HIPAA and Privacy Practices

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.

• Your health information is contained in a medical record maintained by James Consulting
Services, LLC. This medical record is the physical property of James Consulting Services, LLC
which uses and/or discloses your health information to carry out your treatment, to obtain
payment for such treatment, for health care operations and for other purposes either permitted
or required by law. This Notice of Privacy describes how we may use and/or disclose your health
information in connection with providing you with medical treatment or services and describes
your rights to obtain access to your health information.
Health Records
James Consulting Services, LLC strives to ensure facility medical records are accurate and to
provide information that documents the treatment provided and supports the claims submitted.
Tampering with or falsifying medical records, financial documents or other business records of
James Consulting Services, LLC will not be tolerated. The confidentiality of patient records and
information must be maintained in accordance with privacy and security laws and regulations
that protect patient information, including protected health information (PHI), HIPAA and
applicable state laws.
How We May Use or Disclose Your Health Information
• For Treatment – We will use and/or disclose your information to provide you with treatment
and related services, including coordination or management of your care with a third party that
is also involved in your treatment. For example, we may disclose your information to another
health care provider, such as a specialist to whom you are referred by your physician, or to a
laboratory performing tests related to your medical care.
• For Payment – We will use and/or disclose your health information to others, as necessary; to
obtain payment for the treatment or services you receive. For example, a bill, containing
information that both identifies you and your diagnosis or treatment, may be sent to you or
directly to your insurance company, health plan or other third party payer. We may also use

court order, subpoena or other lawful process, or may be required in certain instances to report
certain information to law enforcement officials or other governmental authorities.
• Appointment Reminders and Miscellaneous Other Uses – James Consulting Services, LLC may
also use your health information to provide appointment reminders, or to send you materials
with respect to treatment alternatives or other health-related information that may be of
interest to you.
Confidentiality in Service:
Our in home clinical providers have the ability to deliver services in various environments, such
as homes, schools, homeless shelters, or street locations. Please let our providers know where
you wish to receive services and keep in mind that if you prefer to meet staff at a community
location other than your home or other conspicuous locations (e.g. their school). We wish to
never breech the youth’s privacy/confidentiality. Our staff is sensitive to and respectful of you
and your family's privacy/confidentiality rights and preferences in this regard to the greatest
extent possible (e.g. if staff must meet with a youth during their school time, choosing
inconspicuous times and locations to promote privacy).
Modification of Privacy Notice
James Consulting Services, LLC reserves the right to change its information practices and make
new provisions effective for all protected health information it maintains. Any modification shall
have prospective application, but will apply to health records made both before and after the
effective date of the policy modification. Revised Notices will be made available to all then
current patients and posted in a prominent location within our office. We will also mail copies to
any current or former patient who has advised us, in writing, that they want us to mail them
HIPAA and Privacy Practice Acknowledgement of Receipt
By signing the provided consent for treatment form, you acknowledge receipt of the Notice of
Privacy Practices of the Offices of James Consulting Services, LLC. Our Notice of Privacy Practices
provides information. We encourage you to read it in full. Our Notice of Privacy Practices is
subject to change. If we change our notice, you may obtain a copy of the revised notice by
contacting us.
Your Rights and Our Commitment to You:
• We will provide you with the most appropriate care in the most time efficient fashion.

• We will treat you with respect and professionalism.
• In order to give you as much notice as possible, we request a phone contact so that we can
reach you in person during the day, such as a business number or cell phone.
• We will do our best to move your appointment to an earlier time or date if we have a
cancellation in our office schedule. If you have any questions regarding this information, please
do not hesitate to ask us. We are here to help you.
• You have a right to receive an assessment to determine your, your child's or family's need for
services. If there are sufficient indications of a mental illness and/or substance related disorders,
there will be further diagnostic assessments completed. If the youth does not have sufficient
indications of a mental illness and/or substance related disorder, or if the youth does not appear
to meet criteria for the services we provide then an appropriate referral to other services or
agencies is provided.
• Services are justified through comprehensive, person-centered, service related, assessments,
monthly service plans, and session progress notes.
Your Health Information Rights
• You have the right to inspect and copy your health record. (However, federal and/or state laws
may prohibit inspection of certain records, such as psychotherapy notes.)
• You have the right to request a restriction on certain uses and disclosures of your information.
However, James Consulting Services, LLC is not obliged to agree to the requested restriction.
• You have the right to request communications of your health information by alternative
means or at alternative locations. (We will accommodate reasonable requests made, in writing,
to our Privacy Officer.)
• You may have the right to have your physician amend your health information. (You may
request an amendment, and in certain cases we many deny your request, in which event, you
may file a statement of disagreement and we may opt to prepare a rebuttal thereto, in which
case, we will provide you with a copy of such rebuttal.)
• You have a right to revoke your authorization to use or disclose your health information,
except to the extent that action has already been taken.
• You have the right to receive an accounting of certain disclosures of protected health
information we have made.
(This right pertains to disclosures made after April 14, 2003 and does not include disclosures
made for treatment, payment or operation purposes or as covered by other restrictions,
exceptions or limitations set forth in federal regulations at 45 CFR Section 164.58.)
• You have the right to obtain a paper copy of this Notice from us upon request.