Alabama Head Injury Foundation

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HIPAA Notice of Privacy Practices

This information describes how medical/mental health information about you may be used and disclosed and how you can get access to this information.  Please review it carefully.
Alabama Head Injury Foundation only releases information in accordance with state and federal laws. This notice describes your Support Specialist's policies related to the use and disclosure of your records.

Treatment- your Support Specialist may need to use or disclose information from your counseling records to provide, manage, or coordinate your treatment or related serves, which could include consultation with medical or mental health professionals and potential referral sources. This also includes your Support Specialist consulting with internal treatment teams and also with their license supervisors.

Support Specialist Operations
– your Support Specialist may need to use information about you to review treatment procedures and business activity.  This may involve supplying statistical data.  In such cases, your name and personal information will not be divulged.

Other uses or disclosure of your information that does not require your authorization or consent
- these disclosures are described under the section:  “Limits of Confidentiality,” in the State of Understanding, which was given to you.

I have read (or have had read to me) and understand the above information. By typing my name below and entering today's date, this is my digital consent that I have read and understand the above information. 

    HIPAA Policy Acknowledgement and Consent

Submit
500 Chase Park South  Suite 130  Hoover, AL  35244
Phone:  (205) 823-3818 or 1-800-433-8002
Fax:  (205) 823-4544

E-mail:  info@ahif.org

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Improving the quality of life for survivors of traumatic brain injury and for their families