Notice of Privacy Practices--Brief Version
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.
Our commitment to your privacy
Our practice is dedicated to maintaining the privacy of your personal health information (PHI) as part of providing professional care. We also are required by law to keep your information private. These laws are complicated, but we must give you this important information. This document is a shorter version of the full, legally required Notice of Privacy Practices (NPP) for you to retain for your records. You may request the longer version of the NPP from the front office. However, we can't cover all possible situations that may arise, so please talk to our Privacy Officer (see the end of this pamphlet) about any questions or problems.
We will use the information about your health which we get from you or from others mainly to provide you with treatment, to arrange payment for our services, and for some other business activities which are called in the law, health care operations. After you have read this NPP we will ask you to sign a Consent Form to let us use and share your information in accordance with this notice and the law. If you do not consent and sign the form, we cannot treat you.
If you or your therapist want to use or disclose (send, share, release) your information for any other purposes other than those described above, we will discuss this with you and ask you to sign an Authorization form to allow this disclosure.
Of course we will keep your PHI private, but there are some times when laws require us to use/ share it. For example:
1. When there is a serious threat to your health and safety or the health and safety of another individual or the public. We will only share information with a person or organization that is able to help prevent or reduce the threat.
2. Some lawsuits and legal court proceedings.
3. If a law enforcement official requires us to do so.
4. For Workers Compensation and similar benefit programs.
There are some other situations like these, but they don't happen very often. They are described in the longer version of the NPP. We do have the right to use your PHI for our own marketing and fundraising purposes but you may opt out of those by informing us that you would like to opt out in writing.
We also have the responsibility to inform you if a breach of your information occurs. If a breach would occur we will notify you according to the directions set forth in the law for us to do so. If you would like more information regarding what we will do in that situation, it is described in more detail in the longer version of the NPP which can be obtained from our privacy officer.
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 which is more private for you. For example, you can ask us to call you at home and not at work to schedule or cancel an appointment. We will try our best to do as you ask.
2. You have the right to ask us to limit what we tell people involved in your care or the payment for your care, such as family members and friends. You also have the right to ask us not to share information with your insurance company if you pay for the session in full yourself.
3. You have the right to look at the PHI we have about you such as your medical and billing records. You can even get a copy of these records, but we may charge you for these copies. However, because psychotherapy notes are held extremely confidential and prohibited by the law to be released even to you, a special authorization is required for you to access these. This access may or may not be granted and will be determined by your therapist. Contact our Privacy Officer to ask about the process of requesting to see your records.
4. If you believe the information in your records is incorrect or missing important information, you can ask us to make certain kinds of changes (called amending) to your health information. You have to make this request in writing and send it to our Privacy Officer. You must tell us the reasons you want to make the changes. **Psychotherapy notes can not be amended as they are interpretations by your therapist regarding what was discussed in the session.**
5. You have the right to a copy of this notice. If we change the NPP we will post the new version in our waiting area and you can always get a copy of the NPP from the Privacy Officer.
6. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with our Privacy Officer and/or with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.
If you have any questions regarding this notice or our health information privacy policies, please contact our Privacy Officer, Stacey Eeten in Sioux Falls at (605) 334-3739 or by e-mail at firstname.lastname@example.org or our Records Clerk, Lindsey De Jong in Orange City at (712) 737-2635 or by e-mail at email@example.com.
The original date of this NPP is November 1, 2003. The effective date of this revised notice is February 1, 2013.
Also, you may have other rights which are granted to you by the laws of our state and these may be the same or different from the rights described above. The privacy officer/records clerk will be happy to discuss these situations with you now or as they arise.