NOTICE OF PRIVACY PRACTICES
Privacy Officer: Timothy K. Bradford, Chief Operating Officer email@example.com
Effective Date August 1, 2019
Premier Counseling documents all clinical care provided by our practice. We use your record to obtain payment for the services rendered as approved by your insurance policy and to enable us to meet our professional and legal obligations to operate our practice appropriately. We are required by law to maintain the privacy of protected health information; to provide individuals with notice of our legal duties and privacy practices with respect to protected health information; and to notify affected individuals in the event of a breach of unsecured protected health information. This notice describes how we may use and/or disclose your information. It also describes your rights and our legal obligations with respect to your clinical information.
We collect health information, date of birth, and your social security number and it is stored in our electronic medical records system- iSalus. The clinical record is the property of Premier Counseling, LLC; however, the information within the clinical record belongs to you. The law permits us to use or disclose your information for the following purposes:
We use your information to provide your care. We disclose your information to our team members and others who are involved in providing clinical and medical care to you.
We use your information to obtain payment for the services we provide.
3. Health Care Operations.
We may use and disclose your clinical information to operate the practice. We may use and disclose this information to get your health plan to authorize services. We may also use and disclose this information as necessary for clinical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your clinical information with our “business associates,” such as our billing service, that perform administrative services for us. We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your protected health information. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, their protocol development, case management or care-coordination activities, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts.
4. Notification and Communication with Family.
We may disclose your information to notify or assist in notifying a family member, your personal representative or another responsible party for your care about your location and your condition. We may also disclose information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a crisis over your objection if it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, we will use our best judgment in communication with your family and others.
We do not receive payment for making the following communications: we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may benefit you.
6. Required by Law.
As required by law, we must report abuse, neglect and/or domestic violence. We may be ordered to respond to judicial or administrative proceedings, and we will comply with the requirement set forth concerning those events.
7. Health Oversight Activities.
We may, and are sometimes required by law, to disclose your information to health oversight agencies subject to the limitations imposed by law.
8. Judicial and Administrative Proceedings.
We may be asked to disclose your information during administrative or judicial proceeding authorized by a court or administrative order. We may also disclose information about you in response to a subpoena.
9. Public Safety.
We have a responsibility to keep all people say. We are required by law, to disclose your information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of others.
10. Workers’ Compensation.
We will disclose your information as necessary to comply with workers’ compensation laws.
11. Change of Ownership.
In the event Premier Counseling, LLC is sold or merged with another organization, your information/record will become the property of the new owner. You will maintain the right to request that copies of your information be transferred to another clinical practice.
12. Breach of Information Notification.
In the case of a breach of unsecured protected information, we will notify you as required by law.
13. Clinical Documentation.
We will not use or disclose your clinical documentation without your (or your legal responsible party’s) prior written authorization except for the following: use by the originator of the notes for your treatment; for training our staff, students and other trainees; to defend ourselves if you sue us or bring some other legal proceeding; if the law requires us to disclose the information to you or the Secretary of HHS or for some other reason; in response to health oversight activities concerning your clinician; or to avert a serious and imminent threat to health or safety.
When Premier Counseling May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, Premier Counseling, LLC will not use or disclose information which identifies you without your written authorization if it is in accordance with the law. If you do authorize this Premier Counseling, LLC to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
Your Health Information Rights
- Right to Request Special Privacy Protections.
You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed. If you request that we do not disclose your information to your health insurance plan concerning services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request and will notify you of our decision.
- Right to Request Confidential Communications.
You have the right to request that you receive your information in a specific way or at a specific location. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
- Right to Inspect and Copy.
You have the right to inspect and copy your health information, with limited exceptions. To access your information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. We will provide copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic format, your choice of a readable electronic or hardcopy format. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary. We may deny your request under limited circumstances. If we deny your request to access your clinical documentation you will have the right to have them transferred to another mental health professional.
- Right to Amend or Supplement.
You have a right to request that we amend your information if you believe it is incorrect or incomplete. You must submit the request to amend in writing and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information and will provide you with information about the denial as well as how you can disagree with the denial. If we deny your request, you may submit a written statement of your disagreement with that decision. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
- Right to an Accounting of Disclosures.
You have a right to receive an accounting of disclosures of your information made by this medical practice
Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at any time. Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted on our website and a copy will be made available to you.
Complaints about this Notice of Privacy Practices or how Premier Counseling, LLC handles your information should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices.
If you are unsatisfied with the manner in which Premier Counseling, LLC handles your complaint, at no penalty, you may submit a formal complaint to: OCRMail@hhs.gov