Notice of Privacy Policies
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Privacy is a very important concern for all those who come to this office. It is also complicated, because of the many federal and state laws and our professional ethics. This notice will tell you how I handle your medical information. It tells how I use this information here in this office, how I share it with other professionals and organizations, and how you can see it. I want you to know all of this so that you can make the best decisions for yourself and your family.
WHAT WE MEAN BY YOUR HEALTH INFORMATION
Each time you visit me or any doctor’s office, hospital, clinic, or other health care provider, information is collected about you and your physical and mental health. It may be information about your past, present, or future health or conditions, or the tests and treatment you got from me or from others, or about payment for health care. The information I collect from you is called “PHI,” which stands for “protected health information.” This information goes into your medical or health care records in my office.
We use PHI for many purposes. For example, I may use it:
To plan your care and treatment.
To decide how well treatments are working for you.
When I talk with other health care professionals who are also treating you, such as your family doctor or the professional who referred you to us.
To show that you actually received services from me, which I billed to you or to your health insurance company.
When you understand what is in your record and what it is used for, you can make better decisions about who, when, and why others should have this information. Although your health care records in my office are my physical property, the information belongs to you. You can read your records, and if you want a copy I can make one for you (but I will charge you for the costs of copying and mailing, if you want it mailed to you). In some very rare situations, you cannot see all of what is in your records. If you find anything in your records that you think is incorrect or believe that something important is missing, you can ask me to amend (add information to) your records, although in some rare situations I don’t have to agree to do that.
PRIVACY AND THE LAWS ABOUT PRIVACY
I am required to tell you about privacy because of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires me to keep your PHI private and to give you this notice about my legal duties and my privacy practices. I will obey the rules described in this notice. If I change my privacy practices, they will apply to all the PHI I keep. I will also post the new notice of privacy practices on my website at jenniferburkhardtlpc.com.
HOW YOUR PROTECTED HEALTH INFORMATION CAN BE USED AND SHARED
Except in some special circumstances, when I use your PHI in this office or disclose it to others, I share only the minimum necessary PHI needed for those other people to do their jobs. The law gives you rights to know about your PHI, to know how it is used, and to have a say in how it is shared. So I will tell you more about what I do with your information. Mainly, I will use and disclose your PHI for routine purposes to provide for your care, and I will explain more about these below. For other uses, I must tell you about them and ask you to sign a written authorization form. However, the law also says that there are some uses and disclosures that don’t need your consent or authorization.
USES AND DISCLOSURES WITH YOUR CONSENT
After you have read this notice, you will be asked to sign a separate consent form to allow me to use and share your PHI. In almost all cases I intend to use your PHI here or share it with other people or organizations to provide treatment to you, arrange for payment for my services, or some other business functions called “health care operations.”
THE BASIC USES AND DISCLOSURE: FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS:
For treatment. I use your medical information to provide you with therapy services. These might include individual, couples or family therapy; treatment planning; or measuring the benefits of my services.
For payment. I may use your information to bill you, your insurance, or others, so I can be paid for the treatments I provide to you. I may contact your insurance company to find out exactly what your insurance covers. I may have to tell them about your diagnoses, what treatments you have received, and the changes I expect in your conditions. I will need to tell them about when we met, your progress, and other similar things.
OTHER USES AND DISCLOSURES IN HEALTH CARE
Appointment reminders. I may use and disclose your PHI to reschedule or remind you of appointments for treatment or other care. If you want me to call or text you only at your home or your work, or you prefer some other way to reach you, I usually can arrange that.
Treatment alternatives. I may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of help to you.
Business associates. I hire other businesses to do some jobs for me. In the law, they are called our “business associates.” Examples include a copy service to make copies of your health records, and a billing service to figure out, print, and mail our bills. These business associates need to receive some of your PHI to do their jobs properly. To protect your privacy, they have agreed in their contract with me to safeguard your information.
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
If I want to use your information for any purpose besides those described above, I need your permission on an authorization form. I don’t expect to need this very often. If you do allow me to use or disclose your PHI, you can cancel that permission in writing at any time. I would then stop using or disclosing your information for that purpose. Of course, I cannot take back any information I have already disclosed or used with your permission.
USES AND DISCLOSURES THAT DON’T REQUIRE YOUR CONSENT OR AUTHORIZATION
The law lets me use and disclose some of your PHI without your consent or authorization in some cases. Here are some examples of when I might do this.
When required by law There are some federal, state, or local laws that require me to disclose PHI:
I have to report suspected child abuse. If you are involved in a lawsuit or legal proceeding, and I receive a subpoena, discovery request, or other lawful process, I may have to release some of your PHI. I will only do so after trying to tell you about the request, consulting your lawyer, or trying to get a court order to protect the information they requested.
I have to disclose some information to the government agencies that check on me to see that we are obeying the privacy laws.
For law enforcement purposes I may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.
For specific government functions I may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment. I may disclose your PHI to workers’ compensation and disability programs, to correctional facilities if you are an inmate, or to other government agencies for national security reasons. To prevent a serious threat to health or safety If I come to believe that there is a serious threat to your health or safety, or that of another person or the public, I can disclose some of your PHI. I will only do this to persons who can prevent the danger.
USES AND DISCLOSURES WHERE YOU HAVE AN OPPORTUNITY TO OBJECT
I can share some information about you with your family or close others. I will only share information with those involved in your care and anyone else you choose. If it is an emergency, and I cannot ask if you disagree, I can share information if I believe that it is what you would have wanted and if I believe it will help you if I do share it. If I do share information, in an emergency, I will tell you as soon as I can. If you don’t approve I will stop, as long as it is not against the law.
YOUR RIGHTS CONCERNING YOUR HEALTH INFORMATION
You can ask me to communicate with you about your health and related issues in a particular way or at a certain place that is more private for you. For example, you can ask me to call you at home, and not at work, to schedule or cancel an appointment.
You have the right to ask me to limit what I tell people involved in your care or with payment for your care, such as family members and friends. I don’t have to agree to your request, but if I do agree, I will honor it except when it is against the law, or in an emergency, or when the information is necessary to treat you.
You have the right to look at the health information I have about you, such as your medical and billing records. You can get a copy of these records, but I may charge you.
If you believe that the information in your records is incorrect or missing something important, you can ask me to make additions to your records to correct the situation. You have to make this request in writing and must also indicate the reasons you want to make the changes.
You have the right to a copy of this notice. If I change this notice, I will post the new one on my website jenniferburkhardtlpc.com.
You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with the Secretary of the U.S. Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care I provide to you in any way.
You may have other rights that are granted to you by the laws of our state, and these may be the same as or different from the rights described above. I will be happy to discuss these situations with you now or as they arise.
IF YOU HAVE QUESTIONS OR PROBLEMS
If you need more information or have questions about the privacy practices described above, please let me know. As stated above, you have the right to file a complaint with me and with the Secretary of the U.S. Department of Health and Human Services. I promise that I will not in any way limit your care here or take any actions against you if you complain. If you have any questions or problems about this notice or my health information privacy policies, please let me know.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on OCTOBER 27, 2017
Acknowledgement of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPPA Notice of Privacy Practices.
BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.