770-847-8611 marissa@ezell-lcsw.com

Policies and Credits

Terms and conditions

These terms and conditions ("Terms", "Agreement") are an agreement between Website Operator ("Website Operator", "us", "we" or "our") and you ("User", "you" or "your"). This Agreement sets forth the general terms and conditions of your use of the marissaezell.com website and any of its products or services (collectively, "Website" or "Services").


We are not responsible for Content residing on the Website. In no event shall we be held liable for any loss of any Content. It is your sole responsibility to maintain appropriate backup of your Content. Notwithstanding the foregoing, on some occasions and in certain circumstances, with absolutely no obligation, we may be able to restore some or all of your data that has been deleted as of a certain date and time when we may have backed up data for our own purposes. We make no guarantee that the data you need will be available.

Links to other websites

Although this Website may link to other websites, we are not, directly or indirectly, implying any approval, association, sponsorship, endorsement, or affiliation with any linked website, unless specifically stated herein. We are not responsible for examining or evaluating, and we do not warrant the offerings of, any businesses or individuals or the content of their websites. We do not assume any responsibility or liability for the actions, products, services, and content of any other third-parties. You should carefully review the legal statements and other conditions of use of any website which you access through a link from this Website. Your linking to any other off-site websites is at your own risk.

Prohibited uses

In addition to other terms as set forth in the Agreement, you are prohibited from using the Website or its Content: (a) for any unlawful purpose; (b) to solicit others to perform or participate in any unlawful acts; (c) to violate any international, federal, provincial or state regulations, rules, laws, or local ordinances; (d) to infringe upon or violate our intellectual property rights or the intellectual property rights of others; (e) to harass, abuse, insult, harm, defame, slander, disparage, intimidate, or discriminate based on gender, sexual orientation, religion, ethnicity, race, age, national origin, or disability; (f) to submit false or misleading information; (g) to upload or transmit viruses or any other type of malicious code that will or may be used in any way that will affect the functionality or operation of the Service or of any related website, other websites, or the Internet; (h) to collect or track the personal information of others; (i) to spam, phish, pharm, pretext, spider, crawl, or scrape; (j) for any obscene or immoral purpose; or (k) to interfere with or circumvent the security features of the Service or any related website, other websites, or the Internet. We reserve the right to terminate your use of the Service or any related website for violating any of the prohibited uses.

Intellectual property rights

This Agreement does not transfer to you any intellectual property owned by Website Operator or third-parties, and all rights, titles, and interests in and to such property will remain (as between the parties) solely with Website Operator. All trademarks, service marks, graphics and logos used in connection with our Website or Services, are trademarks or registered trademarks of Website Operator or Website Operator licensors. Other trademarks, service marks, graphics and logos used in connection with our Website or Services may be the trademarks of other third-parties. Your use of our Website and Services grants you no right or license to reproduce or otherwise use any Website Operator or third-party trademarks.

Limitation of liability

To the fullest extent permitted by applicable law, in no event will Website Operator, its affiliates, officers, directors, employees, agents, suppliers or licensors be liable to any person for (a): any indirect, incidental, special, punitive, cover or consequential damages (including, without limitation, damages for lost profits, revenue, sales, goodwill, use of content, impact on business, business interruption, loss of anticipated savings, loss of business opportunity) however caused, under any theory of liability, including, without limitation, contract, tort, warranty, breach of statutory duty, negligence or otherwise, even if Website Operator has been advised as to the possibility of such damages or could have foreseen such damages. To the maximum extent permitted by applicable law, the aggregate liability of Website Operator and its affiliates, officers, employees, agents, suppliers and licensors, relating to the services will be limited to an amount greater of one dollar or any amounts actually paid in cash by you to Website Operator for the prior one month period prior to the first event or occurrence giving rise to such liability. The limitations and exclusions also apply if this remedy does not fully compensate you for any losses or fails of its essential purpose.


You agree to indemnify and hold Website Operator and its affiliates, directors, officers, employees, and agents harmless from and against any liabilities, losses, damages or costs, including reasonable attorneys’ fees, incurred in connection with or arising from any third-party allegations, claims, actions, disputes, or demands asserted against any of them as a result of or relating to your Content, your use of the Website or Services or any willful misconduct on your part.


All rights and restrictions contained in this Agreement may be exercised and shall be applicable and binding only to the extent that they do not violate any applicable laws and are intended to be limited to the extent necessary so that they will not render this Agreement illegal, invalid or unenforceable. If any provision or portion of any provision of this Agreement shall be held to be illegal, invalid or unenforceable by a court of competent jurisdiction, it is the intention of the parties that the remaining provisions or portions thereof shall constitute their agreement with respect to the subject matter hereof, and all such remaining provisions or portions thereof shall remain in full force and effect.

Changes and amendments

We reserve the right to modify this Agreement or its policies relating to the Website or Services at any time, effective upon posting of an updated version of this Agreement on the Website. When we do, we will revise the updated date at the bottom of this page. Continued use of the Website after any such changes shall constitute your consent to such changes. Policy was created with WebsitePolicies.

Acceptance of these terms

You acknowledge that you have read this Agreement and agree to all its terms and conditions. By using the Website or its Services you agree to be bound by this Agreement. If you do not agree to abide by the terms of this Agreement, you are not authorized to use or access the Website and its Services.

Contacting us

If you have any questions about this Agreement, please contact us.


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HIPAA Notice of Privacy Practices and Client Rights

Marissa Ezell LCSW LLC Privacy Protection Notice

This notice describes how your mental health records may be used and disclosed and how you can
get access to this information. Please read it carefully. This policy is posted on our website at
www.marissaezell.com/policies and a paper copy is available in the office waiting room.

I. Your Rights to Privacy under the HIPAA Preamble: Communications between
psychotherapists and their clients are privileged and, therefore, are protected from forced
disclosure in cases arising under federal law. There is a difference between privileged
conversations and documentation in your mental health records. Records are kept
documenting your care as required by law, professional standards, and other review

HIPAA very clearly defines what kind of information is to be included in your “Designated
Medical Record” as well as some material, known as “Psychotherapy Notes” which is not
accessible to insurance companies and other third-party reviewers and in some cases, not to
the client himself/herself. HIPAA provides privacy protections about your personal health
information, which is called “protected health information” (PHI) which could personally
identify you. PHI consists of three (3) components: treatment, payment, and health care
operations. Treatment refers to activities in which I provide, coordinate or manage your
mental health care or other services related to your mental health care. Examples include a
psychotherapy session, psychological testing, or talking to your primary care physician about
your medication or overall medical condition. Payment is when I obtain reimbursement for
your mental health care. The clearest example of this parameter is filing insurance on your
behalf to help pay for some of the costs of the mental health services provided you.
Health care operations are activities related to the performance of my practice such as quality
assurance. In mental health care, the best example of health care operations is when
utilization review occurs, a process in which your insurance company reviews our work
together to see if your care is “really medically necessary.” The use of your protected health
information refers to activities my office conducts for filing your claims, scheduling
appointments, keeping records and other tasks within my office related to your care.
Disclosures refer to activities you authorize which occur outside my office such as the
sending of your protected health information to other parties (i.e., your primary care
physician, the school your child attends).

II. Uses and Disclosures of Protected Health Information Requiring Authorization
The law requires authorization and consent for treatment, payment and healthcare
operations. I may disclose PHI for the purposes of treatment, payment and healthcare
operations with your consent. You have signed this general consent to care and authorization
to conduct payment and health care operations, authorizing me to provide treatment and to
conduct administrative steps associated with your care. Additionally, if you ever want me to
send any of your protected health information of any sort to anyone outside my office, you
will always first sign a specific authorization to release information to this outside party. A
copy of that authorization form is available upon the request. The requirement of your
signing an additional authorization form is an added protection to help insure your protected
health information is kept strictly confidential. An example of this type of release of
information might by your request that I talk to your child’s teacher about his/her ADHD
condition and what this teacher might do to be of help to your child. Before I talk to that
teacher, you will have first signed the proper authorization for me to do so.
There is a third, special authorization provision potentially relevant to the privacy of your
records: my psychotherapy notes. In recognition of the importance of the confidentiality of
conversations between psychotherapist and clients in treatment settings, HIPAA permits
keeping separate “psychotherapy notes” separate from the overall “designated medical
record.” “Psychotherapy notes” cannot be secured by insurance companies nor can they
insist upon their release for payment of services as has unfortunately occurred over the last
two decades of managed mental health care. “Psychotherapy notes” are my notes “recorded
in any medium by a mental health provider documenting and analyzing the contents of a
conversation during a private, group or joint family counseling session and separated from
the rest of the individual’s medical record.” “Psychotherapy notes” are necessarily more
private and contain much more personal information about you hence, the need for
increased security of the notes. “Psychotherapy notes” are not the same as your “progress
notes” which provide the following information about your care each time you have an
appointment at my office: medication prescriptions and monitoring, assessment/treatment
start and stop times, the modalities of care, frequency of treatment furnished, results of
clinical tests, and any summary of your diagnosis, functional status, treatment plan,
symptoms, prognosis and progress to date. Certain payors of care, such as Medicare and
Workers Compensation, require the release of both your progress notes and my
psychotherapy notes in order to pay for your care. If I am forced to submit your
psychotherapy notes in addition to your progress notes for reimbursement for services
rendered, you will sign an additional authorization directing me to release my psychotherapy
notes. Most of the time I will be able to limit reviews of your protected health information to
only your “designated record set” which include the following: all identifying paperwork you
completed when you first started your care here, all billing information, a summary of our
first appointment, your mental status examination, your individualized, comprehensive
treatment plan, your discharge summary, progress notes, reviews of you care by managed
care companies, results of psychological testing, and any authorization letters or summaries
of care you have authorized me to release on your behalf.

Please note that the actual test questions or raw data of psychological tests, which are
protected by copyright laws and the need to protect clients from unintended, potentially
harmful use, are not part of your “designated mental health record.” I never release any
information of any sort for marketing purposes. You may, in writing, revoke all authorizations
to disclose protected health information at any time. You cannot revoke an authorization for
an activity already done that you instructed me to do or if the authorization was obtained as a
condition for obtaining insurance and the insurer has the right to contest the claim under the

III. Business Associates Disclosures
HIPAA requires that I ensure that all those performing ancillary administrative service for my
practice and refers to these people as “Business Associates” sign and enter into a HIPAA
compliant Business Associate Agreement so that your privacy is ensured.

IV. Uses and Disclosures Not Requiring Consent nor Authorization
By law, protected health information may be released without your consent or authorization
for the following reasons:
• Suspected Child Abuse
• Adult and Domestic Abuse
• Health Oversight Activities (i.e., licensing board for Professional Counselors in Georgia)
• Judicial or Administrative Proceedings (i.e., if you are ordered here by the court)
• Serious Threat to Health or Safety (i.e., out “Duty to Warn” Law, national security threats)
• Workers Compensation Claims (if you seek to have your care reimbursed under
Workers Compensation, all of your care is automatically subject to review by your
employer and/or insurer(s).

V. Client’s Rights and My Duties
You have a right to the following:
• The right to request restrictions on certain uses and disclosures of your protected health
information, which I may or may not agree to, but if I do, such restrictions shall apply
unless our agreement is changed in writing;
• The right to receive confidential communications by alternative means and at alternative
locations. For example, you may not want your bills sent to your home address, so I will
send them to another location of your choosing;
• The right to inspect and receive a copy of your protected health information in my designated
mental health record set and any billing records for as long as protected health information is
maintained in the records;
• The right to amend material in your protected health information, although I may deny
an improper request and/or respond to any amendment(s) you make to your record;
• The right to an accounting of non-authorized disclosures of your protected health information;
• The right to a paper copy of notices/information from me, even if you have
previously requested electronic transmission of notices/information; and
• The right to revoke your authorization of your protected health information except to the
extent that action has already been taken.
For more information on how to exercise each of these rights, please do not hesitate to ask
me for further assistance on these matters. I am required by law to maintain the privacy of
your protected health information and to provide you with a notice of your Privacy Rights and
my duties regarding your PHI. I reserve the right to change my privacy policies and practices
as needed with these current designated practices being applicable unless you receive a
revision of my policies when you come for your future appointment(s). My duties as a
Licensed Clinical Social Worker on these matters include maintaining the privacy of your
protected health information, to provide you this notice of your rights and my privacy
practices, and to abide by the terms of this notice unless it is changed, and you are so

VI. Complaints
Marissa Ezell is the appointed “Privacy Officer” for Marissa Ezell LCSW LLC per HIPAA
regulations. If you have any concerns of any sort that my office may have compromised your
privacy rights, please do not hesitate to speak to me immediately about this matter. You will
always find me willing to talk to you about preserving the privacy of your protected mental
health information. You may also send a written complaint to the Secretary of the U.S.
Department of Health and Human Services.

HIPAA provides client protections related to the electronic transmission of data (the
transaction rule), the keeping and use of client records (“privacy rules”), and storage and
access to health care records (“the security rules”).

HIPAA applies to all health care providers, including mental healthcare, and providers and
health care agencies throughout the country are now required to provide clients a notification
of their privacy rights as it relates to their health care records.

As you might expect, the HIPAA law and regulations are extremely detailed and difficult to
grasp if you don’t have formal legal training. My Client Notification of Privacy Rights is my
attempt to inform you of your rights in a simple yet comprehensive fashion. Please read this
document as it is important you know what client protections HIPAA affords all of us. In
mental health care, confidentiality and privacy are central to the success of the therapeutic
relationship and as such, you will find I will do all I can to protect the privacy of your mental
health records.

This document was last updated on August 8, 2019