Notice of Privacy Practices

Notice of Privacy Practices

Health Insurance Portability and Accountability Act (HIPAA)

The Samaritan Counseling Center of Atlanta (SCCA) is dedicated to maintaining the privacy of your protected health information (PHI).  SCCA creates and maintains client records that include personal healthcare information including your presenting problems, symptoms, demographic information, diagnosis, personal and family history, treatment plan, progress notes, and any plans for future care or treatment.  This notice describes how PHI may be used and disclosed and how you can get access to this information


Although your client record is the property of the Samaritan Counseling Center of Atlanta, you have the right to:

1.      Get an electronic or paper copy of your medical record: 

You can ask to see or get an electronic or paper copy of your medical record. Written authorization is required, and you must specify if records are to be provided in electronic format. We will provide a copy or a summary of your health information, within 30 days of your request. Under certain circumstances, we may feel we must deny your request. In this case, we will give you, in writing, the reasons for the denial and explain your right to have its denial reviewed. If you ask for copies of your PHI, you will be charged a reasonable fee per page and the fees associated with supplies and postage.

2.     Ask us to limit what we share: 

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care or in cases of emergency situations. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

3.      Get a list of those with whom we shared information:

You are entitled to a list of disclosures of your PHI that we have made. The list will not include uses or disclosures to which you have specifically authorized (i.e., those for treatment, payment, or health care operations, sent directly to you, or to your family). The request must be in writing and state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003. You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. SCCA will respond to your request for an accounting of disclosures within 60 days of receiving your request. We will provide the list to you at no cost, unless you make more than one request in the same year, in which case it will charge you a reasonable sum based on a set fee for each additional request.

4.      The Right to Choose Someone to Act for You: 

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

5.      The Right to Amend Your PHI: 

If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that SCCA correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of receipt of your request. We may deny your request if we find that the PHI is: (a) correct and complete, (b) forbidden to be disclosed, (c) not part of its records, or (d) written by someone other than SCCA. Denial will be in writing and state the reasons for the denial as well as an explanation of your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and our denial will be attached to any future disclosures of your PHI. If we approve your request, SCCA will make the change(s) to your PHI. Additionally, we will tell you that the changes have been made and will advise all others who need to know about the change(s) to your PHI.

6.      The Right to Get a Copy of this Notice: 

You have the right to get this notice by email or to request a paper copy.

7.      The Right to File a Complaint if You Feel Your Rights Are Violated. 

You can complain if you feel we have violated your rights by contacting the SCCA Privacy Officer and Executive Director, Katie Sundermeier, at (404) 228-7777. 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 We will not retaliate against you for filing a complaint.

8.       Submit all Written Requests to: 

Gretchen Rees, LCSW, Clinical Director, at the address listed on top of page one of this document.


SCCA will not use or disclose your PHI without your written authorization, except as described in this Notice or as described in the “Information, Authorization, and Consent to Treatment” document. Below you will find the different categories of possible uses and disclosures with some examples.

  1. For Treatment: SCCA may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are; otherwise involved in your care. Example: If you are also seeing a psychiatrist for medication management, we may disclose your PHI to her/him to coordinate your care.   Except for in an emergency, SCCA will always ask for your authorization in writing prior to any such consultation.
  2. For Health Care Operations: SCCA may disclose your PHI to facilitate the efficient and correct operation of its practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.
  3. To Obtain Payment for Treatment: SCCA may use and disclose your PHI to bill and collect payment for the treatment and services SCCA provided to you. Example: We might send your PHI to your insurance company or managed health care plan in order to get payment for the health care services that have been provided to you. We may also provide your PHI to billing companies, claims processing companies, and others that process health care claims for our office..
  4. Employees and Business Associates:  There may be instances where services are provided to SCCA by an employee or through contracts with third-party “business associates.” Whenever an employee or business associate arrangement involves the use or disclosure of your PHI, SCCA will have a written contract that requires the employee or business associate to maintain the same high standards of safeguarding your privacy that is required of SCCA.

Note:  This state and Federal law provides additional protection for certain types of health information, including alcohol or drug abuse, mental health, and AIDS/HIV, and may limit whether and how we may disclose information about you to others.

USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES: SCCA may use and/or disclose your PHI without your consent or authorization for the reasons listed below:

1.    Law Enforcement: Subject to certain conditions, SCCA may disclose your PHI when required by federal, state, or local law; judicial, board, or administrative proceedings; or law enforcement. Example: SCCA may make a disclosure to the appropriate officials when a law requires SCCA to report information to government agencies, law enforcement personnel, and/or in an administrative proceeding.

2.    Lawsuits and Disputes:  SCCA may disclose information about you to respond to a court or administrative order, a search warrant, or in response to a subpoena.

3.   Serious Threat to Health or Safety: We may disclose your PHI if you are in such mental or emotional condition as to be dangerous to yourself or the person or property of others and if your therapist determines in good faith that disclosure is necessary to prevent the threatened danger. Under these circumstances, SCCA may provide PHI to law enforcement personnel or other persons able to prevent or mitigate such a serious threat to the health or safety of a person or the public.

4.    Minors:  If you are a minor (under 18 years of age), SCCA may be compelled to release certain types of information to your parents or guardian in accordance with applicable law.

5.    Abuse and Neglect:  SCCA may disclose PHI if mandated by Georgia child, elder, or dependent adult abuse and neglect reporting laws. Example: If SCCA has a reasonable suspicion of child abuse or neglect, SCCA will report this to the Georgia Department of Child and Family Services.

6.    Public Health Risks: In the following circumstances, SCCA will only disclose your PHI if we are required to do so by law or with your written permission.

·       Preventing Disease. SCCA may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability, to report births and deaths, and to notify persons who may have been exposed to a disease or are at risk for getting or spreading a disease or condition.

·       Food and Drug Administration (FDA): SCCA may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products, and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

7.   Coroners, Medical Examiners, and Funeral Directors: SCCA may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person, determine the cause of death, or other duties as authorized by law. SCCA may also disclose PHI to funeral directors, consistent with applicable law, to carry out their duties.

8.    Address workers’ compensation, law enforcement, and other government requests. We can use or share health information about you:

·      For workers’ compensation claims

·      For law enforcement purposes or with a law enforcement official

·      With health oversight agencies for activities authorized by law

·      For special government functions such as military, national security, and presidential protective services.

9.  For Research Purposes: In certain limited circumstances, SCCA may use information you have provided for medical/psychological research, but only with your written authorization. The only circumstance where written authorization would not be required would be if the information you have provided could be completely disguised in such a manner that you could not be identified, directly or through any identifiers linked to you.

10.  Appointment Reminders: SCCA is permitted to contact you, without your prior authorization, to provide appointment reminders or information about alternative or other health-related benefits and services that you may need or that may be of interest to you.

11.  Health Oversight Activities: SCCA may disclose health information to a health oversight agency for activities such as audits, investigations, inspections, or licensure of facilities. These activities are necessary for the government to monitor the health care system, government programs, and compliance with laws. Example: When compelled by the U.S. Secretary of Health and Human Services to investigate or assess SCCA’s compliance with HIPAA regulations.

15.  If Disclosure is Otherwise Specifically Required by Law.

In the Following Cases, SCCA will NEVER share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

  • Fundraising. (If we contact you for fundraising efforts, you can tell us not to contact you again).

Other Uses and Disclosures Require Your Prior Written Authorization:  In any other situation not covered by this notice, SCCA will ask for your written authorization before using or disclosing medical information about you. If you chose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision. You understand that SCCA is unable to take back any disclosures it has already made with your permission, we will continue to comply with laws that require certain disclosures, and SCCA is required to retain records of the care that its therapists have provided to you.

Samaritan Counseling Center of Atlanta’s Responsibilities: We are required by law to maintain the privacy and security of your PHI. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website. If you have any questions or concerns, please talk with your therapist, or contact our Executive Director at (404) 228-7777.

Date of Last Revision: 02/07/23