Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY. 

You should read this Notice before signing the Disclosure and Consent form which consents to the use and disclosure of health information for treatment, payment and health care operations of therapists at A Family Place. 

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how I may use and disclose your PHI in accordance with applicable law and the NASW Code of Ethics. It also describes your rights regarding how you may gain access to and control your PHI. 

Mental Health therapists are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of the Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that is maintained at that time. A copy of the revised Notice of Privacy Practices will be provided by posting a copy on this website, sending a copy to clients in the mail upon request, or providing one to clients at their next appointment, upon request. 

HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED 

Our therapists use and disclose PHI for a variety of reasons. For most uses/disclosures, we must obtain your consent. For others, we must have your written authorization. However, the law provides that we are permitted to make some uses/ disclosures without your consent or authorization. The following offers more description and examples of potential uses/disclosures of your PHI. 

For Treatment/Services. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultant only with your authorization. For safety reasons, for homebased services, each therapst will provide names and addresses of appointments to the other therapist. 

For Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection. 

For Health Care Operations. We may use or disclose, as needed, your PHI in order to support business activities including, but not limited to, quality assessment activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes, PHI will be disclosed only with your authorization. 

Coordination/Appointment Reminders/Mailings. Unless you provide us with alternative instructions, we may call to coordinate appointments, leaving a message on your machine/voicemail if needed. We also may send appointment reminders, brochures, and/or other similar materials to your home, unless otherwise instructed. 

Without Authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those that are: 

• Required by Law – We may disclose PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, or relating to suspected criminal activity. We must also disclose PHI to you upon your request, and to authorities who monitor compliance with these privacy 

• Required by Court Order 

• Necessary to avert threat to health or safety – If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons, such as law enforcement, who may reasonably be able to prevent or lessen the threat, including the target of the threat. 

• For Public Health Activities – We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority. 

• For health oversight activities – We may disclose PHI to an accrediting organization or another agency responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents. With Authorization. For uses and disclosures beyond treatment, payment and operations purposes, we are required to have your written authorization, unless the use or disclosure falls within the exceptions described above. Like consents, authorizations may be revoked at any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization. Verbal Permission. We may use or disclose your information to family members or others that are directly involved in your treatment with your verbal permission. We may also share PHI with these people to notify them about your location, general condition, or death. 

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION 

You have the following rights regarding PHI maintained about you. To exercise any of these rights, please submit your request in writing to your therapist at A Family Place. 

• Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request. 

• Right to Request Confidential Communication. You have the right to request that your therapist communicate with you about medical matters in a certain way or at a certain location. 

• Right of Access to Inspect and Copy. Unless your access is restricted for clear and documented treatment reasons, you have the right to see your PHI if you put your request in writing. We will respond to your request within 30 days. If we deny your access, we will give written reasons for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, you may be charged a reasonable, cost-based fee for copies. 

• Right to Amend. If you feel that there is a mistake or missing information in our record of your PHI, you may request, in writing, that we correct or add to the record, although we are not required to agree to the amendment. We will respond within 60 days of receiving your request. 

• Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures that we make of your PHI. You may be charged a reasonable fee if you request more than one accounting in any 12month period. 

• Right to a Copy of this Notice. You have the right to a copy of this notice. 

COMPLAINTS If you believe we have violated your privacy rights, you have the right to file a complaint with us, by following our Grievance Procedure, described on this website.