may request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided an authorization. I will respond within 60 days. The list will cover disclosures made in the last six years unless you request a shorter period. There is no charge for the first request in a year; I may charge a reasonable, cost-based fee for additional requests in the same year.6. The right to correct or update your PHI. If you believe there is a mistake in your PHI, or that important information is missing, you may request that I correct or add to it. I may decline, but I will tell you why in writing within 60 days.7. The right to get a paper or electronic copy of this notice. You have the right to a paper copy of this notice, and the right to receive it by email. Even if you have agreed to receive it by email, you may still request a paper copy.VII. ComplaintsIf you believe your privacy rights have been violated, you may file a complaint with me directly, using the contact information at the top of this notice. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services:Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue SW, Washington, D.C. 20201
Telephone: 1-877-696-6775
Online: www.hhs.gov/ocr/privacy/hipaa/complaints/I will not retaliate against you in any way for filing a complaint. Filing a complaint will not affect your care.VIII. QuestionsIf you have questions about this notice or about how your health information is handled, please ask me at any time, or contact me at [email protected] or 770-333-4531.