4575 Webb Bridge Road #4301 Alpharetta, GA 30023
678-313-6721
NOTICE OF PRIVACY PRACTICES
GENESIS COUNSELING SERVICES, LLC
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. OUR COMMITMENT TO YOUR PRIVACY
GENESIS COUNSELING SERVICES, LLC is dedicated to maintaining the privacy of your protected health information (PHI). PHI is information that identifies you and relates to your past, present, or future physical or mental health condition. We are required by law to maintain the privacy of your PHI and to provide you with this Notice of our legal duties and privacy practices.
II. CHANGES TO THIS NOTICE
We reserve the right to amend this Notice. Any changes will apply to all PHI we maintain. If we change this Notice, we will post the new version in our office and on our website. You may request a copy of the current Notice at any time.
III. HOW WE MAY USE AND DISCLOSE YOUR PHI
We typically use or share your health information in the following ways:
For Treatment: We can use your health information and share it with other professionals who are treating you (e.g., your primary care physician or psychiatrist) to coordinate your care.
For Health Care Operations: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
To Obtain Payment: We can use and share your health information to bill and get payment from health plans or other entities. Note: If you pay for a service in full out-of-pocket, you have the right to restrict disclosures of that information to your health plan.
Business Associates: We may share PHI with third-party "business associates" (e.g., billing services, EHR providers) who perform functions on our behalf. We have written contracts with them requiring the same high level of privacy protection.
IV. SPECIAL CIRCUMSTANCES (NO AUTHORIZATION REQUIRED)
We may share your information without your consent in these specific situations:
Public Health and Safety: To prevent a serious threat to your health or safety or the safety of others; to report suspected child, elder, or dependent adult abuse/neglect to the Georgia Department of Human Services.
Law Enforcement & Legal Proceedings: To respond to a court order, administrative order, or a lawful subpoena.
Substance Use Disorder (SUD) Records: If your records are protected under 42 CFR Part 2, we will not use or disclose such records in civil, criminal, administrative, or legislative proceedings against you without your specific written consent or a specialized court order.
National Security: For intelligence and counterintelligence activities authorized by law.
Research: In limited cases for research, provided strict privacy protocols are met.
V. USES REQUIRING YOUR WRITTEN AUTHORIZATION
We will never share your information for the following purposes unless you give us written permission:
Marketing purposes or the sale of your information.
Psychotherapy Notes: Most uses and disclosures of psychotherapy notes require your authorization.
Fundraising: If we contact you for fundraising, you have the right to opt-out.
VI. YOUR RIGHTS REGARDING YOUR PHI
Right to Access: You can ask to see or get an electronic or paper copy of your medical record. We will provide this within 30 days. We may charge a reasonable, cost-based fee.
Right to Amend: You can ask us to correct health information you think is incorrect or incomplete. We may say "no," but we’ll tell you why in writing within 60 days.
Right to Request Restrictions: You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, unless you pay for a service out-of-pocket in full and ask us not to share that info with your insurer.
Right to Confidential Communications: You can ask us to contact you in a specific way (e.g., home or office phone) or to send mail to a different address.
Right to an Accounting of Disclosures: You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
Right to a Paper Copy: You can ask for a paper copy of this notice at any time.
Right to a Good Faith Estimate: Under the No Surprises Act, you have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost if you are uninsured or not using insurance.
VII. OUR RESPONSIBILITIES
We are required by law to maintain the privacy and security of your PHI.
Breach Notification: We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by notifying us in writing.
VIII. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with:
Stephanie D. Leoni, LPC, CPCS (Privacy Officer) at the address provided in your intake paperwork.
The Secretary of the U.S. Department of Health and Human Services by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, or calling 1-877-696-6775.
We will not retaliate against you for filing a complaint.
Effective Date: January 2017 Date of Last Revision: April 29, 2026