HIPAA Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The Purpose of This Notice: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) directs health care agencies to develop policies and procedures to ensure the security and privacy of health information and to safeguard access to and disclosure of protected health information. We are required by law to provide you information on how we may use or disclose your personally identifiable health information and to give you notice of our privacy practices.
Effective Date: The effective date of this Notice of Privacy Practices is: May 14, 2019
Your Rights. You have the right to:
Get a copy of your paper and electronic health and claims records
Correct your health and claims records
Request confidential communication
Ask us to limit the information we share
Get a list of those with whom we’ve shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated
Your Choices. You have some choices in the way that we use and share information:
Who we share your information with
What we share about you
Our Uses and Disclosures. We may use and share your information as we:
Facilitate your treatment and schedule your appointments
Obtain payment for your services
Help with public health and safety issues
Comply with the law
Address workers’ compensation, law enforcement, and
other government requests
Respond to lawsuits and legal actions
I. YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities.
1. Get an electronic or paper copy of your health and claims records
You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
2. Ask us to correct your health and claims records
You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
3. Request confidential communications
You can ask us to contact you in a specific way (for example, home or cell phone) or to send mail to a different address.
We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
4. Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. You may not limit the uses and disclosures we are legally required or allowed to make.
If you pay for service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
5. Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
6. Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
7. Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
8. File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us using the information on the first page of this privacy notice.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
II. YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in payment for your care
• Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. Except in limited circumstances, we must obtain your prior authorization to disclose your health information for:
Sale of your information
Most sharing of psychotherapy notes
In the event you give us written authorization for the foregoing, you may revoke your authorization by giving written notice to firstname.lastname@example.org.
III. OUR USES AND DISCLOSURES
How do we typically use or share your health information? We use and disclose health information for many reasons. For some use or disclosures, we need your prior consent or authorization. However, unless otherwise indicated below, we typically use and may share your health information in the following ways without obtaining your prior consent:
1. Help manage the health care treatment you receive
We can use your health information and share it with professionals who are treating you and to coordinate care for you.
We may disclose health information to your family or friends who are involved in your care or who assists in taking care of you unless you object.
We may give information to someone who helps pay for your care unless you object.
We may disclose information about you to an entity assisting in a disaster relief so that your family can be notified about your condition, status, and location.
2. Run our organization
We can use and share your health information to help run the practice, improve your care, and contact you when necessary.
- Example: We use health information about you to develop better services for you.
- Example: Your provider may consult with other HWP providers about issues surrounding your care and treatment.
- Example: We may disclose your health information to those assisting with setting up electronic health record software and maintaining those systems.
- Example: We may use or disclose your health information to remind you that you have an appointment or check on you after treatment.
3. To obtain payment for your health services
We can use and disclose your health information to obtain payment for your health services and to receive prior approval or to determine whether your health insurance plan will cover the treatment.
- Example: We share information about you with your health insurance to coordinate payment for your services.
We also may engage business associates to assist with the processing and collection of payments from you.
- Example: We may disclose the fact you are a client to third parties responsible for collecting or processing payment information.
4. How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
A. Help with public health and safety issues
We can share health information about you for certain situations such as:
Preventing disease and certain public health reporting activities
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
B. Perform research
We can use or share your information for health research, but we shall ensure that your personally identifiable information is not disclosed, the researcher certifies in writing that they shall only use the health information for research, he or she shall maintain the confidentiality of the information he or she receives, and agrees he or she will not remove any health information from HWP.
C. Comply with the law
We will share information about you if local, state, or federal laws require it, including the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
D. Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
E. Address workers’ compensation, law enforcement, and other government requests
*We can use or share health information about you:
i. For workers’ compensation claims
ii. For law enforcement purposes or with a law enforcement official
iii. With health oversight agencies for activities authorized by law
iv. For special government functions, such as military, national security, and presidential protective services
v. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the correctional institution or law enforcement official.
F. Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
IV. OUR RESPONSIBILITIES
Our responsibilities include:
We are required by law to maintain the privacy and security of your protected health information and adopt reasonable processes to keep your protected health information private.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
We are required by state and federal law to obtain your prior consent to disclose:
Certain information regarding your metal health or substance abuse treatment; and
Certain infectious diseases (including HIV/AIDS tests or results).
V. CHANGES TO THE TERMS OF THIS NOTICE
We reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the information we already have. The new notice will be available upon request, and a copy will be provided to you.
VI. FOR MORE INFORMATION
For more information, contact the plan representative noted above or see