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Notice of Privacy Practices

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. If you have any questions about this notice please contact:

Crystin Rice, LMFT
111 S. Whittier Rd., Ste 4000C
Wichita, KS 67207-1045
P: 785-422-7113


Understanding Your Health Information

Each time you visit my office, a record of your visit is made. Typically, this record may contain information regarding your symptoms, assessment and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

  • Basis for planning your care and treatment

  • Means of communication among the many health professionals who contribute to your care

  • Legal document describing the care you received

  • Means by which you or a third-party payer can verify that services billed were actually provided

  • A source of information for public health officials

  • A source of data for facility planning and marketing

  • A tool with which I can assess and continually work to improve the care which I render and the outcomes of that care


Understanding what is in your record and how your health information is used helps you to:

  • Ensure its accuracy

  • Better understand who, what, when, where, and why others may access your health information

  • Make more informed decisions when authorizing disclosures to others


Your Health Information Rights

Although your health record is the physical property of Anchor of Hope Counseling LLC, the information belongs to you. You have the right to:

  • Request a restriction on certain uses and disclosures of your information

  • Receive a paper copy of this Notice of Privacy Practices (Notice) upon request

  • Request to inspect and obtain a copy of your health record

  • Request to amend your health record

  • Receive confidential communications of your health information from Anchor of Hope Counseling LLC. Delivery may be requested by alternative means or to alternative locations.

  • Receive a list of disclosures of your health information

  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken


My Responsibilities

Anchor of Hope Counseling LLC is required to:

  • Maintain the privacy of your health information

  • Provide you with a notice of my legal duties and privacy practices with respect to information I collect and maintain about you

  • Abide by the terms of this Notice

  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

  • Notify you if I am unable to agree to a requested restriction


I reserve the right to change my Notice and to make the new provisions effective for all protected health information which I maintain. Should my information practices change, I will prominently display the revised Notice and provide printed copies of the revised Notice upon request. I will not use or disclose your health information without your authorization, except as described in this Notice or as required by law. I will use professional judgment to interpret this Notice in individual circumstances. All communication will be via commonly accepted methods such as face-to-face, written, telephone, fax or e-mail.


To Report a Problem

If you believe that your privacy rights have been violated, you can file a complaint with the Office for Civil Rights (OCR) Office for Civil Rights, U.S. Department of Health & Human Services, 601 East 12th Street - Room 248,  Kansas City, MO 64106, (816) 426-7278; (816) 426-7065 (TDD), (816) 426-3686 FAX. OCR provides further information on its website about how to file a complaint.  There will be no retaliation for filing a complaint.


Examples of Uses or Disclosures

I will use your health information for mental healthcare treatment.

  • Example 1: Information obtained during the course of your treatment will be recorded in your health record for ongoing treatment planning.

  • Example 2: Sometimes therapy occurs in group settings or appointments with your family. Health information may be disclosed in these settings unless you request otherwise.

  • Example 3: Health information may be disclosed for the purpose of providing medical treatment in emergency situations.

  • Example 4: Health information may be disclosed for the purpose of promoting continuity of care between  Anchor of Hope Counseling, LLC and your other healthcare providers.


I will use your health information for payment.

  • For example: I may submit requests for payment to third-party payors. The third-party payors (or other business associates helping me obtain payment) request information from me regarding medical care given. I will provide information to them about you and the care given.


I will use your health information for regular health care operations.

  • For example: I will use information in your health record to assess the care you receive and the outcome of that care. This information will then be used in my efforts to continuously improve the services which I provide.

  • Abuse and Neglect: I may be required to disclose your protected health information to public authorities as required by law to report abuse or neglect.

  • Appointment Reminders: I may contact you by phone or mail to provide appointment reminders. If this contact is made by phone, Crystin Rice or Anchor of Hope Counseling LLC may display on caller identification systems. I may also leave a reminder on your answering machine or voice mail system.

  • Surveys:  I may use and disclose health information to contact you to assess your satisfaction with the care you receive from me.

  • Business Associates: There are some services provided for Crystin Rice, LMFT through business associates. Examples include the utilization of administrative assistants who may not be an employee of Anchor of Hope Counseling LLC, copy services I might use when making copies of your client mental health record, accountants, and attorneys. I may disclose your health information to my business associates so that they can perform the jobs I‘ve asked them to do. To protect your health information, I require the business associates to appropriately safeguard your information.

  • Coroners, Medical Examiners, and Funeral Directors:  Anchor of Hope Counseling LLC may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. I may also release health information to funeral directors as necessary to carry out their duties

  • Emergencies or Disasters: I may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care in an emergency situation. I may also disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

  • Judicial/Administrative Proceedings: I may disclose your health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.

  • Law Enforcement: I may disclose health information for law enforcement purposes as required by law or in response to a valid court order.

  • Military and Veterans: If you are a member of the armed forces, Anchor of Hope Counseling LLC may release your health information as required by military command authorities and allowed by law.

  • Public Health: As required by law, I may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

  • Workers Compensation: I may disclose health information to the extent authorized by, and necessary to comply with, laws relating to workers compensation or other similar programs established by law.


Other Uses of Health Information

Other uses and disclosures of health information not covered by this Notice or the laws that apply will be made only with your written authorization, which may be revoked at any time.

Rev 07-08-2023

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