Effective date 10-01-2018
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. As part of our professional practice, Roanoke Park Counseling (RPC) maintains personal information about you and your health. State and federal law protects such information by limiting its uses and disclosures.
“Protected health information“ (PHI) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health or condition, the provision of health care services, or the past, present or future payment for the provision of health care.
Your Rights Regarding Your PHI
The following are your rights regarding PHI that RPC maintains about you:
- Right of Access to Inspect and Copy. You can ask to see your medical records on file with RPC. You may receive either a paper or an electronic copy. There may be a small charge for a copy. Your request for a copy may include the direction to transmit the copy to a third party. If you request information stored on a computer, it will be provided in that form, unless it is not readily available in the form you request. In that case, it will be provided in a form we agree upon. This right excludes psychotherapy notes and information that is compiled in reasonable anticipation of a civil, criminal, or administrative action.
- Right to Amend. If you feel that the health information that RPC has about you is incorrect or incomplete, you may ask RPC to amend the information; although, RPC is not required to agree to the amendment.
- Right to an Accounting of Disclosures. You have the right to request a copy of the list of times that RPC shared your health information for six years prior to the date you ask, except for disclosures made for treatment, payment or health care purposes and certain other disclosures.
- Right to Request Restrictions. You have the right to ask us not to share certain health information for treatment, payment, or health care operations. RPC is not required to agree to your request if it would affect your care. If your request would restrict disclosure to a health plan for payment or healthcare operation purposes and RPC has been paid in full for all of the services covered by your requests, then RPC will honor your request unless the law requires us to share that information.
- Right to be Notified. You have the right to be notified promptly if there is a breach of your health information.
- Right to Request Confidential Communication. You have the right to request that RPC communicates with you by an alternative means or at an alternative location. RPC will accommodate reasonable requests.
- Right to a Copy of This Notice. You have the right to a paper copy of this notice at any time, even if you agreed to receive the notice electronically.
- Right of Complaint. You have the right to file a complaint in writing with RPC or with the Secretary of Health and Human Services if you believe that RPC has violated your privacy rights. RPC will not retaliate against you for filing a complaint.
- For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your
Cases in Which HIPAA Provides You the Right to Object
Please contact our office with the information provided above if you wish to object to these uses of your healthcare information.
- Including your information in a Directory. RPC may provide directory information, unless you have objected. *Note: We do not create or manage a directory.
- Sharing with Your Prior Health Care Providers. RPC may provide your PHI to prior health care providers, unless RPC has given you an opportunity to object and you objected in writing.
- Sharing With Those With Whom You Have a Close Personal Relationship. RPC may, in accordance with good professional practice, disclose your health information to your family, close friends, or others involved with your care, unless you have objected. If you are unable to tell us your preference, as in situations of incapacity or emergency disclosure, RPC will act according to what, it their clinical judgment, would be in your best interests.
- For Disaster Relief Purposes. We may disclose your PHI to a public or private entity authorized by law to assist in disaster relief efforts, which are directly relevant to your care or personal safety.
Other Uses and Disclosures
We may disclose limited health care information in other ways -- usually for purposes of public health and health care operations. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
- Required by Law. RPC may use or disclose your PHI to the extent that the use or disclosure is required by federal or state law, made in compliance with the law, and limited to the relevant requirements of the law. Examples are abuse and neglect reports or when necessary to minimize an imminent danger to the health or safety of you or any other individual. RPC must also make disclosures to the Secretary of the Dept. of Health and Human Services for the purpose of investigating or determining RPC’s compliance with the requirements of the Privacy Rule.
- Health Oversight. RPC may disclose your PHI to a health oversight agency for activities authorized by law, such as professional licensure. Oversight agencies also include government agencies and organizations that audit their provision of financial
assistance to RPC (such as third-party payers).
- Threat to Health or Safety. RPC may disclose your PHI when necessary to minimize an imminent danger to the health or safety of you or any other individual.
- Business Associates. RPC may disclose your PHI to the extent minimally necessary to Business Associates (BA) that are contracted by RPC to perform health care operations or payment activities on RPC’s behalf which may involve their collection, use or disclosure of your PHI. To safeguard the privacy of your PHI, such contracts are regulated by the Det. of Health and Human Services and must
contain provisions designed to limit the use and re-disclosure of your PHI, to require compliance by the BA with your individual rights, to subject the BA to specified security obligations, and to require the BA require such obligations on subcontractor.
- Compulsory Process. RPC will disclose your PHI is a court of competent jurisdiction issues and appropriate order. RPC will also disclose your PHI if (1) you and RPC have been notified in writing at least fourteen days in advance of a subpoena or other legal demand, which identifies the PHI sought and the date by which a protective order must be obtained to avoid RPC’s compliance, (2) no qualified judicial or administrative protective order has been obtained, (3) or RPC has received satisfactory assurances that you received notice of an opportunity to have the subpoena limited or it was cancelled, and (4) the time it was valid has passed.
Uses and Disclosures of PHI With Your Written Authorization
RPC will make other uses and disclosures of your health information only with your written authorization. You may revoke this authorization in writing at any time, unless we have taken a substantial action in reliance on the authorization, such as providing you with services for which we must submit subsequent claim for payment. You may revoke your written authorizations at any time.
Legal Requirement to Have This Notice
RPC is required by law to maintain the privacy of your PHI and to provide you with notice of our legal duties and privacy practices with respect to your PHI. We are required to abide by the terms of this notice. The terms stated above may change at any time. Any new Notice of Privacy Practices will be effective for all PHI in our records. We will make available a revised Notice of Privacy Practices by providing you a copy upon your request or providing a copy to you at your next appointment.
If you believe RPC has violated your privacy rights, you may file a complaint in writing to RPC using contact information at the top of this notice or available on RPC’s website. RPC will not retaliate against you for filing a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.