This notice is effective as of June 26, 2025.

Sarah Quist, Privacy Officer
Gloversville Clinic
11-21 Broadway, Gloversville, NY 12078
(518) 725-4310

The Family Counseling Center of Fulton County, Inc.

HIPAA 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: HIPAA Privacy Officer.

Our Responsibilities

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) for treatment, payment, or healthcare operations and other purposes permitted or required by law. It also describes your rights regarding your PHI.

We are required to abide by the terms of this Notice and may change the terms at any time. Updated notices will be posted at our locations and made available online at thefamilycounselingcenter.org, by phone, by mail, or in person.

Uses and Disclosures of PHI

We may use or disclose your PHI as follows:

Employees: For diagnosis, treatment, billing, insurance, and business activities.
Secretary of Health and Human Services: To determine compliance with HIPAA rules.
Business Associates: Who provide services on our behalf under strict confidentiality.
Crimes on Premises: To law enforcement regarding crimes or threats at our facilities.
Suspected Abuse/Neglect: To state/local authorities as required by law.
Court Orders: When mandated by legal authority.
Emergency Situations: To medical personnel during emergencies.
Research: If approved by an Institutional Review Board.
Audit & Evaluation: Under limited, regulated conditions.
Cause of Death: To authorized public health authorities.

Authorization: All other uses/disclosures require written authorization. You may revoke authorization at any time in writing.

Patient/Client Rights

You have the following rights regarding your PHI:

Right to Notice: To receive this notice electronically or on paper.
Right to Access: To inspect and copy your PHI, including in electronic format.
Right to Amend: To request corrections to your PHI.
Right to an Accounting: To request a list of certain disclosures of your PHI.
Right to Request Restrictions: On how we use/disclose your PHI (some restrictions are not guaranteed).
Out-of-Pocket Payments: To restrict disclosure of paid-in-full services to health plans.
Right to Confidential Communication: To request communication by alternative means or locations.
Right to Notification of a Breach: To be notified in case of a data breach involving your PHI.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information:

The Family Counseling Center of Fulton County, Inc.
11-21 Broadway
Gloversville, NY 12078
Phone: 1-518-725-4310
Fax: 1-518-725-2556

Or contact:

Office of Civil Rights
Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
Phone: 1-800-368-1019
Fax: 1-202-619-3818
TDD: 1-800-537-7697