Notice of Privacy Practices

    THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

 

I.            Purpose

 

This notice of Privacy Practices describes how I may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.  This notice also describes your rights regarding health information I maintain about you and a brief description of how you may exercise these rights.  This Notice further states the obligations I have to protect your health information.

 

Protected Health Information (PHI) means health information (including identifying information about you) I have obtained from you or received from health care providers, health plans, your employer or a health care clearinghouse.  It may include information about your past, present or future physical or mental health conditions, the provision of your health care, and payment for your health care services.

 

I am required by law to maintain the privacy of your health information and to provide you with this notice of my legal duties and privacy practices with respect to your health information.

 

II.        Ways I May Use and Disclose Your Health Information

 

I will use and disclose your health information as describe in each category listed below.  For each category, I will explain what I mean in general, but not describe all specific uses or disclosures.

 

A.    Uses and Disclosures for Treatment, Payment and Operations

1.     For treatment.  I will use and disclose your health information without your authorization to provide your health care and any related services.  I will also use and disclose your health information to coordinate and manage your health care and related services.  I may also disclose your health information in a clinical supervision/ consultation meeting.  For example, I may discuss your case with another mental health clinician for the purpose of clinical consultation.

2.     For Payment.  I may use or disclose your health information without your authorization so that the treatment and services you receive are billed to, and payment is collected from, your health plan or other third party payer.  For example, I may disclose your health information to permit your health plan:

§   To make a determination of eligibility or coverage for health insurance;

§   To review your services to determine if they were medially necessary, appropriately authorized or certified in advance of your care;

§   To review your services for purposed of utilization review, to ensure the appropriateness of your care or to justify the charges for your care; or

§   To determine if the plan will approve additional mental health sessions.

3.     For Health Care Operations.  I may use and disclose health information about you without your authorization for my health care operations (activities that relate to performance and operation of practice).  This is necessary to ensure that you receive quality care.  This includes business-related matters such as audits, licensing and administrative services.  I may also provide your health information to other health care providers or to your health plan to assist them in performing their own health care operations.  I will do so only if you have or have had a relationship with the other provider or health plan.  I may also use and disclose your health information to contact you to remind you of your appointment and to notify you when an appointment is canceled or rescheduled.

 

B.    Other Permitted/Required Uses and Disclosures of Your Health Information

 

I may use or disclose your protected health information for reasons including but not limited to the following:

 

§   For public health purposes such as reporting child or elder abuse or neglect;

§   For mental health oversight activities (for example, audits, inspections or investigations of administration and management);

§   In response to a court order, judicial, administrative or other legal proceedings;

§   For law enforcement purposes;

§   To prevent a serious threat to health or safety of self or others;

§   To military authorities if you are a member of the armed services;

§   To national security and intelligence agencies as authorized by law;

§   To comply with Workers’ Compensation or other similar laws; and

§   When federal, state or local law otherwise requires disclosure.

 

C.    Uses and Disclosures of Your Health Information with Your Permission

 

Uses and disclosures not described in the “Ways I May Use and Disclose Your Health Information” (section II) of this Notice will generally only be made with your written permission, called an “authorization.”  You have the right to revoke an authorization at any time in writing.  If you revoke your authorization, I will not make any further uses or disclosures of your health information under that authorization, unless I have already taken action relying upon the uses or disclosures you have previously authorized.  In some instances revocation of your authorization may result in suspension of treatment.

 

III.         Your Rights Regarding Your Health Information

 

Upon written request, you have the right to:

§   Inspect and copy health information used to make decisions about your care.  This does not include psychotherapy notes.  There will be a fee for the cost of reviewing, copying, mailing and supplies associated with your request.  I may deny your request in certain limited circumstances.

§   Amend any health information used to make decisions about your care.  To request an amendment you must state why you believe the information is in correct or inaccurate.  I am not required to agree to a requested amendment, for example, if what you are requesting to be amended is already accurate and complete.

§   An accounting of Disclosure I have made of your health information.  An accounting is a list of disclosures.  But this list will not include certain disclosure of your health information, for example, those I have made for purposes of treatment, payment, and health care operations.

§   Requested Restrictions on certain uses or disclosures of your Protected Health information.  I am not required to agree to a requested restriction.  If I do agree, I will honor your request unless the restricted health information is needed to provide you with emergency treatment.

§   Request Confidential Communications; that is, you have the right to request that I communicate with you about your health care only in a certain location or through a certain method.

 

You have the right to obtain a paper copy of this Notice of Privacy Practices at any time.

 

IV.     Duties Regarding the Use and Disclosure of  Your PHI

 

I am committed to maintaining your privacy and am required:

§   By law to maintain the privacy of PHI and to provide you with notice of my legal duties and privacy practices with respect to PHI; and

§   To abide by the terms of my Notice of Privacy Practices currently in effect.

 

I reserve the right to change the terms of this privacy notice, and have such changes be effective for all PHI that is maintained.  I will have available a copy of this Notice of Privacy Practices at my office.

 

VI.         How to File a Complaint Regarding the Use and Disclosure of PHI

 

If you believe your privacy rights have been violated, you may file a complaint with me or with the Secretary of the U.S. Department of Health and Human Services.  All complaints must be in writing.  If you choose to file a complaint, I will not retaliate against you for exercising your right to file a complaint.

 

 

VII.       Contact Information

 

Leslie Downs Mullen, MS, LMFT

1450 Boyson Rd. Bldg C, Suite 2B

Hiawatha, IA  52233

Ph: 319.294.9206

Content Copyright 2011-2017. Resilience Family Counseling, PLLC. All rights reserved.