Allison B. Ford, PhD, LPC, NBCC

Triangle Behavioral Health, PLLC


"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."

The providers and employees of Triangle Behavioral Health are committed to respecting and preserving the privacy and confidentiality of patient information. This Privacy Policy describes the personal information we collect, and how and when we use or disclose that information.

Understanding Your Health Record

Each time you visit Triangle Behavioral Health a record of your visit is made. Typically, this record contains your mental health and medical history, current psychiatric symptoms, mental health assessment and test results, diagnoses, treatment and any plans for future care or treatment. The information contained in your record serves as a:

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Although your health record is the physical property of Triangle Behavioral Health, the information belongs to you. You have the right to:

Our Responsibilities

Providers and employees of Triangle Behavioral Health are responsible for:

We reserve the right to change our privacy policy. Should our privacy policy change, we will mail a revised notice to the address you've supplied us and post the revised privacy policy in our office. We will not use or disclose your health information without your authorization, except as described below. We will also discontinue to use or to disclose your health information after we have received a written revocation of the authorization.

Examples of Uses and Disclosures of Health Information for Treatment, Payment, and Health Operations

We will use your health information:

We will disclose your health information:

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the Privacy Officer at Triangle Behavioral Health.

If you believe your privacy rights have been violated, you can file a complaint with the practice's Privacy Officer or with the Office for Civil Rights. Office for Civil Rights U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201

There will be no retaliation for filing a complaint.