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.
We are required to follow the terms of this Notice currently in effect. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you.
I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you and certain obligations I have regarding the use and disclosure of
your health information. I am required by law to:
• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of my legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
I have the right to change the terms of this notice, and such changes will apply to all information I have about you.
The new notice will be available upon request, in the Renewal Counseling Group office location or by request to Melanie Wall (224-326-4200).
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that this office uses and discloses health information. For each category of uses or disclosures there will be an explanation and some example. Not every use or disclosure in a category will be listed. However, all the ways this office is permitted to use and disclose information will fall within one of the categories.
For Treatment, Payment, or Health Care Operations:
Federal privacy regulations allow health care providers who have a direct treatment relationship with the client to use or disclose the client’s personal health information without the client’s written authorization to carry out the health care provider’s own treatment, payment, or health care operations. This office may also disclose your protected health information for the treatment purposes of any health care provider, this too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one provider to another.
Lawsuits and Disputes:
If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about you or your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1. Psychotherapy Notes: This office keeps “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your authorization unless the use or disclosure is:
a. For the use in treating you.
b. For training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
c. For our use in defending ourselves in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes: This office will not use or disclose your PHI for marketing purposes.
3. Sale of PHI: This office will not sell your PHI in the regular course of this business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:
Subject to certain limitations in the law, this office can use and disclose your PHI without your authorization for the following reasons:
1) When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2) For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3) For health oversight activities, including audits and investigations.
4) For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an authorization from you before doing so.
5) For law enforcement purposes, including reporting crimes occurring on Renewal Counseling Group premises.
6) To coroners or medical examiners, when such individuals are performing duties authorized by law.
7) For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8) Specialized government functions including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; helping to ensure the safety of those working or housed within correctional institutions.
9) For workers' compensation purposes. Although our preference is to obtain an authorization from you, we may provide your PHI to comply with workers' compensation laws.
10) Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with our office. I may also use and disclose your PHI to tell you about treatment alternatives, other health care services, or benefits that we offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:
Disclosures to family, friends, or others: We 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.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and may say “no” if we believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. The Right to Choose We Send PHI to You: You have the right to ask the office to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI: Other than “psychotherapy notes,” you have the right to get electronic or paper copy of your medical records. We will provide you with a copy of your record or a summary of it within 30 days of receiving a written request from you (through signing a release of information). If you agree to receive a paper copy of your medical records, we may charge a reasonable, cost-based fee for doing so.
5. The Right to Get a List of the Disclosures This Office Has Made: You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, health care operations, or for which you provided with this office with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, there will be a reasonable cost- based fee for each additional request.
6. The Right to Correct or Update Your PHI: If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but you will be notified why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice: You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by email. Even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it.