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Notice of Privacy Practices (HIPAA)

This Notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

 

Your Protected Health Information (PHI)

 

Vibrant Road Counseling is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this Notice of Privacy Practices.

 

How We May Use and Disclose Your Information

 

We may use or disclose your PHI for:

  • Treatment (providing therapy services)

  • Payment (billing and insurance purposes)

  • Health care operations (practice management and quality assurance)

We may also disclose your information when required by law or to prevent serious harm to you or others.

 

Your Rights

 

You have the right to:

  • Access and obtain a copy of your records

  • Request corrections to your records

  • Request restrictions on certain uses or disclosures

  • Request confidential communications

  • Receive a copy of this Notice

 

Our Responsibilities

 

We are required by law to:

  • Maintain the privacy of your PHI

  • Provide you with this Notice

  • Follow the terms described in this Notice

Telehealth Informed Consent

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Telehealth involves the delivery of mental health services using secure electronic communications. By participating in telehealth services, you acknowledge and agree to the following:

 

Benefits of Telehealth

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  • Increased access to care

  • Convenience and flexibility

  • Ability to receive services from your home or private location

 

Potential Risks

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  • Technology failures or interruptions

  • Privacy limitations related to electronic communication

  • Unauthorized access despite security measures

 

Client Responsibilities

 

You agree to:

  • Participate from a private and secure location

  • Use a stable internet connection

  • Inform your therapist of your physical location during sessions

  • Not record sessions without consent

 

Confidentiality

 

Telehealth sessions are protected by the same confidentiality and HIPAA standards as in-person therapy.

 

Emergencies

 

Telehealth is not appropriate for crisis or emergency situations. In case of emergency, please call 911 or go to your nearest emergency room.

 

Practice Information

 

Vibrant Road Counseling
Phone: 732-956-6986
Email: vrawal@vibrantroadcounseling.com

Services are provided to clients physically located in New Jersey at the time of session.

Telehealth consent
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