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.
Notice of Privacy Practices
A. Introduction - To Our Clients
Privacy is a very important concern for us and for all those who come to our office. This notice will tell you how we handle
information about you. It tells how we use this information here in this office, and how it can be disclosed to other parties.
You will also be informed of your rights, as well as our duties related to privacy. We believe it is important that you understand
all of this so that you can make the best decisions for yourself and your family.
B. What is Medical Information?
When you become a client of the agency, like other "healthcare providers," we create a file about you and the services
you receive. During your initial intake, we begin collecting information about you and your physical and mental health. Every
time we interact with you or take some other action related to your case, we add more information to that file. Much of that
information is also put on our computer system. Approximately 18 months after your last visit, the information in your paper
file is copied to a CD and the paper file is destroyed. In the law, all of that information is called, Protected Health Information,
of PHI. We are required to keep that information for seven years for adult clients and for seven years beyond the age of 18
for minor clients.
Notice Regarding Non-PHI Services:
The agency provides some services which do not result in the creation of PHI. Educational services are services during
which no counseling takes place, and no record is made of the client’s response to the material presented or their participation
level, for example, a workshop about parenting. On the other hand, the agency also runs parenting groups that do create PHI,
because they have a group counseling component, or are associated with the client’s counseling at the agency. In that
case, records are kept of client response, participation level or progress.
Other non-PHI services are Forensic Services. Forensic Services are services ordered by the court, directly related to
a court case, or performed with a reasonable expectation they will be the subject of a future court case. An example is a
custody evaluation, or supervised visitation. Under federal regulations, records related to those cases are not health
care records and are not protected by federal privacy regulations. In general, client’s rights related to those
records are determined by the client’s agreement with the provider and/or by the court of jurisdiction.
If you have questions about whether your service creates PHI or not, you should ask your provider, or our privacy officer.
C. Privacy and the Law
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to keep your PHI private, and to give
you this notice of our legal duties and our privacy practices, which is called Notice of Privacy Practices or NPP. We are
required to abide by our current NPP. Those duties and practices may change. If they do, the new NPP will apply to all of
the PHI we keep. If we change the NPP, we will post the new notice in our office where everyone can see. You or anyone else
can also get a copy from our Privacy Officer at any time and it will be posted on our website at CCDCOUNSELING.COM.
D. Use and Disclosure
When your information is read by your therapist or others in this office, the law calls that "use." If the information
is shared with or sent to others outside this office, the law calls that "disclosure." We use and disclose information for
several reasons. Mainly, we will use and disclose it for the routine purposes of treatment, payment and health care operations
(TPO), which are explained below. Some other uses and disclosures require us to tell you about them and to have a written
authorization. There are also uses and disclosures that are permitted or even required without your authorization.
E. Uses and Disclosures of PHI with your consent
After you have read this Notice, you will be asked to sign a separate Consent Form to allow us to use and share your PHI.
In almost all cases we intend to use your PHI here or share your PHI with other people or organizations to provide treatment
to you, arrange for payment for our services, or some other business functions called health care operations. Together, these
routine purposes are called TPO, and the Consent Form allows us to use and disclose your PHI for TPO. Reread that last sentence
until it is clear, because it is very important.
You have to agree to let us collect the information, and to use it and share it as necessary to care for you properly.
Therefore you must sign the Consent Form before we begin to treat you because if you do not agree and consent, we cannot treat
you. Following are specific examples of TPO uses and disclosures.
For treatment
Your therapist will use your PHI to plan for your treatment services. They may share this information with others in the
agency to coordinate additional services, such as groups, or evaluative services. We routinely discuss cases in "case review"
meetings to decide if the best services are being provided for those clients. In "case review" we make every effort to protect
the specific identity of the client whose case is being reviewed.
For payment
We may use your PHI to bill you, or another third party such as your insurance company to be paid for the treatment we
provide you. We may also contact that third party to verify your coverage and to find out exactly which services are covered.
We may have to tell them about your diagnoses, what services you have received, your progress, and other similar things that
are part of your PHI.
For health care operations
There are some other ways we may use or disclose your PHI which are called health care operations. For example, we may
use your PHI to see where we can make improvements in the care and services we provide. We also are subject to performance
audits by various organizations who need to see PHI to confirm that services are being delivered according to contract or
other rules.
F. Other Uses and Disclosures
Appointment Reminders.
Although we do not routinely send appointment reminders, we may need to use your PHI to contact you for scheduling purposes.
Business Associates.
There are some jobs we hire other businesses to do for us. In the law, those people are called our Business Associates.
Examples include the service we use to scan our paper files unto CD and the people at the answering service. These business
associates need to receive some of your PHI to do their jobs properly. To protect your privacy, they have agreed in their
contract with us to safeguard your information.
G. Use and Disclosures requiring your Authorization
If we want to use your PHI for any purpose besides the TPO or those we described above we need your permission on an Authorization
Form. If you do authorize us to use or disclose your PHI, you can revoke (cancel) that permission, in writing, at any time.
After that time we will not use or disclose your PHI for the purposes that required authorization. Of course, we cannot take
back any information we had already disclosed with your permission or that we had used in our office.
H. Uses and Disclosures of PHI Not Requiring Consent or Authorization
The laws let us, and sometimes require us to disclose some of your PHI without your consent or authorization in some cases.
For example:
- We have to report suspected child or elder abuse and/or neglect.
- If you are involved in a lawsuit or legal proceeding and we receive a subpoena, or other lawful process, we may have
to release some of your PHI. If the service you received is directly related to the court action, such as a child custody
evaluation or it was ordered by the court, we will release all requested information. Otherwise, we will do so only after
trying to tell you about the request, consulting your attorney, or trying to get a court order to protect the information
they requested.
- If your therapist is a Licensed Professional Counselor (LPC), they are required to "...take reasonable action to inform
medical or law enforcement personnel if the professional determines that there is a probability of imminent physical injury
by the client; to the client, or others, or there is a probability of immediate mental or emotional injury to the client."
Other therapists are not required, but the law says that they "may disclose" in this circumstance.
-Other possible required disclosures include, but are not limited to: abuse of patients in mental health facilities; sexual
exploitation by a mental health professional; possible transmission of AIDS/HIV; criminal prosecutions; suits in which the
mental health of a party is an issue; fee disputes between the therapist and client; a negligence suit brought by the client
against the therapist; the filing of a complaint with the licensing board; or the disclosure of some information to the government
agencies which check on us to see that we are obeying the privacy laws. If you are participating in the group, each group
member is instructed to keep group information confidential, but the members, and not the therapist have ultimate control
over the quality of that confidentiality. This is not a complete list, but only examples of the many laws that require or
permit release of your PHI. We are committed to protecting your privacy, but will always abide by the law.
I. Your Rights Regarding your PHI
Although your health record is the physical property of the agency, the information belongs to you. You have the following
rights regarding your health information. You may exercise these rights by making a written request to the Privacy Officer.
- Right to request restrictions on certain uses and disclosures, but we are not required to agree to your request.
- Right to confidential communications. If you want us to call or write you only at your home or work, or prefer some other
way to reach you, we usually can arrange that.
- Right to inspect and copy. You have right to inspect, read, or review your medical record. If you would like a copy,
we can make one for you, but may charge you for the costs of copying. In some very unusual circumstances, you cannot see all
of what is in your records. There are specific rules for this circumstance and the Privacy Officer can tell you about them.
- Right to amend. If you find anything in your records that you think is incorrect or something important is missing, you
can ask us to amend (add information to) your record, although in some rare instances, we don’t have to agree to do
that.
- Right to an accounting of disclosures. When we disclose your PHI for other than TPO purposes, we record that. You may
request a list of those disclosures.
- Right to a Copy of this Notice. You will receive a copy of our current NPP in your first meeting, but you or anyone else
can also get a copy from our Privacy Officer at any time and it will be posted on our website at WWW.CCDCOUNSELING.COM. (I guess you knew that.)
J. If you have questions or a problem If you need more information or have questions about the privacy practices described,
please speak to the Privacy Officer. If you have a problem with how your PHI has been handled or if you believe your privacy
rights have been violated, contact the Privacy Officer. You have the right to file a complaint with us and with the Secretary
of the Federal Department of Health and Human Services. We promise that we will not retaliate against you if you complain.
Privacy Officer
Cindy D. Jacobson
(940) 382-5328 ext. 17
The effective date of this notice is April 14, 2003
