THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU OR YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
We have a legal duty to safeguard and maintain the privacy of our clients’ personal health information (called “protected health information” [PHI]) and to provide you with this notice of our legal duties and privacy practices, with respect to PHI.
I. Uses and Disclosures of your Protected Health Information
Uses and disclosure for treatment. We will use and disclose your PHI as necessary for your treatment. For instance, a) our treatment team may discuss you to plan your treatment, and b) we will send updates to your primary care physician following your appointments with any of our physicians.
Uses and disclosure for payment. We may communicate with your health insurer if prior authorization for services or medication is required.
Uses and disclosures for health care operations. We may use your PHI as necessary for purposes of improving clinical treatment and care of our clients.
II. Uses and Disclosures Requiring Authorization
In instances when we are asked to provide information for purposes outside of those listed above, we will obtain an authorization (written permission) from you before releasing this information.
We must also obtain a special authorization from you before releasing psychotherapy notes (which are those notes we may make about conversations during sessions which we keep distinct from the rest of your medical record). Those notes are given a greater degree of protection than PHI.
You have the right to revoke an authorization in writing unless we have taken any action in reliance on that authorization.
III. Uses and Disclosures with Neither Consent nor Authorization
We may use or disclose PHI without your consent or authorization in the following circumstances:
Child Abuse: If, in our professional capacity, we know or suspect that a child under age 18 or a mentally retarded, developmentally disabled, or physically impaired child under age 21 has suffered or faces a threat of suffering any physical or mental wound, injury, disability, or condition of a nature that reasonably indicates abuse or neglect, we are required by law to immediately report that knowledge or suspicion to the county Department of Job and Family Services.
Adult and Domestic Abuse: If we have reasonable cause to believe that an adult is being abused, neglected, or exploited, or is in a condition that is the result of abuse, neglect, or exploitation, we are required by law to immediately report such belief to the county Department of Job and Family Services.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your evaluation, diagnosis, and treatment and the records thereof, such information is privileged under state law and we will not release it without written authorization from you or your personal or legally-appointed representative, or court-order. The privilege does not apply when you are being evaluated for a third-party or wehre the evaluation is court-ordered. You will be informed in advance if this is the case.
Serious Threat to Health or Safety: If we believe that you pose a clear and substantial risk of imminent serious harm to yourself or another person, we may disclose your relevant confidential information to public authorities, the potential victim, other professionals, and/or your family in order to protect against such harm. If you communicate to us an explicit threat of inflicting imminent and serious physical harm or causing the death of one or more clearly identifiable victims, and we believe you have the intent or ability to carry out the threat, then we are required by law to take one or more of the following actions in a timely manner: 1) take steps to hospitalize you on an emergency basis, 2) establish and undertake a treatment plan calculated to eliminate the possibility that you will carry out the threat, and initiate arrangements for a second opinion risk assessment with another mental health professional, 3) communicate to a law enforcement agency and, if feasible, to the potential victim(s), or victim’s parent or guardian if a minor, all of the following information: a) the nature of the threat, b) your identity, and c) the identity of any potential victim.
IV. Your Rights Regarding PHI and Treatment Provider Duties
On your request, we will discuss with you the details of any of these rights.
Access to your PHI. You have the right to receive a copy and/or inspect your treatment record unless excluded by law. We may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed.
Amendments to your PHI. You have the right to request in writing that the PHI we maintain about you be amended. We may deny your request.
Accounting for disclosures of your PHI. You have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization.
Requesting restrictions. You have the right to request restrictions on certain uses and disclosures of your PHI. However, we are not required to agree to a restriction you request.
Receiving confidential communications. You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family memter to know that you are seeing us, and, upon your request, we will send correspondence to another address.)
Paper copy. You have the right to obtain a paper copy of this Notice from us upon request, even if you have agreed to receive the Notice electronically.
Treatment Provider Duties:
We reserve the right to change this Notice and to make the new Notice effective for all PHI that we maintain. We will provide you with a revised Notice at your next scheduled appointment in the case changes are made. If we revise our policies and procedures, you may receive a copy of the new Notice at our office, by requesting that a copy be mailed to you, or viewing it on our website.
If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact Dr. Chris Mayhall at (513) 984-1000. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. Chris Mayhall can provide you with the appropriate address upon request.
For further information regarding how The Affinity Center handles information learned about you from your visit(s) to our website, please read our Website/Electronic Information Policy.