THIS NOTICE DESCRIBES HOW CLINICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
Your medical record may contain personal information about your health. This information may identify you and relate to your past, present or future physical or mental health condition and related health care services and is called Protected Health Information (PHI). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the main upon request or providing one to you at your next appointment.
How we may use and disclose health care information about you:
For Care or Treatment:
Your PHI may be used and disclosed to any parties that are involved in payment for care or treatment. If you pay for your care or treatment completely out of pocket with no use of any insurance, you may restrict the disclosure of your PHI for payment. Example: Your payer may require copies of your PHI during the course of a medical record request, chart audit or review. Different personnel in our office may share information about you and disclosure information to people who do not work in our office in order to coordinate your care, such as phoning in prescriptions to your pharmacy, or scheduling lab work or consultations. Family members and other mental health/healthcare providers may be part of your clinical care outside this office and may require information about you that we have.
Federal and State law require your written consent to release mental health/health information.
The Consent will specify who is to receive the information, the purpose of the release of information, and a time period after which the Consent will terminate. You may modify or revoke a Consent at any time. If we are unable to fulfill our requirements related to treatment, payment or mental health/healthcare operations, we may choose to discontinue providing you with mental health/healthcare treatment and services. In some instances, we may need specific, written authorization from you in order to disclose certain types of specifically protected information such as HIV, substance abuse and genetic testing information.
For Business Operations:
We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities or employee review activities. We may also disclose PHI in the course of providing you with appointment reminders or leaving messages on your phone or at your home about questions you asked or test results. Example: We may share your PHI with third parties that perform various business activities (e.g., information technology services, provided we have a written contract with the business that requires it to safeguard the privacy of your PHI.
Required by Law:
Under the law, we must make disclosures of your PHI available to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule, if so required.
Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of other situations. Examples of some of the types of uses and disclosures that may be made without your authorization are those that are:
- Required by Law, such as the mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations (such as the Health Department)
- Required by Court Order
- Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
We may use or disclose your information to family members that are directly involved in your receipt of services with your verbal permission
Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked. Your explicit authorization is required to release psychotherapy notes and PHI for the purposes of marketing, subsidized treatment communication and for the sale of such information.
Your rights regarding your PHI
You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Clinic Coordinator:
- Right of Access to Inspect and Copy. . You have the right, which may be restricted only in exceptional circumstances or with documents released to us, to inspect and copy PHI that may be used to make decisions about services provided.
- Right to Amend. .If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment.
- Right to an Accounting of Disclosures. .You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
- Right to Request Restrictions. . You have the right to request a restriction or limitation on the use or disclosure of your PHI for services, payment, or business operations. We are not required to agree to your request.
- Right to Request Confidential Communication. . You have the right to request that we communicate with you about PHI matters in a specific manner (e.g., telephone, email, postal mail, etc)
- Right to a Copy of this Notice. . You have the right to a copy of this notice.
Any personal information you provide us with via our website, including your email address, will never be sold or rented to any third party without your express permission. If you provide us with any personal or contact information in order to receive anything from us, we may collect and store that personal data. We do not automatically collect your personal email address simply because you visit our site.
You will be notified immediately if we receive information that there has been a breach involving your PHI.
If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Clinic Coordinator at (Children’s Program). If you have questions and would like additional information, you may contact us at (503) 452-8002 ext. 121.