Privacy Policy

Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law.  You may revoke this authorization, at any time, in writing.  Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.  Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in the Notice.

Emergencies:  We may use or disclose your protected health information in an emergency treatment situation.  In the event of your incapacity or emergency circumstances, we will disclose health information based on determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare.  If this occurs, the agency will try to obtain your consent as soon as reasonably practicable after the delivery of treatment.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your consent or authorization.  These situations include:

Required by Law:  We may use or disclose your protected health information to the extent that the use or disclosure is required by law.  The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.  You will be notified, as required by law, of any such uses or disclosures.

Public Health:  We may disclose your protected health information for public health activities and purposes, to a public health authority that is permitted by law to collect or receive this information.

Health Oversight:  We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.

Abuse or Neglect:  We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.  In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information.  In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Legal Proceedings:  We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement:  We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.

Criminal Activity:  Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.  We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

National Security:  We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities.  We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or client under certain circumstances.

Appointment Reminders:  We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, text messages, email, or letter).

Required Uses and Disclosures:  Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et.seq.

Client Rights

Access:  You have the right to inspect and copy your protected health information.  You may request that we provide copies in a format other than photocopies.  We will use the format you request unless we cannot practicably do so.  You must submit your request in writing to obtain access to your health information.  You may obtain a form to request access by using the contact information at the end of this notice.  We will charge you a reasonable cost-based fee for expenses such as copies and staff time.  If you request copies, we will charge you $ .25 a page to copy your health information, and postage if you want the copies mailed to you.  If you request an alternative format, we will charge a cost-based fee for providing your health information in that format.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

Restriction:  You have the right to request a restriction of your protected health information.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply.  If we agree to the additional restrictions we will abide by our agreement (except in an emergency).

We are not required to agree to a restriction that you may request.  If we believe it is in your best interest to permit use and disclosure of your protected health information, your protected information will not be restricted. 

Alternative Communication:  You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  You must make your request in writing.  We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact.

Amendment Request:  You have the right to request that we amend your protected health information.  Your request must be in writing and explain why the information should be amended.  In certain cases, we may deny your request for an amendment.  If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

Disclosure Accounting:  You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.  This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices.

Notice:  You have the right to obtain a paper copy of this notice from us upon request.

Treatment Advocate: You have the right to name a treatment advocate. You do not have to name a treatment advocate unless you feel you would like one. Services are not dependent on you naming a treatment advocate.

A treatment advocate is responsible for a variety of duties which you have the right to allow them to do for you. It is your decision what they will do and how they will participate in your treatment. A treatment advocate may help with treatment planning, treatment plan review, help in making decisions during the course of treatment for you as well as other duties you may find necessary.

Questions and Complaints

You issue a complaint to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our privacy contact of your complaint.  We support your right to the privacy of your protected health information.  We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

You may contact our Privacy Officer below for further information about the complaint process.

Privacy Officer:  Lorien Holman, LPC

Phone Number:  (405) 726-9808

Fax Number:      (405) 726-9809