Every effort is made to ensure confidentiality and HIPAA compliance from this office.
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.
CLIENTS RIGHTS & RESPONSIBILITIES:
Client’s rights are established by section 17a-540, Connecticut General Statutes. Drug and alcohol client information is protected by Federal Confidentiality Regulations (42 CFR Part 2). The Health Insurance Portability and Accountability Act (HIPAA), P.L. 104-191 establishes my rights regarding the privacy and security of my medical / health information.
We are required by law to protect the privacy of your medical information that may reveal your identity, and to provide you with a copy of this notice, which describes the medical / health information privacy practices of our office (psychotherapist, counselors, coaches, staff, employees, trainees, students, vendors, and volunteers). If you have any questions and/or concerns about this notice, please contact us in by phone, or e-mail.
COMMITMENT TO YOUR PRIVACY
We are committed to protecting the privacy of your medical information. In conducting our business, we will create records about you and the treatment and services we provide to you. These records are our property. However, we are required by law to:
- Maintain the confidentiality of your medical information
- Provide you with this notice of our legal duties and privacy practices concerning your medical information
- Follow the terms of our notice of privacy practices in effect at the time
This notice provides you with the following important information:
- How we may use and disclose your medical information
- Your privacy rights in regard to your medical information
- Our obligations concerning the use and disclosure of your medical information
Patient information will be kept confidential except as is necessary to provide services or to ensure that all administrative matters related to your care are handled appropriately. This specifically includes the sharing of information with other healthcare providers and health insurance payors as is necessary and appropriate for your care.
WHO WILL FOLLOW THIS NOTICE
In handling your medical / health information, our office may share your information as needed to treat you, to seek payment for services, and to conduct day-to-day operations.
RIGHT TO A COPY OF THIS NOTICE OF PRIVACY PRACTICES, AND CHANGES TO THIS NOTICE
The terms of this notice apply to all records containing your medical / health information that are created or retained by us. We may change our privacy practices at any time. The new notice will be effective for all of the information that we maintain at that time, as well as any medical information that we may receive, create or maintain in the future. You have a right to receive a paper copy of our Notice of Privacy Practices at any time and to ask for updated version. Our office will also maintain a current notice for your review in a prominent location. Our office is required to abide by the terms of the notice that is currently in effect.
I. HOW WE MAY USE, DISCLOSE AND REPORT YOUR MEDICAL/HEALTH INFORMATION
The following categories describe the different ways in which we may use and disclose your medical information. Please note that each particular use or disclosure is not listed below. However, the different ways we are permitted to use and disclose your medical information do fall within one of the categories. Special privacy protections may further restrict how we use or disclose confidential HIV related information, genetic information, alcohol and substance abuse treatment information or mental health information. Some parts of this general notice may not apply to these types of information.
- Limits of Confidentiality: Discussions between adult clients and their therapist are strictly confidential, and will be released only with the client’s written consent, with minors as an exception. It is also customary practice in mental health and/or medical professions to, at times, consult with other professionals on cases to ensure the highest level of care. In all such discussions, I maintain the anonymity of clients. In Couple or Family Counseling, information shared with me individually will be kept confidential.
- Limits of Confidentiality for Minors: I will encourage minors to communicate critical information to their parents/guardians if in my opinion, the situation warrants. If minors are non-compliant, I have a duty to disclose the information if I feel they or others are at risk of harm.
- Limits of Confidentiality for Young Adults (18-25) Who are Depended on a Parent or Guardian: May be required to add their parent(s) / guardian(s) to our/their “Authorization to Release, Obtain & Exchange Confidential Information” form. With this consent, young adults are hereby informed that I will disclose information to their parents or guardians if I feel they are at risk of harm to self or others.
- Exceptions To Confidentiality: Law mandates that mental health professionals report certain situations to the appropriate person(s) and/or agencies. Possible situations presenting exceptions to confidentiality include but not limited to:(1) Acute risk or homicidal or suicidal behavior. (2) Court order or subpoena. (3) Suspicion of physical, emotional, or sexual abuse or neglect involving a child under 18, adult over 65, or any disabled person. Mental health professionals are mandated by law to report any level of concern to Department of Children & Families under CT General Statute 17a-101. (4) Unpaid client fees will be sent to collection. (5) AIDS/HIV and/or other health issue involving possible transmission to other parties. (6) Situations where the counselor has a duty to warn, notify, or disclose potential harm.
- Release of Information to Family/Friends: Upon written consent of patient, we may release your medical information to a friend, family member, or authorized representative, who is involved in your care or who assists in taking care of you.
- Required by Law: We will use or disclose medical information about you when required by federal, state or local law. If we, as defined in State and/or Federal Statutes reasonably determines that the information is detrimental to the physical or mental health of the patient, or is likely to cause the patient to harm himself / herself or another; we may withhold the information from the patient. The information may be supplied to an appropriate third party or to another agent / provider who may release the information to the patient.
- Serious Threats to Health or Safety: We may use and disclose your medical information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to someone able to help prevent the threat, for example, to law enforcement officers if you participated in a violent crime that might have caused serious physical harm to another person.
- Abuse, Neglect or Domestic Violence: We may disclose your medical information to a government authority if we believe you are a victim of abuse, neglect or domestic violence. If we make such a disclosure, we will inform you of it, unless we think that informing you places you at risk of serious harm or, if we were to inform your personal representative, it is otherwise not in your best interest. We will make every effort to obtain your permission before releasing this information, but in some cases we may be required or authorized to act without your permission.
- Law Enforcement: We may disclose your health information to law enforcement officials, so long as applicable legal requirements are met, for law enforcement purposes. These purposes include: to comply with court orders or laws; to assist law enforcement officers with identifying or locating a suspect, fugitive, witness or missing person; if you have been the victim of a crime and (1) we have been unable to obtain your agreement because of an emergency or your incapacity, (2) law enforcement officials represent that they need this information immediately to carry out their law enforcement duties, and (3) in our professional judgment disclosure to these officers is in your best interests; if we suspect that your death resulted from criminal conduct; if necessary to report a crime that occurred on our property; or if necessary to report a crime discovered during an offsite medical emergency.
- Public Health Activities and Food and Drug Administration: We may disclose your medical information for public health and adverse event or product monitoring activities, including generally to: prevent or control disease, injury or disability; maintain vital records, such as births and deaths; report child abuse or neglect; notify a person regarding potential exposure to a communicable disease; notify a person regarding a potential risk for spreading or contracting a disease or condition; report reactions to drugs or problems with products or devices; and to notify individuals if a product or device they are using has been recalled, etc.
- Incidental Disclosures: While we will take reasonable steps to safeguard the privacy of your medical information, certain disclosures of your medical information may occur during or as unavoidable result of our otherwise permissible uses and disclosures of your health information. For example, during the course of your visit, other patients or staff may see, or overhear discussion of, your medical information.
- Confidential Communications: You have the right to request that we communicate with you about your health & related issues in a particular manner, or at a certain location. For instance, you may ask that we contact you by cell phone or at home, rather than at work. You do not need to give a reason for your request. In order to request a type of confidential communication, you must make a written request via certified mail / return receipt to our office. Please specify in your request how or where you wish to be contacted, and how payment for your health care will be handled if we communicate with you through this alternative method or location. We will accommodate reasonable requests.
- Specialized Government Functions: We may disclose your medical information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities. In addition, we may disclose your medical information to federal officials for intelligence and national security activities authorized by law. We also may disclose your medical information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
- Treatment: We may use and disclose your medical information to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. In addition, we may use and disclose medical information when we refer you to another health care provider.
- Treatment Alternatives / Health-Related Benefits and Services: We may use and disclose your medical information to inform you of treatment alternatives and/or health-related benefits and services that may be of interest to you.
- Health Oversight Activities: We may disclose your medical information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.
- Inmates and Correctional Institutions: If you are an inmate or under the custody of law enforcement officials, we may disclose your medical information to the correctional institution or law enforcement officials if necessary: (1) to provide you with health care, (2) for the safety and security of the institution, and/or (3) to protect your health and safety or the health and safety of other individuals.
- Coroners, Medical Examiners, and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.
- Lawsuits and Administrative Proceedings: Excluding certain conditions, we may disclose your medical information in response to a court order or subpoena if you are involved in a lawsuit or administrative proceeding.
- Health Care Operations: We may use and disclose your medical information to operate our business. These uses and disclosures include internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use your medical information to evaluate the competence and performance of our staff in caring for you, or to educate our staff on how to improve the care they provide for you.
- Business Associate: We may disclose your medical information to vendors: contractors, agents and other business associates who need the information in order to assist us in obtaining payment or carrying out our business operations. For example, we may share your medical information with a billing company that helps us to obtain payment. Another example is that we may share your medical information with an accounting firm, law firm or risk management organization that provides professional advice to us about how to improve our health care services and comply with the law. If we do disclose your medical information to a business associate, we will have a written contract to ensure that the business associate also protects the privacy of your medical information.
- Appointment and Account Balance Reminders: We may use and disclose your medical information to remind you that you have an appointment or a balance on your account. This may occur by phone, letter, email, text, or by an automated telephone system.
- Workers’ Compensation: We may release your medical information for workers’ compensation and similar programs. Completely De-Identified or Partially De-Identified Information. We may use and disclose your medical information if we have removed any information that has the potential to identify you so that the medical information is “completely de-identified.” We also may use and disclose “partially de-identified” medical information about you if the person who will receive the information signs an agreement to protect the privacy of the information as required by federal and state law. Partially de-identified medical information will not contain any information that would directly identify you (such as your name, street address, social security number, phone number, fax number, electronic mail address, website address or license number).
- Payment: We may use and disclose your medical information in order to bill and collect payment for the services and items you receive from us. For example, we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. This may include reviewing services provided for medical necessity and/or undertaking utilization review activities. We also may use and disclose your medical information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your medical information to bill you directly for services and items.
II. YOUR RIGHTS, RECORDS, REQUESTS and ADMINISTRATION REGARDING YOUR MEDICAL / HEALTH INFORMATION
You have the following rights regarding the information we maintain about you:
- Patient's Record Requests: Upon a written request of a patient, the patient's attorney or authorized representative, or pursuant to a written authorization, we shall furnish to the person making such request a copy of the patient’s medical / health record and other technical information used in assessing the patient’s medical / health condition. Record requests shall be furnish pursuant to state and/or federal regulation and/or guidelines.
- Requesting Restrictions: You have the right to request a restriction in our use or disclosure of your medical information for treatment, payment or health care operations. Additionally, you have the right to request that we limit our disclosure of your medical information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request, except in the case of a request that we not release to a payor medical information that pertains solely to a health care item or service for which you have paid us out of pocket in full. In other circumstances, if we agree to your request, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat to you. In order to request a restriction in our use or disclosure of your medical information, you must make a request in writing by certified mail / return receipt to our office. Your request must describe in a clear and concise fashion: (1) the information you wish restricted; (2) whether you are requesting to limit our use, disclosure or both; and (3) to whom you want the limits to apply.
- Inspection and Copies: You have the right to inspect and obtain a paper or electronic copy of the health information we retain that may be used to make decisions about you, including medical and billing records, but not including psychotherapy notes. You must submit your request in writing to our office, or by e-mail, in order to inspect and/or obtain a copy of your medical information. We may charge a fee for the cost of copying, mailing, labor and supplies associated with your request. The fee must generally be paid before or at the time we give you the copies. We may deny your request to inspect and/or receive a copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted not by the person that denied your initial request, but by another licensed health care professional chosen by us. Our office shall charge a fee; equal to or less than; as mandated by state or federal regulation/guidelines in regard to copies made and their delivery via USPS, UPS, and/or Federal Express.
- Original Patient Records and Copies: No provider shall refuse to return to a patient original records or copies of records that the patient has brought to the provider from another provider.
- Patient Files: Shall be stored in a locked file cabinet, or other secured means.
- Amendment: You may ask us to amend your medical information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for us. To request an amendment, you must make a written request to our office or by e-mail. You must provide us with a reason that supports your request for amendment. We will deny your request if you fail to submit your request (specifying the reason) in writing. Also, we may deny your request if you ask us to amend information that is: accurate and complete; not part of the medical information kept by or for us; not part of the medical information which you would be permitted to inspect and copy; or not created by us, unless the individual or entity that created the information is not available to amend the information. A written statement of your challenge to the accuracy of the information in the record will become a permanent part of your medical record and will be released with the record.
- Marketing and Advertising: Your confidential information will not be used for the purposes of third party marketing or advertising of products, goods or services. However, we may send you emails, and/or mailing about our office, products and services that we may provide that could be of benefit to your care.
- Research: In most cases, we will ask for your written authorization before using your health information or sharing it with others in order to conduct research. However, under some circumstances, we may use and disclose your health inform
- U.S. Department of Health and Human Services: Our office Notice of Privacy Practices is a GENERAL BASIC OVERVEIW of a patient’s (Client) rights and responsibilities in regard to HIPAA. Additional information is available from the U.S. Department of Health and Human Services web site: www.hhs.gov.
- ation without your written authorization. To do this, we are required to obtain approval through a special process to ensure that research without your written authorization poses minimal risk to your privacy. Under no circumstances, however, would we allow researchers to use your name or identity publicly.
- Right to Provide an Authorization for Other Uses and Disclosures: We will obtain your written authorization for uses and disclosures that are not identified by this notice or are not permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your medical information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your medical information for the reasons described in the authorization. Of course, we are unable to take back any disclosures that we have already made with your authorization. We are required to retain records of the care that we provided to you.
- Right to File a Complaint: If you believe your privacy rights have been violated, you may file a written complaint with our office. We will not retaliate or take action against you for filing a complaint of a patient’s (Client) rights and responsibilities in regard to HIPAA. Additional information is available from the U.S. Department of Health and Human Services web site: www.hhs.gov.
- GENERAL BASIC OVERVIEW: Our office Notice of Privacy Practices is a U.S. Department of Health and Human Services