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Myers Counseling Group - HIPPA Notice of Privacy PracticesI. 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. II. IT IS OUR LEGAL
DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI). We are required by applicable
federal and state law to insure that your PHI is kept private. The PHI
constitutes information created or noted by us that can be used to identify
you. It contains data about your
past, present, or future health or condition, the provision of health
care services to you, or the payment for such health care.
We are required to provide you with this Notice about our privacy
procedures. This Notice must explain when, why, and how we would use
and/or disclose your PHI. Use of PHI means when we share, apply, utilize,
examine, or analyze information within the practice; PHI is disclosed
when we release, transfer, give, or otherwise reveal it to a third party
outside our practice. With some exceptions, we may not use or disclose
more of your PHI than is necessary to accomplish the purpose for which
the use or disclosure is made; however, we are always legally required
to follow the privacy practices described in this Notice. This notice
takes effect Please note that we
reserve the right to change the terms of this Notice and our privacy
policies at any time. Any changes
will apply to PHI already on file with us.
Before we make any important changes to our policies, we will
immediately change this Notice and post a new copy of it in my office
and on my website. You may also request a copy of this Notice from
us, or you can view a copy of it in our office or on our website, which
is located at www.myerscounseling.com III. HOW WE WILL USE
AND DISCLOSE YOUR PHI. We will use and disclose your PHI for many different
reasons. Below you will find the different categories of our uses and
disclosures, with some examples. A. Uses and
Disclosures Related to Treatment, Payment, or Health Care Operations.
1. For treatment.
We may disclose your PHI to physicians, psychiatrists, psychologists,
and other licensed health care providers who provide you with health
care services or are otherwise involved in your care. We may use or
disclose your PHI to a health care provider so that we can make prior
authorization decisions under your benefit plan. 2. For health care operations.
We may disclose
your PHI to facilitate the efficient and correct operation of our practice.
Health care operations include the business functions conducted by a
health insurer. These activities may include providing customer services,
responding to complaints and appeals from members, providing case management
and care coordination under the benefits plans, conducting medical reviews
of claims and other quality assessment and improvement activities. We
may also provide your PHI to our attorneys, accountants, consultants,
and others to make sure that we are in compliance with applicable laws. 3. To obtain
payment for treatment. We may use and disclose your PHI to bill and collect
payment for the treatment and services we provided you, subject to the
federal Privacy Rules. We could also provide your PHI to business associates,
such as billing companies, claims processing companies, and others that
process health care claims for our office. B. Certain Disclosures
Do Not Require Your Consent. We may use and/or disclose your PHI without your consent or
authorization for the following reasons: 1. When disclosure is
required by federal, state, or local law; judicial, board, or administrative
proceedings; or, law enforcement. 2. If disclosure is compelled
by a party to a proceeding before a court of an administrative agency
pursuant to its lawful authority. 3. If disclosure is required
by a search warrant lawfully issued to a governmental law enforcement
agency. 4. If disclosure is compelled
or permitted by the fact that you are in such mental or emotional condition
as to be dangerous to yourself or the person or property of others,
and if we determine that disclosure is necessary to prevent the threatened
danger. 5. If disclosure is mandated
by the Illinois Department of Children and Family Services law. 6. If disclosure is compelled
or permitted by the fact that you tell us of a serious/imminent threat
of physical violence by you against a reasonably identifiable victim
or victims. 8. For public health activities.
9. For health oversight
activities. Example: we may be required to provide
information to assist the government in the course of an investigation
or inspection of a health care organization or provider. 10. For specific government
functions. Examples: we may disclose PHI of military
personnel and veterans under certain circumstances. Also, we may disclose
PHI in the interests of national security, such as protecting the President
of the 11. For Workers' Compensation
purposes. We may provide PHI in order to comply with Workers' Compensation laws. 12. Appointment reminders
and health related benefits or services. Examples: we may use PHI to provide
appointment reminders. We may use PHI to give you information about
alternative treatment options, or other health care services or benefits
we offer. 13. If an arbitrator or
arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant
to subpoena duces tectum (e.g.,
a subpoena for mental health records) or any other provision authorizing
disclosure in a proceeding before an arbitrator or arbitration panel. 14. If disclosure is otherwise
specifically required by law. C. Certain Uses and Disclosures
Require You to Have the 1. Disclosures to family,
friends, or others. We may provide your PHI to a family member, friend, or other individual
who you indicate is involved in your care or responsible for the payment
for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency
situations. D. Other Uses and Disclosures
Require Your Prior Written Authorization. In any other situation not described
in Sections IIIA, IIIB, and IIIC above, we will request your written
authorization before using or disclosing any of your PHI. Even if you
have signed an authorization to disclose your PHI, you may later revoke
that authorization, in writing, to stop any future uses and disclosures
(assuming that we haven't taken any action subsequent to the original
authorization) of your PHI by us. IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI These are your rights with respect to your PHI: A. The Right to See and
Get Copies of Your PHI. In general, you have the right to see
your PHI that is in our possession, or to get copies of it; however,
you must request it in writing. If we do not have your PHI, but we know
who does, we will advise you how you can get it. You will receive a
response from us within 30 days of my receiving your written request.
Under certain circumstances, we may feel we must deny your request,
but if I do, I will give you, in writing, the reasons for the denial.
We will also explain your right to have our denial reviewed. If you ask for copies of your PHI, we will charge you not more
than $.25 per page. We may see fit to provide you with a summary or
explanation of the PHI, but only if you agree to it, as well as to the
cost, in advance. B. The Right to Request
Limits on Uses and Disclosures of Your PHI. You have the right to ask that I limit how we use and
disclose your PHI. While we will consider your request, we are not legally
bound to agree. If we do agree to your request, we will put those limits
in writing and abide by them except in emergency situations. You do
not have the right to limit the uses and disclosures that we are legally
required or permitted to make. C. The Right to Choose
How We Send Your PHI to You. It is your right to ask that your PHI be sent to you at an
alternate address (for example, sending information to your work address
rather than your home address) or by an alternate method (for example,
via email instead of by regular mail). We are obliged to agree to your
request providing that we can give you the PHI, in the format you requested,
without undue inconvenience. D. The Right to Get a
List of the Disclosures We Have Made. You are entitled to a list of disclosures of your PHI that
we have made. The list will not include uses or disclosures to which
you have already consented, i.e., those for treatment, payment, or health
care operations, sent directly to you, or to your family; neither will
the list include disclosures made for national security purposes, to
corrections or law enforcement personnel, or disclosures made before
We will respond to your request for an accounting of disclosures
within 60 days of receiving your request. The list we give you will
include disclosures made in the previous six years (the first six year
period being 2003-2009) unless you indicate a shorter period. The list
will include the date of the disclosure, to whom PHI was disclosed (including
their address, if known), a description of the information disclosed,
and the reason for the disclosure. We will provide the list to you at
no cost, unless you make more than one request in the same year, in
which case we will charge you a reasonable sum based on a set fee for
each additional request. E. The Right to Amend
Your PHI. If
you believe that there is some error in your PHI or that important information
has been omitted, it is your right to request that we correct the existing
information or add the missing information. Your request and the reason
for the request must be made in writing. You will receive a response
within 60 days of my receipt of your request. We may deny your request,
in writing, if we find that: the PHI is (a) correct and complete, (b)
forbidden to be disclosed, (c) not part of our records, or (d) written
by someone other than us. Our denial must be in writing and must state
the reasons for the denial. It must also explain
your right to file a written statement objecting to the denial.
If you do not file a written objection, you still have the right to
ask that your request and our denial be attached to any future disclosures
of your PHI. If we approve your request, we will make the change(s)
to your PHI. Additionally, we will tell you that the changes have been
made, and we will advise all others who need to know about the change(s)
to your PHI. F. The Right to Get This
Notice by Email. You
have the right to get this notice by email. You have the right to request
a paper copy of it, as well. V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES If, in your opinion, we may have violated your privacy rights,
or if you object to a decision we made about access to your PHI, you
are entitled to file a complaint with the person listed in Section VI
below. You may also send a written complaint to the Secretary of the
Department of Health and Human Services at VI. PERSON TO CONTACT
FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES If you have any questions about this notice or any complaints
about our privacy practices, or would like to know how to file a complaint
with the Secretary of the Department of Health and Human Services, please
contact Mark Myers, Myers Counseling Group, VII. EFFECTIVE DATE OF THIS NOIICE This notice went into effect on
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