Privacy Notice


NOTICE OF PRIVACY PRACTICES

 

This Notice of Privacy Practices is applicable only in circumstances where a Counsellor Member is subject to compliance with the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ('HIPAA'), as amended from time to time.

 

Effective Date: August 1, 2014

 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

 

PLEASE REVIEW THIS NOTICE CAREFULLY.

 

MY PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI):

 

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which I may use and disclose health information about you. This notice also describes your rights to get access to the health information I keep about you and describes certain obligations I have regarding the use and disclosure of your health information.

 

In accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), I am required by law to:

 

 

YOUR RIGHTS REGARDING YOUR PHI:

 

You have the following rights with respect to your PHI:

 

  1. Right to Inspect and Copy: You have the right to inspect and copy all or any part of your medical or health record, as provided by federal regulations. You may request and receive an electronic copy of your PHI if your PHI is maintained in an electronic health record.

 

To inspect and copy your PHI, you must submit your request in writing to me. If you request a copy of your PHI, I may charge a reasonable, cost-based fee in accordance with state law for the costs associated with fulfilling your request.

 

I may deny your request to inspect and copy your PHI in certain limited circumstances.

  1. Right to Amend: You have the right to request that I amend your PHI or a medical or health record about you if you feel that health information I have about you is incorrect or incomplete. You have the right to request an amendment for as long as I keep the information. To request an amendment, your request must be made in writing, submitted to me at info@counsellorx.com. You must provide a reason that supports your request for an amendment.

 

I may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, I may deny your request if you ask me to amend information that:

 

 

Any amendment I make to your PHI or other medical or health records about you will be disclosed to those with whom I disclose information.

 

  1. Right to an Accounting of Disclosures: You have the right to request a list accounting for any disclosures of your PHI I have made, except for disclosures made for the purpose of treatment, payment, health care operations, and certain other purposes if such disclosures were made through a paper record or other health record that is not electronic, as set forth in federal regulations. If you request an accounting of disclosures of your PHI, the accounting may include disclosures made for the purpose of treatment, payment, and health care operations to the extent that disclosures are made through an electronic health record.

 

To request an accounting of disclosures, you must submit your request in writing to me at info@counsellorx.com. Your request must state a time period, which may not be longer than six years. The first list you request within a 12 month period will be free. For additional lists, I may charge you for the costs of providing the list. I will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. I will, to the extent possible, mail you a list of disclosures in paper form within 60 days of your request, or notify you if I am unable to supply the list within that time period and by what date I can supply the list, which will be no later than 90 days from the date you made the request.

 

  1. Right to Request Restrictions: You have the right to request a restriction or limitation on the use and disclosure of your PHI. You also have the right to request a restriction or limitation on the disclosure of your PHI to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that I restrict a specified person from use of your PHI or that I not disclose information to your spouse about your treatments.

 

I am not required to agree to your request for restrictions, except if you pay for a service entirely out-of-pocket. If you pay for a service entirely out-of-pocket, you may request that information regarding the service be withheld and not provided to a third party payor for purposes of payment or health care operations. I am obligated by law to abide by such restriction.

 

To request a restriction on the use and disclosure of your PHI, you must make your request in writing to me at info@counsellorx.com. In your request, you must tell me what information you want to limit and to whom you want the limitations to apply; for example, use of any PHI by a specified person, or disclosure of specified treatment to your spouse. I will notify you of my decision regarding the requested restriction. If I do agree to your requested restriction, I will comply with your request unless the information is needed to provide you emergency treatment.

 

  1. Right to Receive Confidential Communications: You have the right to request that I communicate with you about your health information in a certain way or have such communications addressed to a certain location. For example, you can ask that I only contact you at a particular email address or other address or by mail to a post office box.

 

To request confidential communications, you must make your request in writing to me at info@counsellorx.com. I will not ask you the reason for your request. I will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

 

  1. Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this notice at any time upon request. At the time of first service rendered, I am required to provide you with a copy of this notice. To obtain a copy of this notice at any other time, please request it from me at info@counsellorx.com.

 

  1. Right to Revoke Authorization: If you execute any authorization(s) for the use and disclosure of your PHI, you have the right to revoke such authorization(s), except to the extent that action has already been taken in reliance on such authorization.

 

  1. Right to Receive Notification of a Breach: You have the right to receive notification if I discover a breach of any of your PHI that is not secured in accordance with federal guidelines.

 

HOW I MAY USE AND DISCLOSE PHI ABOUT YOU WITHOUT YOUR AUTHORIZATION:

 

The following categories describe different ways that I may use and disclose your PHI without your authorization. For each category of such uses or disclosures I will explain what I mean and, if applicable, give some examples. Not every use or disclosure in a category will be listed.

 

  1. For Treatment: I may use your PHI to provide you with health care treatment or services. I may disclose your PHI to provide you with health care treatment or services. I may disclose your PHI to doctors, nurses, technicians, health students, or other personnel who are involved in taking care of you. They may work at a hospital or at a doctor’s office, lab, pharmacy, or other health care provider to whom I may refer you for consultation or for treatment purposes. I may also provide your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

 

  1. For Payment: I may use and disclose your PHI so that the treatment and services you receive from me may be billed to and payment collected from you, an insurance company, or a third party. For example, I may need to give your health plan information about treatment you receive from me so your health plan will pay me or reimburse you for the treatment. I may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

 

  1. For Health Care Operations: I may use and disclose your PHI for operations of my practice. These uses and disclosures are necessary to run my practice and make sure that all of my clients receive quality care. For example, I may use health information to review my treatment and services and to evaluate my performance in caring for you. I may also combine health information about many clients to decide what additional services I should offer, what services are not needed, whether certain new treatments are effective, or to compare how I am doing with others and to see where I can make improvements. I may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning who my specific clients are.

 

  1. For Research: I may disclose your PHI for the purpose of research. I will only disclose your PHI for research purposes upon your express authorization or if the research protocol has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

 

  1. For Quality Improvement: I may use your PHI as a tool for quality assurance and continuous quality improvement.

 

  1. As Required By Law: I may disclose your PHI when required to do so by federal, state, or local law.

  2. To Avert a Serious Threat to Health or Safety: I may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

 

  1. Military and Veterans: If you are a member of the armed forces or separated/discharged from military services, I may release your PHI as required by military command authorities or the Department of Veterans Affairs as may be applicable. I may also release health information about foreign military personnel to the appropriate foreign military authorities.

 

  1. Workers’ Compensation: I may release your PHI as authorized by, and in compliance with, laws related to workers’ compensation and similar programs established by law that provide benefits for work-related illnesses and injuries without regard to fault.

 

  1. Public Health Risks: I may disclose your PHI for public health activities. These activities generally include the following to:

 

 

  1. Health Oversight Activities: I may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

 

  1. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, I may disclose your PHI in response to a court or administrative order. I may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

 

  1. Law Enforcement: I may disclose your PHI to law enforcement officials for law enforcement purposes including the following:

 

 

  1. Organ and Tissue Donation: I may disclose your PHI to organizations involved in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue, for the purpose of facilitating organ, eye, and tissue donation where applicable.

 

  1. Abuse, Neglect, and Domestic Violence: I may disclose your PHI to an appropriate governmental authority if I reasonably believe that you may be a victim of abuse, neglect, or domestic violence.

 

  1. Coroners, Health Examiners, and Funeral Directors: I may disclose your PHI to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. I may also disclose your PHI to funeral directors as necessary to carry out their duties.

 

  1. National Security and Intelligence Activities: I may disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law, or for the purpose of providing protective services to the President or foreign heads of state.

 

  1. Protective Services for the President and Others: I may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

 

  1. Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, I may disclose your PHI to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

 

 

EXAMPLES OF OTHER PERMISSIBLE OR REQUIRED DISCLOSURES OF PHI ABOUT YOU WITHOUT YOUR AUTHORIZATION:

 

  1. Business Associates: Some activities are provided on my behalf through contracts with business associates. Examples of when I may use a business associate include for the provision by a third party of a website and a secure platform for the delivery of counseling services on-line and for storage of client information, coding and claims submission performed by a third party billing company, quality assurance activities provided by an outside consultant, computer and online billing and coding audits performed by an outside auditor, and other legal and consulting services provided in response to billing and reimbursement issues which may arise from time to time. When I enter into contracts to obtain these services, I may need to disclose your PHI to my business associate so that the associate may perform the job which I have requested. To protect your PHI, however, I require my business associate to appropriately safeguard your information.

 

  1. Notification: I may use or disclose your PHI to notify or assist in notifying a family member, personal representative, close personal friend, or other person responsible for your care of your location and general condition. I will not disclose your PHI to your family members, personal representative or close personal friends as described in this paragraph if you object to such disclosure. Please notify me in writing at info@counsellorx.com if you object to such disclosures.

 

  1. Communication with family members: Health professionals (employed or under contract) may disclose to a family member, other relative, personal representative, close personal friend or any other person you identify, health information relative to that person’s involvement in your care or payment related to your care, unless you object to the disclosure. Please notify me in writing at info@counsellorx.com if you object to such disclosures.

 

Federal law allows for the release of your PHI to appropriate health oversight agencies, public health authorities, or attorneys, provided that a work force member or business associate believes in good faith that I have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

 

 

I MAY NOT USE OR DISCLOSE YOUR PHI FOR THE FOLLOWING PURPOSES WITHOUT YOUR AUTHORIZATION:

 

I must obtain an authorization from you to use or disclose therapy notes unless it is for treatment, payment or health care operations or is required by law, permitted by health oversight activities, to a coroner or medical examiner, or to prevent a serious threat to health or safety.

 

I must obtain an authorization for any use or disclosure of your PHI for any marketing communications to you about a product or service that encourages you to use or purchase the product or service unless the communication is either: (1) a face-to-face communication or; (2) a promotional gift of nominal value. However, I do not need to obtain an authorization from you to provide information regarding your course of treatment, case management, or care coordination, to describe a health-related products or services that I provide, or to contact you in regard to treatment alternatives. If the marketing involves financial remuneration, I must notify you if such remuneration is involved.

 

I must obtain an authorization for any disclosure of your PHI which constitutes a sale of such PHI.

 

MY RESPONSIBILITIES:

 

I am required by law to maintain the privacy of your PHI, to provide you with this notice as to my legal duties and privacy practices with respect to your PHI I maintain and collect, and notify you if I discover a breach of any of your PHI that is not secured in accordance with federal guidelines.

 

I am required by law to abide by the terms of this notice as it is currently in effect.

 

CHANGES TO THIS NOTICE:

 

I reserve the right to change my privacy practices for all PHI that I collect or maintain and any terms of this notice. If my privacy practices materially change, I reserve the right to make the revised or changed notice effective for PHI I already have about you as well as any information I receive in the future. A copy of the current notice will be posted on the Counsellor Exchange website. The notice will contain at the top of the first page, the effective date and you will be notified if there are any changes made to the notice.

 

FOR MORE INFORMATION OR TO MAKE A COMPLAINT:

 

If you believe your privacy rights have been violated, you may file a complaint with me or with the Secretary of the Department of Health and Human Services. To file a complaint with me, you must submit your complaint to the Privacy Officer for Counsellor Exchange, Inc. at the following email address: info@counsellorx.com. All complaints must be submitted in writing. There will be no retaliation against you for filing a complaint.

 

If you have any questions or would like additional information, you may contact the Privacy Officer for Counsellor Exchange, Inc. at 1.888.518.3786.

 

OTHER USES AND DISCLOSURES OF PHI:

 

Other uses and disclosures of your PHI not covered by this notice or the laws that apply to me will be made only with your written permission. If you provide me permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, I will no longer use or disclose PHI about you for the reasons covered by your written authorization. You understand that I am unable to take back any disclosures I have already made with your permission, and that I am required to retain my records of the care that I provided to you.

 

DISCLAIMER:

 

This Notice of Privacy Practices has been established specifically for and in accordance with HIPAA, and it only applies to the extent that the services you are receiving from Counsellor Exchange are covered by HIPAA.  All other services are covered by Counsellor Exchange’s general privacy policies, which may be found here: https://www.counsellorx.com/pages#privacy