|
Notice of Privacy Practices THIS DOCUMENT IS WRITTEN FROM THE STANDPOINT OF YOUR THERAPIST AT CML: 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.
I.
I HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED
HEALTH INFORMATION (PHI). I am
legally required to protect the privacy of your PHI, which includes information
that can be used to identify you that I’ve created or received about your
past, present, or future health or condition, the provision of health care to
you, or the payment of this health care. I
must provide you with this Notice about my privacy practices, and such Notice
must explain how, when, and why I will “use” and “disclose” your PHI.
A “use” of PHI occurs when I share, examine, utilize, apply, or
analyze such information within my practice; PHI is “disclosed” when
it is released, transferred, has been given to, or is otherwise divulged to a
third party outside of my practice.
With some exceptions, I may not use or disclose any more of your PHI than
is necessary to accomplish the purpose for which the use or disclosure is made.
And, I am legally required to follow the privacy practices described in
this Notice.
However, I
reserve the right to change the terms of this Notice and my privacy policies at
any time. Any changes will apply to
PHI on file with me already. Before
I make any important changes to my policies, I will promptly change this Notice
and post a new copy of it in my office and on my website.
You can also request a copy of this Notice from me, or you can view a
copy of it in my office or at my website, which is located at www.modernlife.org.
II.
HOW I MAY USE AND DISCLOSE YOUR PHI.
I will use and disclose your PHI for many different reasons.
For some of these uses or disclosures, I will need your prior written
authorization; for others, however, I do not.
Listed below are the different categories of my uses and disclosures
along with some examples of each category. A.
Uses
and Disclosures Relating to Treatment, Payment, or Health Care Operations Do Not
Require Your Prior Written Consent.
I can use and disclose your PHI without your consent for the
following reasons: 1. For
treatment. I can use your
PHI within my practice to provide you with mental health treatment, including
discussing or sharing your PHI with my trainees and interns.
I can disclose your PHI to physicians, psychiatrists, psychologists, and
other licensed health care providers who provide you with health care services
or are involved in your care. For
example, if a psychiatrist is treating you, I can disclose your PHI to your
psychiatrist in to coordinate your care. 2. To
obtain payment for treatment. I can
use and disclose your PHI to bill and collect payment for the treatment and
services provided by me to you. For
example, I might send your PHI to your insurance company or health plan to get
paid for the health care services that I have provided to you.
I may also provide your PHI to my business associates, such as billing
companies, claims processing companies, and others that process my health care
claims. 3. For
health care operations. I can
use and disclose your PHI to operate my practice.
For example, I might use your PHI to evaluate the quality of health care
services that you received or to evaluate the performance of the health care
professionals who provided such services to you. I may also provide your PHI to my accountant, attorney,
consultants, or others to further my health care operations.
4. Patient
Incapacitation or Emergency.
I may also disclose your PHI to others without your consent if you are
incapacitated or if an emergency exists. For
example, your consent isn’t required if you need emergency treatment, as long
as I try to get your consent after treatment is rendered, or if I try to get
your consent but you are unable to communicate with me (for example, if you are
unconscious or in severe pain) and I think that you would consent to such
treatment if you were able to do so. B.
Certain
Other Uses and Disclosures Also Do Not Require Your Consent or Authorization.
I can use and disclose your PHI without your consent or authorization for
the following reasons: 1. When
federal, state or local law requires disclosure.
For example, I may make a disclosure to applicable government officials
when a law requires me to report information to government agencies and law
enforcement personnel about victims of abuse or neglect. 2. When
judicial or administrative proceedings require disclosure.
For example, if you are involved in a lawsuit or a claim for workers’
compensation benefits, I may have to use or disclose your PHI in response to a
court or administrative order. I
may also have to use or disclose your PHI in response to a subpoena.
3. When
law enforcement required disclosure.
For example, I may have to use or disclose your PHI in response to a
search warrant. 4. When
public health activities requires disclosure. For example, I may have to use or disclose your PHI to report
to a government official an adverse reaction that you have to a medication.
5. When
health oversight activities require disclosure.
For example, I may have to provide information to assist the government
in conducting an investigation or inspection of a health care provider or
organization. 6. To
avert a serious threat to health or safety.
For example, I may have to use or disclose your PHI to avert a serious
threat to the health or safety of others. However,
any such disclosures will only be made to someone able to prevent the threatened
harm from occurring. 7. For
specialized government functions.
If you are in the military, I may have to use or disclose your PHI for
national security purposes, including protecting
the President of the United States or conducting intelligence operations.
8. To
remind you about appointments and to inform you of health-related benefits or
services. For example, I
may have to use or disclose your PHI to remind you about your appointments or to
give you information about treatment alternatives, other health care services,
or other health care benefits that I offer that may be of interest to you.
C.
Certain
Uses and Disclosures Require You to Have the Opportunity to Object. 1. Disclosures
to family, friends, or others.
I may provide your PHI to a family member, friend, or other person that
you indicate is involved in your care or the payment of your health care, unless
you object in whole or in part. The
opportunity to consent may be obtained retroactively in emergency situations. D.
Other
Uses and Disclosures Require Your Prior Written Authorization.
In any other situation not described in sections II A, B, and C above, I
will need your written authorization before using or disclosing any of your PHI.
If you choose to sign an authorization to disclose your PHI, you can
later revoke such authorization in writing to stop any future uses and
disclosures (to the extent that I haven’t taken any action in reliance on such
authorization) of your PHI by me.
III.
WHAT RIGHTS YOU HAVE REGARDING YOUR PHI.
You have the following rights with respect to you PHI: A.
The
Right to Request Restrictions on My Uses and Disclosures.
You have the right to request restrictions or limitations on my uses or
disclosures of your PHI to carry out my treatment, payment, or health care
operations. You also have the right
to request that I restrict or limit disclosures of your PHI to family members or
friends or others involved in your care or who are financially responsible for
your care. Please submit such
requests to me in writing. I will consider your requests, but I am not legally required
to accept them. If I do accept your
requests, I will put them in writing and I will abide by them except in
emergency situations. However, be
advised, that you may not limit the uses and disclosures that I am legally
required to make. B.
The
Right to Choose How I Send PHI to You.
You have the right to request that I send confidential information to you
at an alternate address (for example, sending information to your work address
rather than your home address) or by alternate means (for example, email instead
of regular mail). I must agree to
your request so long as it is reasonable and you specify how or where you wish
to be contacted, and, when appropriate, you provide me with information as to
how payment for such alternate communications will be handled.
I may require an explanation from you as to the basis of your request as
a condition of providing communications on a confidential basis.
C.
The
Right to Inspect and Copy Your PHI.
In most cases, you have the right to inspect and copy the PHI that I have
on you, but you must make the request to inspect and copy such information in
writing. If I don’t have your PHI
but I know who does, I will tell you how to get it. I will respond to your request within 30 days of receiving
your written request. In certain
situations, I may deny your request. If
I do, I will tell you, in writing, my reasons for the denial and explain your
right to have my denial reviewed.
If you request copies of your PHI, I will charge you not more than $.25
for each page. Instead of providing
the PHI you requested, I may provide you with a summary or explanation of the
PHI as long as you agree to that and to the cost in advance.
D.
The
Right to Receive a List of the Disclosures I Have Made.
You have the right to receive a list of instances, i.e., an Accounting of
Disclosures, in which I have disclosed your PHI.
The list will not include uses or disclosures made for my treatment,
payment, or health care operations; disclosures made to you; disclosures you
authorized; disclosures incident to a use or disclosure permitted or required by
the federal privacy rule; disclosures made for national security or
intelligence; disclosures made to correctional institutions or law enforcement
personnel; or, disclosures made before April 14, 2003.
I
will respond to your request for an Accounting of Disclosures within 60 days of
receiving such request. The list I
will give you will include disclosures made in the last six years unless you
request a shorter time. The list
will include the date the disclosure was made, to whom the PHI was disclosed
(including their address, if known), a description of the information disclosed,
and the reason for the disclosure. I
will provide the list to you at no charge, but if you make more than one request
in the same year, I may charge you a reasonable, cost-based fee for each
additional request. E.
The
Right to Amend Your PHI. If you
believe that there is a mistake in your PHI or that a piece of important
information is missing, you have the right to request that I correct the
existing information or add the missing information. You must provide the request and your reason for the request
in writing. I will respond within
60 days of receiving your request to correct or update your PHI.
I may deny your request in writing if the PHI is (i) correct and
complete, (ii) not created by me, (iii) not allowed to be disclosed, or (iv) not
part of my records. My written
denial will state the reasons for the denial and explain your right to file a
written statement of disagreement with the denial.
If you don’t file one, you have the right to request that your request
and my denial be attached to all future disclosures of your PHI.
If I approve your request, I will make the change to your PHI, tell you
that I have done it, and tell others that need to know about the change to your
PHI. F.
The
Right to Receive a Paper Copy of this Notice.
You have the right to receive a paper copy of this notice even if you
have agreed to receive it via email.
IV.
HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES.
If you think that I may have violated your privacy rights, or you
disagree with a decision I made about access to your PHI, you may file a
complaint with the person listed in Section V below.
You also may send a written complaint to the Secretary of the Department
of Health and Human Services at 200 Independence Avenue S.W., Washington, D.C.
20201. I will take no retaliatory
action against you if you file a complaint about my privacy practices.
V.
PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR
TO COMPLAIN ABOUT MY PRIVACE PRACTICES. If you have any questions about this notice or any complaints
about my privacy practices, or would like to know how to file a complaint with
the Secretary of the Department of Health and Human Services, please contact me
at: 1032 W. Hedding Street, San Jose, CA 95126, or through my website at www.modernlife.org.
VI.
EFFECTIVE DATE OF THIS NOTICE.
This notice went into effect on April 14, 2003.
|
|
© Copyright 1999 through 2003 Counseling for Modern Life. Any article may be reprinted, but must be printed in its entirety, without alteration, and must show the name and contact information for the author, in order to comply with copyright laws. |