Crisis Resources

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You agree to receive informational messages (appointment reminders, account notifications, etc.) from A Su Lado Therapy PLLC. Message frequency varies. Message and data rates may apply. For help, reply HELP or email us at kim@ksimpsonlcsw.com. You can opt out at any time by replying STOP.  

Information collected:
We may collect information, such as name, phone number, and email address.

Use of information collected:
We may use the information we collect to perform the services requested including billing, customer service, appointment reminders and other administrative requests.

Sharing of information collected:
We may share information we collect with payment processors, legal authorities, partners so that these service providers can perform their normal duties. We do not share, sell, rent, or trade any information provided with third parties for promotional purposes.

As a current or prospective customer, you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help.
You understand that the messaging frequency may vary. Messaging & data rates may apply.
Your mobile information will not be shared with any third parties/affiliates for marketing/promotional purposes. All policies are followed as per CTIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail."

THIS NOTICE DESCRIBES HOW HEALTH CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED. PLEASE REVIEW IT CAREFULLY. IT IS REQUIRED BY LAW TO PROTECT HEALTH CARE INFORMATION

We are required by law to protect the privacy of health care information about you and that identifies you. This may be information about health care services that we provide or are provided to you. It may also be information about your past, present, or future health care condition.  We are also required by law to provide you with this Privacy Notice explaining our legal duties and privacy practices with respect to health care information. We are legally bound to follow the terms of this Notice.  In other words, we are only allowed to use and disclose health care information in the manner that we have described in the Notice.  We reserve the right to make changes and to make the new Notice effective for all health care information that we maintain. If we make changes to the Notice, we will provide you with a copy by mail or provide it in hand at your next appointment. We will not disclose healthcare information about you without signed permission from you or your legally responsible person/personal representative unless otherwise permitted/required by state and federal confidentiality/privacy laws.  If you sign a consent allowing us to disclose healthcare information about you, you may later revoke or cancel it (except in very limited circumstances related to insurance coverage).

How We May Use and Disclose Your Healthcare Information

Treatment: Your Protected Health Information may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, linking or managing your health care or services.  This may also include with clinical supervisors or other treatment team members. We may also disclose information to other consultants only with your approval and consent.

Payment: We may disclose your information in order to receive or submit payment for treatment services provided to you. This will only be done with your approval and consent.

Healthcare Operations: We will use your health information for healthcare operations and to support business activities. In addition, information will be used in an effort to continually improve the quality and effectiveness of the services we provide. We may also contact you via email or phone to provide you appointment reminders or information about treatment choices and services that may be of interest to you.

Required by Law: Under the law, we must make disclosures of your PHI to you upon your request.  In addition, we must make disclosure to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

Without Authorization: Applicable law and critical standards permit us to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those

that are:

1. Required by Law, such as mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations (such as the professional counselor licensing board

or the health department)

2. Required by Court Order

3. Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lesson the threat, including the target of the

threat.

Verbal Permission: We may use or disclose your information to family members that are directly

involved in your treatment with your verbal permission.

With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, with may be revoked.

YOUR RIGHTS REGARDING PHI:

Right to inspect and request copy of record: You have the right to review your record, however, restricted access may be granted only in exceptional circumstances to inspect and copy protected health information that may be used to make decisions about your care. Restrictions will only be enforced when evidence is present that will or could cause serious harm to you. A fee may be charged for copies of records.

Right to Request Amendment to Record: If you believe that your health information is wrong or some information is missing in your record, you must make your request in writing. If the request is approved for amendment, we will change the information in your record, inform you, and tell others who need to know about the change.

Right to Request an Accounting of Certain Disclosures: You have the right to request an accounting by requesting information in writing.

Right to Request a Restriction of Uses or Disclosures: You have the right to ask that we limit how we use or disclose your healthcare information. We cannot agree to limit uses/disclosures that are required by law and am not required to agree with your request.

Right to Request an Alternate Method of Contact: You have the right to ask that we send your healthcare or billing information to or contact you at an address or phone number that is different than your home as well as to other locations or ways.

Filing a Complaint:

If you believe your privacy rights have been violated or you are dissatisfied with these privacy policies, procedures or practice, you can file a complaint or grievance in person or in writing at:

818 S. Main Street, Suite A

Kannapolis, NC 28081

or with US DHHS within 180 days of when you knew or should have known that the act had occurred. The Secretary may waive this 180 day time limit if good cause is shown. There will be no retaliation against you for filing a complaint.