Notice of Privacy Practices
Effective date 4/14/03
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read this carefully. Protecting client privacy is an important legal and ethical obligation. Crooked Tree Counseling is deeply committed to protecting our client's right to privacy and safeguarding client information.
Our Responsibilities:
Our responsibility, as Licensed Mental Health Counselors, we are required to maintain the privacy of your Protected Health Information. This includes information that is collected during the course of your treatment, such as your symptoms, test results, diagnoses, treatment and a plan for future care. Information about care that you have received from other providers may also be included in your record. Health Information also includes demographic information and payment information.
We are required by law to provide you with this Notice of Privacy Practices. This Notice describes how we will use your Health Information and disclose or share it with others. We must abide by the terms of this Notice currently in effect. We reserve the right to change the terms of this Notice and will make the new Notice provisions effective for all Health Information that it maintains. We will give you a copy of any changes to the Notice.
I. Uses and Disclosures of your Health Information: The following are examples of the types of uses and disclosures of your Health Information that I am legally permitted to make.
A. Uses and Disclosures of Health Information for Treatment, Payment and Operations-- We may use and disclose your Health Information to treat and care for you in the following ways:
1. Treatment: We may use your Health Information to provide and manage your health care. If we refer you for other treatment, such as emergency psychiatric treatment, we will provide that health care provider with the necessary information to diagnose or treat you. In addition, we may share your Health Information with other health care providers who may consult with me about your care. We believe this is critical to provide you the very best in health care and is necessary given the complexities of various mental illnesses and issues.
2. Payment: If you are choosing to use your health insurance for reimbursement for mental health care or another provider, we may use and disclose your Health Information as needed to obtain payment for health care services. We may disclose information to your insurance company to make sure your treatment is approved, to verify eligibility or coverage for insurance benefits and to permit the payer to review services provided to you for medical necessity.
3. Health Care Operations: We may use or disclose your Health Information in order to conduct our business to improve the quality and cost effectiveness of the care I deliver to you, such as supervision.
B. Other Permitted and Required Uses and Disclosures of your Health Information That May Be Made Without Your Authorization-- In addition to treatment, payment and health care operations, there are other circumstances in which we are permitted or required to disclose your Health Information, in accordance with applicable law.
1. Involvement of Others in Your Health Care: We will make an effort to ask you if we may share relevant Health Information about you with family members or any other person you identify. If you are not present, unable to communicate, or in an emergency situation, we may exercise professional judgement to determine whether to share this information.
2. Victims of Abuse, Neglect, or Domestic Violence: We are mandated reporters in the state of Massachusetts. As such, we are required by law to report any information we have about a child or an elderly person being abused or neglected by a caregiver.
3. Health Oversight: We may be required to disclose Health Information to a health oversight agency for audits, investigations, inspections, and other health oversight activities.
4. Legal Proceedings: We may be required to disclose Health Information in the course of any judicial or administrative proceeding in response to a legal order or other lawful process including a subpoena. We will consult an attorney or my professional organization to seek advice on ways to protect your confidential information.
5. Law Enforcement: We may be required to disclose Health Information for law enforcement purposes.
6. Threat to health or safety: We may be required to use or disclose Health
Information to prevent or lessen a serious threat to a person’s or the public’s health
or safety. If you were in danger of hurting yourself or others, we would disclose your
Health Information to emergency teams or facilities and potential notification of your
family.
7. Food and Drug Administration: We may disclose to the FDA your Health
Information if it is relative to adverse events with respect to food, supplements,
product and product defects to enable product recalls, repairs or replacement.
8. Worker’s Compensation: We may disclose your Health Information to extent
authorized by and to the extent necessary to comply with laws relating to worker’s
compensation or other similar programs established by law.
Your Rights Regarding Your Health Information:
1. You can ask us to communicate with you about your health and related issues in a particular way or at a certain place. For example, you can ask us to only call you on your cell phone, or to not leave messages on your answering machine.
2. You have the right to ask us to limit what what we tell certain individuals involved in your care or the payment of your care, such as a family member or an insurance company. We do not have to agree or comply with the request if it is against the law, or in an emergency or when the information is necessary to treat you.
3. You have the right to look at the health information we have about you such as your medical and billing records. You can even get a copy of these records, but you will be charged a copying fee.
4. You have the right to amend the information in your file if you believe the information is incorrect or incomplete. You have to make this request in writing, and tell us the reasons you want to make the changes.
5. You have a right to a copy of this notice. If we change this form, it will be posted in the office, and you will get a new copy.
6. You have the right to file a complaint if you believe your privacy rights have been violated. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.
7. You have a right to revoke this authorization to use or disclose your Health Information except to the extent that action has already been taken. You must send me a letter revoking that authorization. We will refuse to continue to treat an individual that revokes his or her authorization.
If you have any questions regarding this notice or our health information privacy policies, please feel free to discuss them with your counselor.
The effective date of this notice is April 14, 2003
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