Notice of Privacy Practices

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

Our commitment

Fair Winds Assessment and Counseling Center is required by law to keep your protected health information (PHI) private, to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if a breach of your unsecured PHI occurs.

How we may use and share your information

• Treatment. To provide, coordinate and manage your care, including with other providers involved in your care.
• Payment. To bill and collect payment from you, your insurance plan or another third party.
• Health care operations. To run our practice, improve care and train staff.
• When required by law. Including reporting suspected abuse or neglect, responding to court orders, and public health and safety needs.
• To prevent serious harm. To lessen a serious and imminent threat to the health or safety of a person or the public.

Psychotherapy notes, marketing uses and sale of your information require your written authorization. You may revoke an authorization in writing at any time.

Your rights

You have the right to:

• See and get a copy of your health and billing records
• Ask us to correct records you believe are incorrect or incomplete
• Request confidential communications, such as contact at a different address or phone number
• Ask us to limit what we use or share
• Get a list of those with whom we’ve shared information
• Get a paper copy of this notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Complaints

You can complain to our office by calling 817-735-4165 or writing to us at 6551 Harris Parkway, Suite 240, Fort Worth, TX 76132. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to this notice

We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on our website.