HIPAA PRIVACY NOTICE
Notice of Privacy Practices
Effective Date of Notice:April 14, 2003
THIS NOTICE DESCRIBES HOW COUNSELING INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
***Please note you must be 19 or older to have counseling without a parent's consent.***
LaDue Counseling Services creates and maintains health care records to provide you with high quality care and to comply with certain legal requirements. We are required to:
· Assure that protected health information that identifies you is private.
· Give you this notice of the privacy practices of this office and legal duties related to protecting the privacy of your health information.
· Follow the terms of the Notice that is currently in effect.
Permitted use and disclosure of your protected health information: LaDue Counseling Services uses your protected health information to provide counseling treatment to you, to collect payment for services and conduct normal office operations. These routine health information uses are permitted without special permission from you. This information can be used and disclosed as follows:
- Treatment— LaDue CounselingServices and any other staff involved with your treatment will use your health information to provide quality treatment. We may also communicate about your condition with other health care professionals such as your physician.
- Payment— LaDue Counseling Services may send bills to you or the responsible party to collect payment for services rendered. We transmit insurance claims to your insurance company. We may utilize a collection agency to collect overdue bills. These activities involve a part of your health information that is used in a limited way.
- Operations— LaDue Counseling Services may use your health information for administrative and managerial functions needed to run the office. Examples may include internal audits of quality of care, deciding whether to participate in managed care plans and offsite storage of records.
Individuals involved with your care: You may bring someone with you on your visit such as family members, relatives, close friends or other persons responsible for your care and include them in the discussion of your health information. They may be informed of your health information that is directly relevant to their involvement with your care only with your consent. (If you choose to come to counseling with another person and do not ask them to leave, your consent is implied.) Emergency situations may require us to notify individuals involved with your care of your location, general condition or death. Disaster relief efforts may require us to disclose information to entities involved with relief efforts.
Marketing: Use of your private information for marketing purposes is restricted. We will not give out or sell information about you for marketing purposes without your written permission.
Your rights:You have the right to adequate notice of the use and disclosure of protected health information and can request a copy of this document at any time. In case of emergency treatment, we will make a good faith effort to provide notice of our privacy policies. This notice will be revised whenever there are changes to the policies and practices and make copies available beginning with the new effective date.
Confidential communication: You may request that we communicate with you at an alternate address or method of contact for confidentiality. We will make reasonable accommodations for that request if you make the request in writing.
Inspect and Copy:You may request in writing copies of your protected health information. The fee of $2.00 per page to cover office expenses must be paid in advance. We will provide copies to you within 30 days of your request or provide a written notice explaining the reason we can’t copy your information.
Disclosures required by law:There may be situations that allow or require LaDue Counseling Servies to disclose your health information to legal authorities and agencies. We will keep a record of these disclosures unless prohibited for specific reasons by the authority or agency. Below is a list of possible situations that require me to disclose protected health information about you without your prior permission:
- Public health agencies or authorities
- The appropriate government agency responsible for responding to concerns about abuse, neglect or domestic violence as permitted by law
- Health oversight agencies may request information to supervise counseling practice
- Judicial or administrative proceedings or in response to a subpoena, discovery request or other lawful requests
- Law enforcement agencies
- Coroners, medical examiners and funeral directors
- For facilitation of organ donation and transplantation
- For research purposes as approved by a Privacy Board
- To prevent or lessen the threat to the health or safety of a person or the public.
- Military and veterans activities, national security, intelligence, protective services for the President, medical suitability for Department of State, correctional and other law enforcement custodial functions
- For purposes of worker’s compensation
Other uses of protected health information:Other use and disclosure of your protected health information will only be made with written permission from you, which you have the right to revoke at any time.
Request restriction:You may request restrictions on normal use and disclosure of your protected health information for treatment, payment or health care operations. A written request must be made describing the restrictions that you want. We are not required to agree to the restrictions request. If we do agree, we will abide by those restrictions except in the case of emergency requiring use or disclosure of your information.
Request Amendment:You may request in writing that we amend your counseling or billing records. Your request should include the specific information that you want changed or corrected. We will notify you in writing within 30 days of receiving your request that the changes have been made to your records or give you the reasons for denying the amendment request.
Request accounting of disclosure:You may request in writing that LaDue Counseling Services provide you a listing of the disclosures made of your protected health information. We will provide you with a written report within 60 days that your request is received. This report will not include normal use of protected health information for treatment, payment or office operations. There may be circumstances where agencies have requested we temporarily suspend accounting of disclosure to them that we cannot report. We will retain records of disclosures for 6 years beginning August 1, 2015. You may request one free report of disclosure per year. Additional reports must be paid for in advance. There are specific forms to fill out if you want to exercise any of these rights.
Changes to this notice: LaDue Counseling Services reserves the right to make changes to this notice of privacy practices. The revisions will be implemented on the effective date of the revision and will apply to all health information collected before or after the date of revision. The revised notice will be available upon request.
Complaints:You may file a complaint with us regarding my policies and procedures or report non-compliance with my policies and procedures at the above address. You may also file a complaint with the Secretary of Health and Human Services. You will not be penalized in any way for filing such a complaint.
If you have any questions about this notice, please contact this office.