GRACE IN CHAOS COUNSELING LLC

Jazlyn Bain, LCSW (CSW009556)

NOTICE OF PRIVACY PRACTICES

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

I. OUR COMMITMENT TO YOUR PRIVACY

Your mental health and medical information are personal, and Grace in Chaos Counseling LLC is committed to protecting them.

A record of your care is created to provide treatment, obtain payment, and comply with legal requirements. This Notice applies to all records of your care maintained by this practice.

We are required by law to:

  • Maintain the privacy and security of your Protected Health Information (PHI)

  • Provide you with this Notice of our legal duties and privacy practices

  • Follow the terms of this Notice currently in effect

We may revise this Notice at any time. Any revisions will apply to all records maintained by this practice and will be made available upon request, in-office, and/or on our website.

II. HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED

The following categories describe different ways your health information may be used or disclosed. Each category includes explanations and examples. Not every specific use or disclosure is listed; however, all permitted uses and disclosures fall within one of these categories.

Treatment, Payment, and Health Care Operations

Federal privacy regulations (HIPAA) permit healthcare providers with a direct treatment relationship with a client to use or disclose the client’s Protected Health Information (PHI) without written authorization for treatment, payment, and health care operations.

PHI may also be disclosed for the treatment activities of other healthcare providers involved in your care without written authorization.

For example, the provider may consult with another licensed healthcare professional regarding diagnosis, treatment planning, or care coordination. In doing so, relevant health information may be shared as necessary to support appropriate assessment, diagnosis, and treatment.

Disclosures for treatment purposes are not subject to the “minimum necessary” standard because providers require full and complete information to deliver safe and effective care.

For purposes of this Notice, “treatment” includes coordination and management of care between providers and third parties, consultations between providers, and referrals for evaluation or treatment.

Legal Proceedings

PHI may be disclosed in response to a court or administrative order. PHI may also be disclosed in response to subpoenas, discovery requests, or other lawful legal processes when required by law, or after reasonable efforts have been made to notify you or obtain protective orders.

III. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Certain uses and disclosures of Protected Health Information (PHI) require your written authorization and are not otherwise permitted or required by law.

Psychotherapy Notes

Psychotherapy notes are defined under HIPAA as notes recorded by a mental health professional documenting or analyzing the contents of counseling sessions and are maintained separately from the clinical record.

Psychotherapy notes will not be used or disclosed without written authorization except in the following limited circumstances:

  • Use by the provider for treatment purposes.

  • Use for training or supervision of mental health professionals.

  • Use in defense of a legal action or proceeding brought by you.

  • Disclosure to the U.S. Department of Health and Human Services for HIPAA compliance investigations.

  • When required by law, limited to the scope of such law.

  • Health oversight activities involving the originator of the notes, as authorized by law.

  • Disclosure to a coroner or medical examiner as permitted by law.

  • To prevent or reduce a serious and imminent threat to health or safety, consistent with applicable law.

Other Uses Requiring Authorization

Written authorization is also required for:

  • Uses or disclosures for marketing purposes

  • Any sale of Protected Health Information

This practice does not engage in either activity.

IV. USES AND DISCLOSURES NOT REQUIRING AUTHORIZATION

Federal and Georgia law permit the use or disclosure of PHI without written authorization in the following circumstances:

Required or Permitted by Law

PHI may be disclosed when required by federal, state, or local law, and such disclosure is limited to the requirements of that law.

Public Health and Safety

PHI may be disclosed for public health activities, including:

  • Reporting suspected child abuse, elder abuse, or abuse of vulnerable adults, as required under Georgia law

  • Preventing or reporting a serious and imminent threat to the health or safety of an individual or the public (duty to warn/protect)

Health Oversight Activities

PHI may be disclosed to health oversight agencies for audits, investigations, licensing, or disciplinary actions.

Judicial and Administrative Proceedings

PHI may be disclosed in response to court or administrative orders. PHI may also be disclosed in response to subpoenas, discovery requests, or other lawful processes when required by law and when reasonable efforts have been made to notify you or obtain protective orders.

Law Enforcement

PHI may be disclosed for law enforcement purposes when required by law, including reporting crimes occurring on the premises.

Coroners, Medical Examiners, and Funeral Directors

PHI may be disclosed as necessary for identification, determining the cause of death, or other duties authorized by law.

Specialized Government Functions

PHI may be disclosed for specialized government functions, including military and veteran activities, national security, intelligence activities, and correctional institution custody and care.

Workers’ Compensation

PHI may be disclosed as authorized under workers’ compensation laws when related to a claim.

Appointment Reminders and Care Coordination

PHI may be used or disclosed to contact you for appointment reminders and to provide information about treatment alternatives or other health-related benefits and services that may be relevant to your care.

Substance Use Disorder Records: If this practice receives or maintains records related to substance use disorder treatment (subject to 42 CFR Part 2), such records will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order that meets specific federal requirements.

V. USES AND DISCLOSURES WHERE YOU MAY OBJECT

PHI may be disclosed to a family member, friend, or other individual involved in your care or payment for care if you agree or do not object.

If you are unable to object due to incapacity or emergency circumstances, PHI may be disclosed if, in the professional judgment of the provider, such disclosure is in your best interest and consistent with applicable law.

VI. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights:

Right to be Notified of a Breach: You have the right to be notified if there is a breach of your unsecured Protected Health Information (PHI) that may have compromised the privacy or security of your information. Grace in Chaos Counseling LLC will provide this notification without unreasonable delay and in no case later than 60 days following the discovery of a breach.

Right to Request Restrictions

You may request restrictions on the use or disclosure of PHI for treatment, payment, or health care operations. Requests are not required to be granted if they would impact care.

Right to Restrict Certain Disclosures to Health Plans

You may request that PHI not be disclosed to a health plan for payment or operations if you have paid in full out-of-pocket. Such requests will be honored when legally required.

Right to Confidential Communications

You may request communication in a specific manner or location. Reasonable requests will be honored.

Right to Access Records

You may inspect or obtain copies of your PHI, excluding psychotherapy notes. Requests will be fulfilled within 30 days and may include a reasonable cost-based fee as permitted by law.

Right to an Accounting of Disclosures

You may request an accounting of certain disclosures made within the past six (6) years. One request per year is provided at no cost; additional requests may include a reasonable fee.

Right to Amend Records

You may request amendments to your PHI if you believe it is incorrect or incomplete. Requests may be denied with a written explanation.

Right to a Copy of This Notice

You may request a paper or electronic copy of this Notice at any time.

VII. QUESTIONS AND COMPLAINTS

If you have questions about this notice or believe your privacy rights have been violated, please contact:

Privacy Officer:
Jazlyn Bain, LCSW
Grace in Chaos Counseling LLC
(470) 531-7714
jazlynbain@gracechaoscounsel.com

You may also file a formal complaint with either of the following agencies: 

  1. Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists

    • Online via the Licensing Complaint Portal or by mail to 237 Coliseum Drive, Macon, GA 31217.

  2. Secretary of the U.S. Department of Health and Human Services (HHS)

Grace in Chaos Counseling LLC will not retaliate against you for filing a complaint with any of these entities

VIII. EFFECTIVE DATE

This Notice is effective: April 20, 2026