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.
MY PRIVACY COMMITMENT TO YOU. Your health information is personal and will be treated as confidential. In the normal course of providing counseling to you I create records about you and the treatment and services I provide to you. This information is called Protected Health Information (PHI) and may include information that can be used to identify you that I've created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care.
I am legally required to protect the privacy of your PHI and provide you with this notice of how I safeguard and use it. I will only release your health information as allowed by law or with special written permission (authorization) from you. With some exceptions, I will not use or disclose any more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made. I am legally required to follow the privacy practices described in this Notice.
WHEN IS THE NOTICE EFFECTIVE? This Notice became effective April 14, 2003. Please note, I reserve the right to change the terms of this Notice and my privacy policies at any time. Any changes will apply to PHI on file with me already. Before I make any important changes to my policies, I will promptly change this Notice and post a new copy of it in my office. You can also request an email copy of this Notice from me, or you can view a copy of it in my office. USE AND RELEASE OF YOUR HEALTH INFORMATION While providing you with health care services, I may need to share your health information with other healthcare providers or individuals who are involved in your treatment. Some uses or disclosures will require your prior authorization while others will not. Listed below are the different categories of my uses and disclosures along with some examples of each category.
A. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written Consent. I can use and disclose your PHI without your consent for the following reasons:
1. For treatment I can disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are involved in your care. For example, if you're being treated by a psychiatrist, I can disclose your PHI to your psychiatrist in order to coordinate your care. However, it is my practice to only do so if you have directly authorized me in writing, unless a threat to your safety is involved.
2. To obtain payment for treatment I may need to disclose a limited amount of your PHI to bill and collect payment for the treatment and services provided by me to you. For example, I might send your PHI to your insurance company or health plan to get paid for the health care services that I have provided to you. I may also provide your PHI to my business associates, such as billing companies, claims processing companies, and others that process my health care claims. All our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
3. For health care operations I can disclose your PHI to operate my practice. For example, I might use your PHI to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided such services to you. I may also provide your PHI to our accountants, attorneys, consultants, and others to make sure I’m complying with applicable laws.
4. Other Disclosures I may also disclose your PHI to others without your consent in certain situations. For example, your consent isn't required if you need emergency treatment, as long as I try to get your consent after treatment is rendered, or if I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) and I think that you would consent to such treatment if you were able to do so.
B. Certain Uses and Disclosures Do Not Require Your Consent. I can use and disclose your PHI without your consent or authorization for the following reasons:
1. When disclosure is required by federal, state or local law; judicial or administrative proceedings; or, law enforcement. For example, I may make a disclosure to applicable officials when a law requires me to report information to government agencies and l enforcement personnel about victims of abuse or neglect; or when ordered in a judicial or administrative proceeding.
2. For public health activities For example, I may have to report information about you to the county coroner.
3. For health oversight activities For example, I may have to provide information to assist the government when it investigates or inspection of a health care provider or organization.
4. For research purposes In certain circumstances, I may provide PHI in order to conduct medical research.
5. To avoid harm In order to avoid a serious threat to you or another person, I may disclose PHI to law enforcement personnel or persons able to prevent or lessen such harm.
6. For specific government functions I may disclose PHI of military personnel and veterans in certain situations. And I may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
7. For workers' compensation purposes I may provide PHI in order to comply with workers' compensation laws.
8. Appointment reminders and health related benefits or services I may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits I offer.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object 1. Disclosures to family, friends, or others I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
D. Uses and Disclosures That Require Your Prior Written Authorization. Except for the types of situations listed above, I must obtain your written permission known as an authorization for any types of releases of your health information. An authorization is required for the sale of your health information for marketing purposes. An authorization is required for most uses and disclosures of psychotherapy notes. If you provide me with an authorization to use or release health information about you, you may cancel (revoke) that authorization in writing at any time. Any authorization you sign may be cancelled (revoked) by following the instructions described on the authorization form. You may receive more information about this by contacting me, the counselor.
E. Other uses and disclosures of your health information not described in this Notice may be made only with your written authorization, and you have the right to take back (revoke) your authorization.
WHAT RIGHTS YOU HAVE REGARDING YOUR PHI You have the following rights with respect to your PHI:
A. Right to Request Confidential Communication You have the right to ask me to communicate your health information to you in different ways or places. For example, you can ask that I only contact you by telephone at work, or that I contact you by mail at home or at a post office box. I will do this whenever it is reasonably possible.
B. Right to Request Restrictions You have the right to request restrictions or limitations on how your health information is used or released. I have the right to deny your request.
C. Out-Of-Pocket You may request that I not disclose your information to your health plan if: you have paid for a health care item or service in full and paid for the item or service out of your own pocket. I must honor your request to restrict your health information from being disclosed to your health plan for purposes of payment or health care operations unless the disclosure is required by law. You may obtain information about how to ask for a restriction by contacting me.
D. The Right to See and Get Copies of Your PHI. In most cases, you have the right to review and receive a copy of your health information, such as progress notes and billing records. You must submit a written request in order to inspect and/or copy your information. If I don't have your PHI but I know who does, I will tell you how to get it. I will respond to you within 30 days of receiving your written request. I may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your information, I will provide a written reason for the denial and explain your right to have my denial reviewed. If you request a copy of your health information, you may incur a fee for the costs of copying, mailing or other associated supplies. As an alternative to providing the PHI you requested, I may provide you with a summary or explanation of the PHI as long as you agree to that alternative and to the cost in advance
E. Right to a Record of Releases (Accounting) You have the right to ask for a list of releases of your health information and may do so by sending me a written request. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, or disclosures that you have authorized. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable fee for each additional request.
F. The Right to Correct or Update Your PHI You have the right to ask that information in your record be changed if it is not correct or complete. You must provide the reason why you are asking for a change. You may request a change by sending me a written request. I may deny your request if the PHI is:• Not created by me Not part of my records Not allowed to be disclosed. The information is already correct and complete
G. Right to Receive This Notice of Privacy You have the right to receive a copy of this notice at any time. You may obtain a paper copy of the current notice in my office or request a copy of this notice by email.
H. Right to Get Notice of a Breach You have the right to be notified following a breach of your unsecured health information. IF YOU HAVE A COMPLAINT ABOUT HOW YOUR HEALTH INFORMATION IS HANDLED,
Please feel free to discuss any concerns with me that you may have. If you feel your concern is not resolved and you believe that your privacy rights have been violated, you may file a complaint with me or with the US Secretary of Health and Human Services. You will not be denied treatment or retaliated or penalized in any way if you file a complaint with a complaint or your complaint can be sent by email, fax, or mail to the HHS’ Office for Civil Rights (OCR).
For more information, go to the OCR website (http://www.hhs.gov/ocr/privacy/hipaa/complaints). Insurance Portability and Accountability Act and Notice Privacy. (If you have any questions about this, please feel free to discuss with me.) Your signature below indicates that you have received a copy of HIPPA Notice of Privacy Practices Health Insurance Portability and Accountability Act (HIPAA) of 1996 and a copy of Notice of Privacy Practices