This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Lake Orion Counseling Center, LLC (LOCC) is required by applicable Federal Law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, legal obligations, and your rights concerning your health information (“Protected Health Information” or “PHT”). We must follow the privacy practices that are described in the notice (which may be amended from time to time).
For more information regarding our privacy practices, please contact us using the information listed in Section II G of this notice.
I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
A. Permissible uses and disclosures without your written authorization: We may use and disclose PHI without your written authorization, excluding Psychotherapy Notes, as described in Section II, for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types and uses of disclosures that are permissible under Federal and State Law.
1. Treatment: We may use and disclose PHI in order to provide treatment to you. For example, we may use PHI to diagnose and provide counseling service to you. Additionally, we may disclose PHI to other health providers involved in your care.
2. Payment: We may use or disclose PHI so that services that you receive are appropriately billed to, and payment is collected from your health plan. For example, we may disclose PHI to permit your health plan to take certain actions before it approves or pays for treatment services.
3. Health care operations: We may use and disclose PHI in connection with our health care operations, including quality improvement activities, training programs, accreditation, certification, and licensing or credentialing activities.
4. Required or permitted by law: We may disclose PHI when we are required or permitted to do so by law. For example, we may disclose PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence, or the possible victim of other crimes. Additionally, we may disclose PHI to the extent necessary to avert a serious injury to your health and safety or the health and safety of others. Other disclosures permitted or required include the following: disclosures for public health activities, health oversight activities including disclosures to state or federal agencies authorized to access PHI; disclosures to judicial and law enforcement officials in response to a court order or other lawful process; disclosures for research when approved by an institutional review board; and disclosures to military or national security agencies, coroners, medical examiners, and correctional institutions or otherwise as authorized by law. Additionally, we may disclose PHI in reminding clients of their appointments and in securing evaluation of the client treatment experience at the conclusion of treatment.
B. Uses and disclosures requiring you written authorization:
1. Psychotherapy Notes: Notes recorded by your therapist documenting the contents of a counseling session with you (“Psychotherapy Notes”) will be used only by LOCC and will not otherwise be used or disclosed without your written authorization.
2. Marketing Communication: We will not use your health information for marketing communications without your written authorization.
3. Other Uses and Disclosures: Uses and disclosures other than those described in Section I.A. above will only be made with your written authorization. For example, you will need to sign an authorization form before we can send PHI to your life insurance company, to a school, or to your attorney. You may revoke any such authorization at any time.
II. YOUR INDIVIDUAL RIGHTS
A. Right to Inspect and Copy: You may request access to your medical records and billing records maintained by us in order to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, we may deny access to your records. We may charge a fee for the cost of copying and sending you any records requested. If you are a parent or legal guardian of a minor, please note that certain portions of the minor’s medical record may not be accessible to you.
B. Right to Alternative Communications: You may request and we will accommodate any reasonable written request for you to receive your PHI by alternative means of communication.
C. Right to Request Restrictions: : You have the right to request a restriction on PHI used for disclosure for treatment, payment, or health care operations. You must request any such restrictions in writing addressed to the Privacy Officer as indicated below. We are not required to agree to any such restrictions you may request.
D. Right to Accounting Disclosures: Upon written request, you may obtain an accounting of certain disclosures of PHI made by us after May 15, 2014. This right applies to disclosures for purposes other than treatment, payment, or health care operations, excluding disclosures made to you or disclosures otherwise authorized by you and is subject to other restrictions and limitations.
E. Right to Request Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information must be amended. We may deny your request under certain circumstances.
F. Right to Obtain Notice: You have the right to obtain a paper copy of this notice by submitting a request to the Privacy Officer at any time.
G. Questions and Complaints: If you desire further information about your privacy rights or are concerned that we have violated your privacy rights, you may contact the Privacy Officer (Crystal Pasciak) at LOCC. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint with the Director.
III. EFFECTIVE DATE AND CHANGES TO THIS NOTICE
A. Effective date: The effective date for this notice is May 15, 2014.
B. Changes to this notice: We may change the terms of this notice at any time. If we change this notice, we may make the new terms effective for all PHI that we maintain, including any information created or received prior to issuing the new notice. If we change this notice, we will post the revised notice in the waiting area of the office. You may also obtain any revised notice by contacting the Privacy Officer.