Client Rights and Responsibilities:
- You have the right to request a copy of any your records at any time by calling us at 432.557.1775 or asking your counseling during a scheduled session. Non-active clients may be charged a fee. Please see our Fees for Service.
- You have the right and responsibility to make sure all your information is correct and up to date. You may make a request to change or updated your information at any time.
- You have the right to be contacted in ways that best fit your needs. You are responsible for letting Affinity Counseling Center know the appropriate ways to contact you.
- You have the right to limit what counselors and staff share about you. Some information cannot be limited if you wish to file with insurance. Or in special situations such as: If we have reason to believe that a child, adult, or disabled individual has been or may be abused, neglected, or sexually abused we must make a report within 48 hours to the Texas Department of Protective and Regulatory Services. If we determine that there is a probability of imminent physical injury by you to yourself or other, or there is a probability of immediate mental or emotional injury to you we may disclose relevant confidential mental health information to medical or law enforcement personnel. We can share health information about you in response to a court or administrative order.
- You have a right to know when your health care information is shared, and who it is shared with.
- You have the right to have access to Affinity Counseling Centers Notice of Privacy Practices, and to request a copy at any time.
- You have the right to have your designated power of attorney or legal guardian act for you. You are responsible for providing documentation that explains the rights of those designated.
- You have the right to file a complaint if we have violated your rights. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
- You have the right to share your information with anyone you choose by filing a Release of Information.
The information you provide in your paperwork, or in sessions is used to:
- Provide you with quality mental health treatment.
- Contact you.
- Bill for your services
- Make sure that you, and those around you are safe.
- Comply with local, state, and federal law.
Our Responsibilities:
- We are responsible for making sure that your information is secure, and that your privacy is protected.
- We are responsible for notifying you if for any reason something may jeopardize your security and privacy.
- We are responsible for complying to your rights and adhering to requests regarding your privacy within reason.
- We are responsible for getting you an updated copy of this notice if any changes have been made.
Affinity Maintains records electronically through Therapy Notes. All files are stored electronically for 5 years after you stop attending counseling at Affinity, or 5 years after a minor who has completed counseling turns 18. Your therapist and Cheryl Willoughby MA, LPC- S, RPT-S are the custodian of all records for Affinity. In the event that they are no longer able to fulfil their responsibilities as custodian, records will be transferred to appropriate clinical and administrative staff at Affinity. If your therapist moves practice, they will take a copy of your notes with them.
If you would like more information about HIPAA or rights and responsibilities regarding your privacy, please visit https://www.hhs.gov/hipaa/for-individuals/index.html
