One Affinity, LLC Notice of Privacy Practices

Effective Date: June 1, 2025

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.

I. Our Pledge Regarding Health Information

One Affinity, LLC is committed to protecting the privacy of your Protected Health Information (PHI). PHI includes information about your past, present, or future physical or mental health conditions, the provision of health care to you, or the past, present, or future payment for the provision of health care to you. This Notice of Privacy Practices outlines our duties and practices concerning your PHI, as required by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws.

II. How We May Use and Disclose Your Protected Health Information (PHI)

We may use and disclose your PHI for treatment, payment, and healthcare operations without your prior written authorization.

  • Treatment: We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes sharing information with other healthcare providers involved in your care (e.g., your physician, psychiatrist, or other specialists) for consultation or referral purposes, with your consent where appropriate.
    • Example: A therapist may discuss your treatment plan with a consulting psychiatrist to coordinate your care.
  • Payment: We may use and disclose your PHI to obtain payment for the counseling services we provide. This may include billing you, your insurance company, or another third-party payer.
    • Example: We may submit a claim to your insurance company that includes your diagnosis, type of service, and dates of service.
  • Healthcare Operations: We may use and disclose your PHI for activities necessary to run our practice and ensure quality care. These activities may include quality assessment and improvement activities, training and supervision, licensing, accreditation, and business planning.
    • Example: We may use your records to review the quality of our services or for training purposes (with all identifying information removed).

III. Uses and Disclosures That Require Your Written Authorization

We will not use or disclose your PHI for purposes other than treatment, payment, or healthcare operations without your specific written authorization. This includes:

  • Psychotherapy Notes: Psychotherapy notes, which are notes documenting or analyzing the contents of conversation during a private counseling session, receive special protection under HIPAA. We will not use or disclose psychotherapy notes without your specific written authorization, except in limited circumstances such as for our own use in supervising our staff, for defending ourselves in legal actions, or as otherwise required by law.
  • Marketing Communications: We will not use or disclose your PHI for marketing purposes without your written authorization.
  • Sale of PHI: We will not sell your PHI without your written authorization.
  • Other Disclosures: Any other uses and disclosures of your PHI not described in this Notice will only be made with your specific written authorization.

You have the right to revoke any authorization you provide at any time, in writing. However, the revocation will not apply to uses or disclosures already made in reliance on your authorization.

IV. Uses and Disclosures That May Be Made Without Your Authorization (Mandated or Permitted by Law)

While your privacy is paramount, there are specific circumstances where we are legally or ethically required or permitted to disclose PHI without your authorization:

  • Serious Threat to Health or Safety: If we believe that you or another person is in imminent danger of serious physical harm, we are legally and ethically obligated to take steps to protect you or others, which may include disclosing your PHI to law enforcement, potential victims, or other necessary parties.
  • Suspected Child Abuse, Dependent Adult Abuse, or Elder Abuse: We are mandated reporters under Georgia's law. If we have reasonable suspicion of child abuse, dependent adult abuse, or elder abuse, we are required to report this information to the appropriate protective services agencies.
  • Court Orders/Legal Proceedings: If we receive a valid court order or subpoena requiring the disclosure of your PHI, we will comply to the extent legally required. We will make every effort to notify you of such requests unless legally prohibited from doing so.
  • Workers' Compensation: We may disclose PHI to the extent authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law.
  • Law Enforcement: We may disclose PHI for law enforcement purposes as required by law (e.g., in response to a warrant, for identifying or locating a suspect, fugitive, material witness, or missing person).
  • Health Oversight Activities: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.
  • Public Health Activities: We may disclose PHI for public health activities, such as preventing or controlling disease, injury, or disability.
  • Coroners, Medical Examiners, and Funeral Directors: We may disclose PHI to these parties to carry out their duties consistent with applicable law.
  • Research: We may disclose PHI for research purposes under certain limited circumstances, typically when the research has been approved by an institutional review board and privacy safeguards are in place.
  • Business Associates: We may share your PHI with "Business Associates" who perform services on our behalf (e.g., billing companies, electronic health record providers). We have written agreements with these associates requiring them to protect the privacy and security of your PHI.

V. Your Rights Regarding Your Protected Health Information

You have the following rights regarding your PHI. To exercise any of these rights, please submit a written request to Michal Collier at info@oneaffinity.org.

  • Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations. We are not required to agree to your request, except if the disclosure is to a health plan for payment or healthcare operations and pertains to a healthcare item or service for which you have paid out-of-pocket in full. If we do agree to a requested restriction, we will abide by it.
  • Right to Request Confidential Communications: You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will accommodate all reasonable requests.
  • Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHi that may be used to make decisions about your care. This right does not apply to psychotherapy notes. We may charge a reasonable, cost-based fee for copying and mailing your records. We may deny your request in certain limited circumstances, and if we do, we will provide you with a written denial and information about your appeal rights.
  • Right to Amend: If you believe that the PHI we have about you is incorrect or incomplete, you may request that we amend it. We may deny your request for an amendment if the information was not created by us, is not part of the information which you would be permitted to inspect and copy, or if the information is accurate and complete. If we deny your request, we will notify you in writing and explain your rights to submit a statement of disagreement that will be added to your record.
  • Right to an Accounting of Disclosures: You have the right to request an "accounting" of certain disclosures we have made of your PHI. This accounting will not include disclosures made for treatment, payment, healthcare operations, disclosures made directly to you, disclosures made with your authorization, or disclosures made to persons involved in your care.
  • Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice, even if you have agreed to receive it electronically. You may request a copy at any time.

VI. Our Responsibilities

  • We are required by law to maintain the privacy and security of your PHI.
  • We are required to provide you with this Notice of our legal duties and privacy practices with respect to your PHI.
  • We are required to notify you if there is a breach of your unsecured PHI.
  • We reserve the right to change the terms of this Notice at any time. Any changes will apply to all PHI that we maintain. If we make material changes, we will make the revised Notice available to you at our office and on our website.
  • We will not use or disclose your PHI for any purpose other than those described in this Notice without your written authorization.

VII. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact Michal Collier at 404-620-1805 or info@oneaffinity.org. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

VIII. Contact Information

If you have any questions about this Privacy Policy, please contact:

Michal Collier
One Affinity, LLC
info@oneaffinity.org
404-620-1805