Privacy policy.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date: March 10th, 2024
This Notice of Privacy Practices informs you how your protected health information (PHI) is protected under state and federal law, as well as ethical bounds of the counseling profession. This notice is to inform you that we will only release your PHI in accordance with these laws and are required to abide by these laws.
This notice also describes how we may use and disclose your PHI. This notice applies to all the records of your care generated by this mental health care practice. Use and disclosure of protected health information is for the purposes of providing services. Providing treatment services and conducting healthcare operations are necessary activities for quality care. State and federal laws allow us to use and disclose your health information for these purposes. We may change the terms of this notice at any time, and a new notice will be effective for all PHI that we maintain at that time. Should terms be changed, a new Notice of Privacy Practices will be provided to you upon request.
1. Uses and Disclosures of Protected Health Information
The following categories describe different ways that we use and disclose health information. You will be asked, as part of the “Consent for Treatment”, to consent to enabling us to use and disclose your protected health information for purposes of treatment, payment, and health care operations. For each category of uses or disclosures an example will be provided. This is not an exhaustive list of examples, but instead a frame of reference for information that will fall under each category. Most uses and disclosures of your PHI, including psychotherapy notes, will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke your authorization at any time, in writing, except to the extent that this organization has already taken an action in reliance on the use or disclosure indicated in the authorization.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment services. Disclosures for treatment purposes are not limited to the minimum necessary standard. This is because health care providers need access to full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another. This also includes psychotherapy notes as defined in 45 CFR § 164.501. This disclosure is done with your consent, unless limited to the uses and disclosures that do not require authorization outlined in this notice. For example, if a clinician were to consult with the agency’s supervising psychotherapist directly related to your care, we would be permitted to use and disclose your personal health information to assist the clinician in diagnosis and treatment of your mental health condition.
Payment: We may use and disclose your protected health information so that we can bill and receive payment for the treatment and services you receive at our clinic. Unless you object, we may use and disclose your protected health information in order to bill and receive payment for the treatment and services from your health insurance plan. For example, we may contact your health insurance plan to verify that you are eligible for benefits and for what range of benefits.
Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the operation activities of this practice. These operations are necessary to manage the clinic and monitor quality of care. These activities include, but are not limited to:
Reviewing the competence of qualification of health care professionals, evaluating practitioner and provider performance, review of treatment procedures or counseling practice activities, conducting training programs, accreditation, certification, licensing or credentialing activities
Medical review, legal services, and auditing, including fraud and abuse detection and compliance
Business planning and development
Business management and general administrative activities, including management activities relating to privacy, customer services, payment and resolution of internal grievances.
For example: we may use protected health information to evaluate our clinic services, including the performance of staff.
Marketing Purposes and Sale of PHI: We will not use or disclose your PHI for marketing purposes. We will not sell your PHI in the regular course of business.
Others Involved in Your Health Care: With your consent, we may provide your PHI to a family member, friend, or other person that you indicate is involved in your care, unless you object in whole or in part. That opportunity to consent may be obtained retroactively in emergency situations, as deemed appropriate by the practitioner.
2. Other Uses and Disclosures Without Your Consent or Authorization
We may disclose your PHI in the following situations without consent or authorization, as subject to certain limitations in the law:
a. When disclosure is required by state or federal law, the use or disclosure complies with and is limited to the relevant requirements of such law.
b. For public health activities, including reporting suspected child, elder, or dependent adult abuse; sexually active adolescent reporting requirements; communicable disease reporting requirements; or overall preventing or reducing a serious threat to anyone’s health or safety.
c. For health oversight activities, including audits and investigations.
d. For any judicial or administrative legal proceedings in response to an order of a court, or in certain conditions, in response to a subpoena, discovery request, or other lawful process.
e. For law enforcement purposes, including reporting crimes occurring on our premises, or required by law and standards of ethical conduct, if we believe in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to you or the public’s health or safety.
f. To coroners or medical examiners, when such individuals are performing duties authorized by law, including identification purposes or determining cause of death. We also may disclose your information to the State Department of Health and Family Services so they can carry out their duties related to deaths associated with a psychotropic medication or suicide.
g. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition. This disclosure would only occur when research has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
h. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
i. For workers’ compensation purposes to comply with workers’ compensation laws. These programs may provide benefits for work-related injuries or illness.
j. Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.
k. Psychotherapy notes. Any use or disclosure requires your consent or authorization unless the use or disclosure pertains to the list under section (2) of this notice or:
I. For our use in treating you.
II. For our use in the training of the mental health practitioner to help improve their skills in group, joint, family, or individual counseling or therapy.
III. For our use in defending ourselves in legal proceedings instituted by you.
IV. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
3.Your Rights
The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights:
a. The right to request restrictions on certain uses or disclosures of PHI. This means that you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. This includes a request that parts of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this notice. Your request must state the specific restriction requested and to whom you want the restriction to apply. We must also inform you of your right to restrict certain disclosures of your PHI to a health plan if you have paid in full out-of-pocket for the health care item or service. Your provider is not required to agree to a restriction that you may request, such as if your provider believes that it would affect your health or safety. You then have the right to use another provider. Your provider may not be able to honor your restriction in the event of an emergency situation.
b. The right to request to receive confidential communications from us by alternative means or at an alternative location (for example, a home or office phone). We will accommodate reasonable requests.
c. The right to inspect and get a copy of your PHI. You have a right to get an electronic or paper copy of your medical record, and other information that we have about you. We will provide you with a record, or a summary if you agree to a summary, within a timeline established in DHS 92.05. A reasonable cost-based fee may be charged for doing so.
d. The right to correct or update your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We have the right to deny your request and will notify you of our decision within 30 days of receiving your written request. Should we deny your request, you have the right to insert a statement of dispute to be included in the record.
e. The right to get a list of the disclosures I have made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an authorization. I will respond to your request within a reasonable time period of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time period. The right to receive this information is subject to certain exceptions, restrictions, and limitations under Wisconsin law.
f. You have the right to receive notifications of a data breach of any unsecured PHI. This notice must be made within 60 days from when we become aware of the breach, and we will notify you by your last known contact information in our records.
g. Your records will be kept for at least 7 years following the date of discharge. In the case of a minor, records will be retained until the person becomes 19 years old or until 7 years after treatment is completed, whichever is longer.
h. You have the right to obtain a paper copy of this Notice of Privacy Practice from us. You also have a right to obtain this notice by email.
You may give us written authorization to use your protected health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights:
4 Complaints
You may complain to us or to the U.S. Department 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 the therapist or owner of the complaint. We will not retaliate against you for filing a complaint. Alternatively, you can contact the Office for Civil Rights: https://www.hhs.gov/hipaa/filing-a-complaint/index.html
Last updated: March 10th, 2024
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Alexis McDonald, MS, LPC
Therapist/Owner
Intentional Minds
4330 Golf Terrace, Suite 202
Eau Claire, WI 54701