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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
This
Notice will tell you how we handle your medical information. It tells how we
use this information here in this office, how we share it with other
professionals and organizations, and how you can see it. We want you to know
all of this so that you can make the best decisions for yourself and your
family. If you have any questions or want to know more about anything in this
Notice, please ask our Privacy Officer for more explanations or more details. B.
What we mean by your medical information
Each
time you visit us or any doctor’s office, hospital, clinic, or any other
what are called “healthcare providers” information is collected about you
and your physical and mental health. It may be information about your past,
present or future health or conditions, or the tests and treatment you got
from us or from others, or about payment for healthcare. The information we
collect from you is called, in the law, PHI which stands for Protected
Health Information. This information goes into your
medical or healthcare record or file at the office. In
this office this PHI is likely to include these kinds of information: •
Your history. As a child, in school and at work,
marriage and personal history. •
Reasons you came for treatment. Your problems,
complaints, symptoms, or needs. •
Diagnoses. Diagnoses are the medical terms for your problems or
symptoms. •
A treatment plan. A list of the treatments and any other services which
we think will be best to help you. •
Progress notes. Each time you come in we write down some things about
how you are doing, what we notice about you, and what you tell us. •
Records we get from others who treated you or evaluated you. •
Psychological test scores, school records, and other reports. •
Information about medications you took or are taking. •
Legal matters •
Billing and insurance information This
list is just to give you and idea and there may be other kinds of information
that go into your healthcare record here. We
use this information for many purposes. For example, we may use it: •
To plan your care and treatment. •
To decide how well our treatments are working for you. •
When we talk with other healthcare professionals who are also treating
you such as your family doctor or the professional who referred you to us. •
To show that you actually received the services from us which we billed
to you or to your health insurance company. •
For teaching and training other healthcare professionals. •
For medical or psychological research. •
For public health officials trying to improve health care in this area
of the country. •
To improve the way we do our job by measuring the results of our work. When
you understand what is in your record and what it is used for you can make
better decisions about who, when, and why others
should have this information. Although
your health record is the physical property of the healthcare practitioner or
facility that collected it, the information belongs to you. You can read it
and if you want a copy we can make one for you( but
may charge you for the costs of copying and mailing, if you want it mailed to
you). In some very rare situations you cannot see all of what is in your
records. For example: when in our
professional judgment your access to the information is likely to endanger
your life or physical safety or the life or physical safety of another person;
when the information makes reference to another person or we have determined
in our professional judgment that your access is reasonably likely to cause
substantial harm to another person; or when you request copies of our
psychotherapy notes. Psychotherapy
notes are defined as “notes recorded (in any medium) by a health care
provider who is a mental health professional documenting or analyzing the
contents of conversation during a private counseling session or a group,
joint, or family counseling session and that are separated from the rest of
the individual’s medical record. If
upon your review of your protected health information, you find anything in
your records that you think is incorrect or believe that something important
is missing you can ask us to amend (add information to) your record although
in some rare situations we don’t have to agree to do that. If you want, our
Privacy Officer, whose name is at the end of this Notice, can explain more
about this. C.
Privacy and the laws
We
are also required to tell you about privacy because of the privacy regulations
of a federal law, the Health Insurance Portability and Accountability Act of
1996 (HIPAA). The
HIPAA law requires us to keep your Personal Healthcare Information (or PHI)
private and to give you this notice of our legal duties and our privacy
practices which is called
the Notice
of Privacy Practices (or NPP).
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 www.couplesandkids.com. D.
How your protected health information can be used and shared
When
your information is read by me or others in this office and used by us to make
decisions about your care that is called, in the law, “use.”
If the information is shared with or sent to others outside this office, that
is called, in the law, “disclosure.”
Except in some special circumstances, when we use your PHI here or disclose it
to others we share only the minimum
necessary PHI needed for those other people to do their jobs. The
law gives you rights to know about your PHI , how
it is used and to have a say in how it is disclosed (shared) and so we will
tell you more about what we do with your information. We
use and disclose PHI for several reasons. Mainly, we will use and disclose it for
routine purposes and we will explain more about these below. For
other uses we must tell you about them and have a written Authorization from
you unless the law lets or requires us to make the disclosure without your
authorization. However, the law also says that there are some uses and
disclosures that don’t need your consent or authorization. 1.
Uses and disclosures of PHI in healthcare not requiring your
consent
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. Next
we will tell you more about TPO. 1a.
For treatment,
payment, or health care operations.
We
need information about you and your condition to provide care to you.
When you come to see us, several people in our office may collect
information about you and all of it may go into your healthcare records here.
Generally, we may use or disclose your PHI for three purposes: treatment,
obtaining payment, and what are called healthcare operations. Let’s see what
these mean. For
treatment We
use your medical information to provide you with psychological treatments or
services. These might include individual, family, or group therapy,
psychological, educational, or vocational testing, treatment planning, or
measuring the benefits of our services. We
may share or disclose your PHI to others who provide treatment to you. We are
likely to share your information with your personal physician. The other
professionals treating you will also enter their findings, the actions they
took, and their plans into your medical record and so we all can decide what
treatments work best for you and make up a Treatment Plan. We may refer you to
other professionals or consultants for services we cannot provide. When we do
this we need to tell them some things about you and your conditions. We will
get back their findings and opinions and those will go into your records here.
If you receive treatment in the future from other professionals we can also
share your PHI with them. These are some examples so that you can see how we
use and disclose your PHI for treatment. For
payment We
may use your information to bill you, your insurance, or others so we can be
paid for the treatments we provide to you. We may contact your insurance
company to check on exactly what your insurance covers. We may have to tell
them about your diagnoses, what treatments you have received, and the changes
we expect in your conditions. We will need to tell them about when we met,
your progress, and other similar things. For
health care operations There
are a few other ways we may use or disclose your PHI for what 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 may be required to
supply some information to some government health agencies so they can study
disorders and treatment and make plans for services that are needed. If we do,
your name and personal information will be removed from what we send. 1b.
Other
uses in healthcare
Appointment
Reminders.
We may use and disclose medical information to reschedule or remind you of
appointments for treatment or other care. If you want us to call or write to
you only at your home or your work or prefer some other way to reach you, we
usually can arrange that. Just tell us. Treatment
Alternatives.
We may use and disclose your PHI to tell you about or recommend possible
treatments or alternatives that may be of help to you.
Other
Benefits and Services.
We may use and disclose your PHI to tell you about health-related benefits or
services that may be of interest to you.
Research.
We
may use or share your information to do research to improve treatments. For
example, comparing two treatments for the same disorder to see which works
better or faster or costs less. In all cases your name, address and
other personal information will be removed from the information given to
researchers. If they need to know who you are we will discuss the research
project with you and you will have to sign a special Authorization form before
any information is shared. Business
Associates.
There
are some jobs we may hire other businesses to do for us. In the law, they are
called our Business Associates. Examples include a copy service used to make
copies of your health records and a billing service who figures out, prints,
and mails bills. These business associates need to receive some of your PHI to
do their jobs properly. To protect your privacy they must agree in their
contract with us to safeguard your information. 2.
Uses and disclosures that require your Authorization
If
we want to use your information for any purpose besides the TPO or those we
described above we need your permission on an
Authorization form. We don’t expect to need this very often. 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 information for the purposes that we agreed to. Of course, we
cannot take back any information we had already disclosed with your permission
or that we had used in our office. 3. Additional uses and disclosures of PHI from mental health records that don’t require a Consent or AuthorizationThe
law lets us use and disclose some of your PHI without your consent or
authorization in some cases. Here are examples of when we might have to share
your information. When
required by law There
are some federal, state, or local laws which require us to disclose PHI. •
We have to report suspected child abuse. •
If you are involved in a lawsuit or legal proceeding and we receive a
subpoena, discovery request, or other lawful process we may have to release
some of your PHI. We will only do so after trying to tell you about the
request, consulting your lawyer, or trying to get a court order to protect the
information they requested. •
We have to disclose some information to the government agencies which
check on us to see that we are obeying the privacy laws. For
Law Enforcement Purposes We
may release medical information if asked to do so by a law enforcement
official to investigate a crime or criminal. For
public health activities We
might disclose some of your PHI to agencies which investigate diseases or
injuries. For
specific government functions We
may disclose PHI of military personnel and veterans to government benefit
programs relating to eligibility and enrollment. We may disclose your PHI to
Workers Compensation and Disability programs, to correctional facilities if
you are an inmate, and for national security reasons. To
Prevent a Serious Threat to Health or Safety If
we come to believe that there is a serious threat to your health or safety or
that of another person or the public we can disclose some of your PHI. 4.
An accounting of disclosures
You
have the right to receive an accounting of disclosures of your protected
health information, excluding disclosures made to carry out treatment, payment
or health care operations; disclosures authorized by you; disclosures made
directly to you; and disclosures made for certain national security or law
enforcement purposes. The
accounting includes the date of disclosure, name of recipient, description of
the protected health information released and the purpose of the disclosure.
E.
Your rights regarding your health information
1.
You can ask us to communicate with you about your health and related
issues in a particular way or at a certain place which is more private for
you. For example, you can ask us to call you at home,
and not at work to schedule or cancel an appointment. We will try our best to
do as you ask. 2.
You have the right to look at the health information we have about you
such as your medical and billing records, excluding our psychotherapy notes if
in our professional judgment this would not be in your best interest. You can
even get a copy of these records but we may charge you. Contact our Privacy
Officer to arrange how to see your records. See below. 3.
You have the right to request that we restrict the use or disclosure of
confidential information in carrying out treatment, payment or health care
operations. We are not obligated
to agree to such a restriction and may decide not to treat you if we cannot
agree on this issue. 4.
If you believe the information in your records is incorrect or missing
important information, you can ask us to make some kinds of changes (called
amending) to your health information. You have to make this request in writing
and send it to our Privacy Officer. You must tell us the reasons you want to
make the changes. 5.
You have the right to a copy of this notice. If we change this NPP we
will post the new version in our waiting area and you can always get a copy of
the NPP from the Privacy Officer. 6.
You have the right to file a complaint if you believe your privacy
rights have been violated. You can file a complaint with our Privacy Officer
and with the Secretary of the Department of Health and Human Services. All
complaints must be in writing. Filing a complaint will not change the health
care we provide to you in any way. F. Duties of Couples & KidsThe
staff at Couples & Kids is required by law to maintain the privacy of PHI
and to provide individuals with notice of their legal duties and privacy
practices with respect to PHI. Couples
& Kids is required to abide by the terms of the Notice currently in
effect. Couples & Kids
reserves the right to change the terms of this Notice and to make the new
notice provisions effective for all protected health information maintained.
You will be given a copy of the revised Notice the first time you come
into the office after its effective date.
G.
If you have questions or problems
If
you need more information or have questions about the privacy practices
described above please speak to the Privacy Officer whose name and telephone
number are listed below. 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 in any way limit your care here or take any actions against
you if you complain. If
you have any questions regarding this Notice or our health information privacy
policies, please contact our
Office by phone at 434-316-9339 or by e-mail at info@couplesandkids.com. The
effective date of this notice is I
have received and read the Notice
of Privacy Practices from Couples & Kids, A Counseling Center
for Families. ___________________________________ Print
your name ___________________________________
_______________________ Signature
Date Please
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