Lacy’s Professional Counseling
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND THE RIGHTS YOU HAVE RELATED TO IT.
MY PLEDGE REGARDING HEALTH INFORMATION:
I am committed to protecting your health information. I create a record of the care and services you receive from me as required, to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by this practice. This notice will tell you about the ways in which I may use and disclose health information about you, describe your rights to this health information and will describe certain obligations I have regarding the use and disclosure of your health information.
I am required by law to:
A. Make sure that your protected, health information (“PHI”) is kept private (see exceptions below).
B. Give you this notice of my legal duties and privacy practices regarding your PHI.
C. Follow the terms of the notice that is currently in effect, which may change at a future time.
If there is a new notice, it will be available upon request.
HOW I MAY USE AND DISCLOSE HEALTH INFORMATION:
The following categories are different ways that I typically use and disclose health information:
- To submit billing to your insurance company,
- To obtain information from other providers, as permitted by you.
- To release information to other providers under ordinary circumstances, as permitted by you.
- To include others in your treatment as permitted by you.
Under ordinary circumstances, you have the right to decline the release of your PHI at anytime, however there may be instances when disclosure will ensure regardless of your requests, especially in emergency or legal situations. These may include:
- For my use in legal proceedings instituted by you or others pertaining to you.
- For use by the Secretary of Health and Human Services to investigate compliance.
C. As required by law for certain health oversight activities.
D. As required by a coroner who is performing duties authorized by law.
E. As required to help avert a serious threat to the health and safety of others.
F. For reporting suspected child, elder, or dependent adult abuse, or preventing or
reducing a serious threat to anyone’s health or safety.
G. For judicial/administrative proceedings, or court/administrative order.
H. For law enforcement purposes,
YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
- The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operation purposes. However, I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
- The Right to Request Restrictions for billing your insurance, if you pay the fee outright.
- The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
- The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.
- The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI. I will respond to your request within 60 days.
- The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information.
- The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail.
Please be advised that after seven years of inactivity, files are securely destroyed.