Privacy Practices

Relief Counseling Group PLLC

Notice of Privacy Practices

This Notice Describes How Health Care Information About You May Be Used And Disclosed And How You Can Get Access To This Information. Please Review It Carefully And Keep This For Your Records.

At Relief Counseling Group (RCG), our goal is to ensure your trust and confidence in us. Each time you visit a healthcare provider, a record of your symptoms, assessment, diagnosis, treatment plan, and treatment recommendations are made. This Protected Health Information (PHI), often referred to as your medical record, serves as a basis for planning your treatment, a means to communicate between service providers involved in your care, as a legal document describing your care and services, and verification for you and/or a third party payer that the services billed were provided to you. It can also be used as a source of data to assure that we are continuously monitoring the quality of services and measuring outcomes. Understanding what is in your medical record and how, when and why we use the information helps you make informed decisions when authorizing disclosure to others. Your health information will not be disclosed without your authorization unless required or allowed by State and Federal laws, rules or regulations. To review the full Article 3 Client's Rights and Advance Instructions Chapter 122C. Mental Health, Developmental Disabilities, and Substance Abuse Act of 1985.


Relief Counseling Group are required by law to protect the privacy of health care information about you and that can be identified with you (which we call protected health information, or PHI). We must protect and secure health information that we have created or received about your past, present, or future health condition, health care we provide to you, or payment for your health care. We are only allowed to use and disclose protected health information in the manner described in this Notice. This Notice is posted on our website and we will provide you a paper copy of this Notice upon your request. Network Providers are also required to comply with all applicable laws relating to confidentiality and/or security of protected health information ("PHI") or other healthcare, public assistance or social services information, including but not limited to the Health Information Portability and Accountability Act (HIPAA) and its implementing regulations, 45 CFR Parts 160, 162 and 164, as further expanded by the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which was adopted as part of the American Recovery and Reinvestment Act of 2009, commonly known as "ARRA" (Public Law 111-5) and any subsequent modifications thereof, the Substance Abuse Confidentiality regulations set forth in 42 CFR Part 2, NCG.S. § 122C-51, et seq., NCG.S. § 108A-80,10A NCAC Subchapter 26B, and DMH/DD/SAS Confidentiality Rules published as APSM 45-1 (effective January 2005).

We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for all PHI that we maintain. If we make changes to the Notice, we will:

  • Post the new Notice in our waiting area
  • Have copies of the new Notice available upon request (you may request a copy of a new Notice from staff at the location from which you receive services)


Relief Counseling Group will not disclose PHI about you outside our organization without authorization (signed permission) from you or your legally responsible person unless otherwise permitted/required by state and federal confidentiality/privacy laws. If you sign an authorization allowing us to disclose PHI about you, you may later revoke or cancel the authorization. If you would like to revoke your authorization, you may do so by completing the revocation section on the authorization form. Your revocation will be honored except for information that may have already been disclosed.

How Relief Counseling Group (RCG) May Use or Disclose Your Health Information Without Permission

The following categories describe ways that RCG may use or disclose your health information. Any use or disclosure of your health information will be limited to the minimum information necessary to carry out the purpose of the use or disclosure. For each category of uses and disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories. Note that we can only use or disclose alcohol and drug abuse records with your consent or as specifically permitted under federal law. These exceptions are listed below.

§ Treatment - Relief Counseling Group is not a provider of treatment but some of our functions require that we make a referral for an assessment or perform other activities which include helping formulate a treatment plan, coordinating appropriate and effective care, treatment and services or setting up an appointment with other behavioral health and health care providers. We may also share your health information with emergency treatment providers when you need emergency services. We may also communicate and share information with other behavioral health service Providers who have Contracts with Alliance or governmental entities with whom we have Business Associate Agreements. These include hospitals, licensed facilities, licensed practitioners, community-based service providers, and governmental entities such as local jails and schools. When these services are contracted, we may disclose your health information to our contractors so that they can provide you services and bill you or your third‐party payer for services rendered. We require the contractor to appropriately safeguard your information. We are required to give you an opportunity to object before we are allowed to share your PHI with another HIPAA Covered Entity such as your Primary Care Physician or another type of physical health type provider. If you wish to object to us sharing your PHI with these types of providers, then there is a form you must sign that will be kept on file and we are required by law to honor your request.

§ Payment - We may use or disclose health information about you to determine eligibility for plan benefits, obtain premiums, facilitate payment for the treatment and services you receive from health care providers, determine plan responsibility for benefits, and to coordinate benefits. Health information may be shared with other government programs such as Medicare, Medicaid, NC Health Choice, or private insurance to manage your medical necessity of health care services, determine whether a particular treatment is experimental or investigational, or determine whether a treatment is covered under your plan.

§ Health Care Operations - We may use and disclose health information about you to carry out necessary managed care/ insurance-related activities. For example, such activities may include premium rating and other activities relating to plan coverage; conducting quality assessment and improvement activities such as handling and investigating complaints; submitting claims for stop-loss coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; and business planning, management and general administration.

§ Other Circumstances - Under the following circumstances, we may use and disclose PHI about you without your authorization. Please understand this is NOT a complete list and is not limited to the examples listed below.

o Persons Involved in Your Care -We are required by state law to disclose limited information about you that is relevant to your care to your next of kin, family member and/or another person involved in your care or other person designated by you with your written or oral consent, except in emergency situations or the limited circumstances noted below. We may also use or disclose PHI about you to a disaster relief organization, such as the Red Cross, if we need to notify someone about your location or condition.

o Required by Law - There are many state and federal laws that require us to use and disclose health care information. For example, state law requires us to report known or suspected child abuse or neglect to the Department of Social Services

o Public Health Activities - We may disclose PHI, when required by law, for public health activities, such as activities related to investigating exposure to tuberculosis or sexually transmitted diseases

o Abuse or Neglect - We are required by law to report to the Department of Social Services if we are have knowledge of, or suspect, abuse or neglect

o Health Oversight Activities - We may disclose PHI about you to an agency that is responsible for overseeing the health care system or certain governmental programs. For example, a government agency may request information from us if they are investigating the appropriate billing of services

o Judicial/Administrative Proceedings - We may disclose PHI about you to a court or an officer of the court with an appropriate order from a judge

o Law Enforcement - We may disclose health information about you to a law enforcement official for specific law enforcement purposes, such as limited information to a police officer if you were being transported to a hospital for involuntary commitment

o Governmental Purposes - We may disclose PHI about you for certain government functions, such as national security or protective services for the President

o Research - Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research.

o Applicability of More Stringent State Laws - Some of the uses and disclosures described in this notice may be limited in certain cases by applicable State laws or rules that are more stringent than Federal laws or regulations, including disclosures related to mental health and substance abuse, intellectual/developmental disabilities, alcohol and other drug abuse (AODA), and HIV testing.


We may use PHI to contact you, either by mail, phone, fax, e-mail and/or voice mail to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. If you have an unpaid balance on your account, we will mail a monthly statement to you. If you prefer that we contact you at an alternate address or phone number, you must provide us with a request in writing by completing an Alternative Contact Request Form, which is available from your therapist or medical record staff. We may accommodate your request as long as it is a reasonable request, but, when appropriate may condition that accommodation on your providing us with information regarding how payment, if any, will be handled.

When RCG Health May Not Use or Disclose Your Protected Health Information

Except as described in this Notice, Alliance will not use or disclose your health information without written authorization from you. If you do authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer be able to use or disclose health information about you for the reasons covered by your written authorization, though we will be unable to take back any disclosures we have already made with your permission.

  • Your authorization is necessary for most uses and disclosures of psychotherapy notes.
  • Your authorization is necessary for any disclosures of health information in which the health plan receives compensation.
  • Your authorization is necessary for most uses and disclosures of alcohol and drug abuse records (exceptions are listed above).



  1. Right to a copy of this Notice

    You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted on our website. If you would like to have a copy of our Notice, please ask the receptionist for a copy or contact our Privacy Officer at 919.357.3339.

  2. Right to Inspect and Copy

    You have the right to request to see and receive an electronic or paper copy of your health information that may be used to make decisions about your plan benefits. You must request access in writing by filling out a Request for Access Form. Access request forms are available through your therapist or medical record staff; we may give you a summary or explanation of the information about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations where we will be unable to grant your request to review records. If you request copies of your health information, we may charge you to cover the cost of copying, supplies, and/any costs associated with preparation of summaries or explanations.

  3. Right to Request Amendment - You have a right to request that we amend your health information that you believe is incorrect or incomplete. We are not required to change your health information and if your request is denied, we will provide you with information about our denial and how you can appeal the denial. To request an amendment, you must make your request in writing to the Privacy Officer and send to 1135 Kildaire Farm Rd., Ste 200, Cary, NC, 27511 or The Privacy Officer will return your request no later than 30 days after the receipt of the request.

  4. Right to Accounting of Disclosures - You have the right to receive a list or accounting of disclosures of your health information made by us in the past six years, except that we do not have to account for disclosures made for purposes of payment functions, healthcare operations of treatment, or made by you. To request this accounting of disclosures, you must submit your request in writing to the Privacy Officer and send to 1135 Kildaire Farm Rd., Ste 200, Cary, NC, 27511 or We will provide one list or accounting per 12-month period free of charge; we may charge you for additional lists or accountings. We will inform you of the cost and you may choose to withdraw or modify your request before any costs are incurred. There are certain exceptions that apply.

  5. Right to Request Restrictions - You have the right to request a restriction on certain uses and disclosures of your health information. We are not required to agree to the restrictions that you request. If you would like to make a request for restrictions, you must submit your request in writing to the Privacy Officer at the address listed below. We will let you know if we can comply with the restriction or not.

  6. Right to request your preferred method of contact

    You have the right to request how and where we may contact you. We must accommodate your request as long as the request is reasonable. The agreed upon form of communication will be determined within 3 days of the request is received. To request confidential communications, you must submit your request in writing to the Privacy Officer to 1135 Kildaire Farm Rd., Ste 200, Cary, NC, 27511 or We are not required to agree to your request.

  7. Right to be Notified of a Breach - You have the right to be notified in the event that we (or one of our Business Associates) discover a breach of your unsecured protected health information. Notice of any such breach will be made in accordance with federal requirements. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the Privacy Officer at 1135 Kildaire Farm Rd., Ste 200, Cary, NC, 27511,, or at (919) 357-3339.

Changes to This Notice and Distribution

RCG reserves the right to amend this Notice of Privacy Practices at any time in the future and to make the new Notice provisions effective for all health information that it maintains. As your health plan, we will provide a copy of our notice upon your enrollment in the plan and will remind you at least every three years where to find our notice and how to obtain a copy of the notice if you would like to receive one. If we have more than one Notice of Privacy Practices, we will provide you with the Notice that pertains to you. The notice is provided and pertains to the named Medicaid beneficiary or other individual enrolled in the plan.

As a health plan that maintains a website describing our customer service and benefits, we also post to our website the most recent Notice of Privacy Practices which will describe how your health information may be used and disclosed as well as the rights you have to your health information. If our Notice has a material change, we will post information regarding this change to the website for you to review. In addition, following the date of the material change, we will include a description of the change that occurred and information on how to obtain a copy of the revised Notice in any annual mailing required by 42 CFR Part 438.


Complaints about this Notice of Privacy practices or about how we handle your health information should be directed to the Privacy Officer at 1135 Kildaire Farm Rd., Ste 200, Cary, NC, 27511 at (919) 357-3339. RCG will not retaliate against you in any way for filing a complaint. All complaints to RCG must be submitted in writing. If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services at plaints/ or call (800) 368-1019. Si necesita información en español, llámenos al (800) 510-9132.