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.
In conducting my counseling services, I will create and maintain records that contain protected health information about you and the treatment provided to you. Protected health information or PHI is information that can reasonably be used to identify you and may include any of the following: Your history, medical problems, medications, why you are coming to treatment, diagnoses, treatment plans, progress notes, records from others involved in your care, medication info, insurance and billing information. This information is used to plan for your treatment, evaluate effectiveness of treatment and your progress, coordinate with other health care professionals, and demonstrate to your insurance company that you are receiving appropriate and quality treatment for services for which they are paying.
This notice describes my privacy practices, which include how I may use, disclose, collect, handle, and protect my clients’ protected health information. I am required by federal and state laws to maintain the privacy of your protected health information. I am also required by the Health Insurance Portability and Accountability Act or HIPAA to give you this notice about our privacy practices, our legal duties, and your rights concerning your protected health information.
This notice takes effect on December 1st, 2019, and will remain in effect until I replace or modify it.
I. How your protected health information can be used and shared
A. Uses and disclosures with your consent—I am allowed to use your PHI for treatment, payment and health care operations, otherwise I will ask you to sign a release of information consent form.
1. Treatment - I may use your PHI to provide you with mental health treatment. This includes development of a diagnosis if applicable and development of a treatment plan based on why you are coming to therapy, your symptoms and your symptom history. I may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who you work with, or I am referring you to, in order to coordinate treatment. I may also send appointment reminders or contact you to reschedule by phone, text, or email.
2. Payment - I may use your PHI to bill you, your insurance company, or use a collection agency so that I can be paid for services provided to you. I may need to call your insurance company to find out what services they will cover, to provide them with a diagnosis, tell them when and for how long we met, or the progress you are making in order to receive reimbursement for treatment. Some insurances may review the entire record during audits to ensure that I am providing adequate treatment to their standards.
3. Health Care Operations - I may use your PHI to review the efficacy of treatment provided in my practice. I may also provide PHI to my attorneys or consultants to make sure I am in compliance with the law. PHI may be shared with business associates, which are other companies that have been hired by me to help run aspects of the business, such as my electronic medical record and billing system. Business associates sign contracts and follow HIPAA to ensure they are safeguarding your information to the extent required by law.
B. Uses and disclosures that do not require your consent or authorization—I will almost always notify you if any of these situations occur, and in many cases, will seek your authorization to release information, even though it is not required.
1. When required by mandatory reporting laws, such as with suspected child abuse and elder/dependent adult abuse.
2. When required by law due to serious and imminent threat to harm yourself or others. Typically this may involve notifying parent/legal guardian, emergency contact, local crisis center, or emergency dispatch/police.
3. When required by law due to lawsuit, law enforcement or other legal proceedings. In the event that my records are subpoenaed, I will typically try to offer a summary of treatment records with minimally necessary information. I will direct you to consult with a lawyer. If you are involved in any legal proceeding, please notify me as soon as possible.
4. When you are seeking worker’s compensation or disability benefits.
5. When required by law due to oversight and regulatory agencies, such as to ensure I am in compliance with HIPAA laws.
C. Uses and disclosures where you have the opportunity to object—I may share information with your family, someone who is involved in your care, or someone who is responsible for paying for your healthcare services, such as to schedule or confirm appointments scheduled, to help set up transportation to services, to review billing information and for which services, and to discuss treatment provided and general progress. I will ask who you would like me to talk to and what you would like me to share, and you are able to object in whole or in part.
II. Your rights about your protected health information
A. You have the right to ask me to communicate with you about your protected health information in a particular way, such as asking me to only contact you using your cell phone number and not your home phone. You have the right to request to communicate using unsecured means, such as through email or text message. A separate release will need to be signed so that you are fully aware of the risks if you choose to communicate this way.
B. You have the right to ask me to limit what I tell people involved in your care. I do not have to agree to your request, but if I do agree, I will honor your request unless it is against the law for me to withhold information or when there is an emergency.
C. You have the right to request a list of disclosed protected health information, including to whom, when, and what was disclosed.
D. You have the right to look at the protected health information I have about you, such as your medical and billing records. You have the right to receive a copy of your medical or billing records by either paper or electronic means. I have the right to refuse or limit your review of your medical record if I believe that this could cause serious harm to you or someone else.
E. You have the right to add to your record to explain or correct anything that is in them. If you believe the information in your record is incorrect or important information is missing, you can ask me to make additions or include your own written statement.
F. You have the right to be notified of any breach of your protected health information.
G. You have the right to a paper copy of this notice.
H. You have the right to file a complaint with me (privacy officer) and with the Secretary of the U.S. Department of Health and Human Services if you believe your protected health information has been mishandled or your privacy rights were violated. There will be no retaliation for complaints.