Couples Therapy Specialist · Charlotte NC · (980) 577-3285 · Free 15-Min Consult
Therapeutic AdvancesPLLC · Private Practice

HIPAA Notice of Privacy Practices

Therapeutic Advances PLLC · Tabitha Evans, LCSW · Effective: January 2024

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Who We Are

Therapeutic Advances PLLC, operated by Tabitha Evans, LCSW, is a covered entity under the Health Insurance Portability and Accountability Act (HIPAA). We are committed to protecting the privacy of your protected health information (PHI).

How We May Use and Disclose Your PHI

Treatment: We may use your PHI to provide, coordinate, or manage your mental health treatment. This includes sharing information with other healthcare providers involved in your care with your consent.

Payment: We may use your PHI to bill and collect payment for services rendered.

Healthcare Operations: We may use your PHI for internal operational purposes, including quality assessment, training, and compliance.

Required by Law: We will disclose your PHI when required to do so by federal, state, or local law, including mandatory reporting requirements (such as child abuse, elder abuse, or imminent risk of harm to self or others).

Your Rights Regarding Your PHI

You have the right to: • Request a copy of your health records • Request corrections to your health records • Request restrictions on how we use or disclose your PHI • Request a list of disclosures we have made • Request confidential communications • Receive a paper copy of this Notice • File a complaint if you believe your privacy rights have been violated

Disclosures We Will Never Make Without Authorization

We will not disclose your PHI to employers, family members, or any third party without your written authorization, except as required by law or as described in this Notice.

Confidentiality Exceptions

Confidentiality will be broken only in limited circumstances: if there is imminent risk of harm to you or others; if there is suspected abuse or neglect of a child, elder, or dependent adult; if a court orders disclosure; or if required by other applicable law. Tabitha will discuss these limits with you in your first session.

How to Exercise Your Rights

To exercise any of the rights described above, contact Tabitha Evans, LCSW at:

Therapeutic Advances PLLC Phone: (980) 577-3285 Email: info@therapeuticadvancespllc.com

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Therapeutic Advances PLLC or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.