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NOTICE OF PRIVACY PRACTICES

 THIS NOTICE DESCRIBES HOW YOUR MENTAL HEALTH INFORMATION MAY BE USED AND DISCLOSED, AS WELL AS HOW YOU MAY ACCESS THIS INFORMATION.

PLEASE REVIEW THIS DOCUMENT CAREFULLY.  THE PRIVACY OF YOUR MENTAL HEALTH INFORMATION IS IMPORTANT TO US.

 

OUR LEGAL DUTY

Your mental health records contain personal information about you.  This information that may identify you, and relates to your past, present, or future physical or mental health or condition and related health care services – is referred to as Protected Health Information (“PHI”).  This Notice of Privacy Practices describes how we may disclose your PHI in accordance with applicable HIPAA (“Health Insurance Portability and Accountability Act”) law and it is consistent with the laws of the State of Connecticut, Federal Government of the United States, the AAMFT and NASW Code of Ethics, as well as that of other professional mental health practitioners, including Psychiatrists, APRNs, Licensed Professional Counselors, and Licensed Alcohol and Drug Counselors.  It also describes your rights regarding how you may gain access to and control your PHI.  Records are maintained and destroyed in accordance with state and federal laws.

 

We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI.  We are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to change the terms of our Notice of Privacy Practices at any time.  Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time.  We will provide you with a copy of the revised Notice of Privacy Practices by mail or at your next appointment.

 

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

 

For Treatment:  Your PHI may be used and disclosed by those employed by Perspectives Center for Care, Inc. who are involved in your care for the purpose of providing, coordinating, and managing your mental health care treatment and related services.  This includes consultation with clinical supervisors or other treatment team members.  We may not disclose PHI to other consultants or professionals without your written authorization.

 

For Payment:  We may use and disclose PHI in order to receive payment for the treatment and services that are provided to you, and only with your authorization.  Examples of payment related activities include, but are not limited to: determining eligibility of coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, and utilization review.  If lack of payment for services necessitates Perspectives Center for Care, Inc. to utilize a collection agency, we will only disclose the minimum amount of PHI necessary for the purposes of collection.

 

For Health Care Operations:  We may use or disclose PHI to support business activities such as quality assessments, employee reviews, licensing, and various other business activities such as billing, or typing services – provided Perspectives Center for Care, Inc. has a written contract with any third party that may participate in these services so that PHI is safeguarded.  For training or teaching purposes, PHI will not be disclosed without your written authorization.  We may mail you information about our treatment and services that may be of assistance to you and your family.

 

Required by Law:  Under the law, we must make disclosures of your PHI to you upon your request.  In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purposes of investigating or determining our compliance with the requirements of the Privacy Rule.

Without Authorization:  Applicable law and ethical standards permit us to disclose information about you without your authorization in the following situations:

• Required by law, such as mandatory reporting of child abuse or neglect, abuse of elderly or handicapped individuals, or mandatory government agency audits or investigations (such as Licensing Board or Department of Public Health);
• Required by Court Order, warrant, or subpoena;
• Emergency situations to protect the health or safety of you, another person, or the general public. If information is disclosed to prevent or lessen a serious threat, the information will be disclosed to persons reasonably able to prevent or lessen the threat, including the target of the threat.

 

Written Authorization:  With your written permission, we may use or disclose your information to family members that are involved in your treatment.  Uses and disclosures not specifically permitted by applicable law will not be made without your written authorization, and may be revoked by you at any time, in writing.

 

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding your PHI.  If you have any questions, you may speak with your clinician, or submit a request in writing to Perspectives Center for Care, Inc.

 

• Right of Access to Inspect and Copy. With the exception of the psychotherapy notes, you have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care.  Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would prove harmful.  Request for access must be made in writing and will be provided according to federal and state laws.  We may charge a reasonable cost based fee for copies.

 

• Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you request in writing to amend the information, although the request alone does not ensure an amendment will occur.

 

• Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures made in regard to your PHI.  We may charge a reasonable fee if more than one request is made in a six month period.

 

• Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations.  Perspectives Center for Care, Inc. is not required to agree with the request.

 

• Right to Request Confidential Communication. You have the right to request a specific process for communicating with you regarding your PHI, for example a specific form and place.

 

• Right to a Copy of this Notice. You have a right to a copy of this notice.

 

COMPLAINTS:

If you believe that your privacy rights have been violated, you have the right to file a complaint in writing to Perspectives Center for Care, Inc. or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W., Washington, D.C. 20201 or by calling (202) 619-0257.  We will not retaliate against you for filing a complaint.

The effective date of this Notice is January 1, 2016.

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