NOTICE OF PRIVACY
PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
I. BSSC PLEDGE REGARDING HEALTH INFORMATION:
Big Sky Supportive Counseling, PLLC (“BSSC”) understands that
health information about you and your health care is personal. BSSC is
committed to protecting health information about you. BSSC creates a record of
the care and services you receive. BSSC needs this record to provide you with quality
care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental
health care practice. This notice will tell you about the ways in which BSSC
may use and disclose health information about you. BSSC also describes your
rights to the health information kept about you, and
describe certain obligations BSSC has regarding the use and disclosure of your
health information. BSSC is required by law to:
·
Make sure that protected health information (“PHI”) that
identifies you is kept private.
·
Give you this notice of my legal duties and privacy practices
with respect to health information.
·
Follow the terms of the notice that is currently in effect.
·
BSSC can change the terms of this Notice, and such changes will
apply to all information BSSC has about you. The new Notice will be available
upon request, in the BSSC office, and on BSSC’s website.
II. HOW BSSC MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that BSSC may
use and disclose health information. For each category of uses or disclosures,
BSSC will explain what is meant and try to give some examples. Not every use or
disclosure in a category will be listed. However, all of
the ways BSSC is permitted to use and disclose information will fall within one
of the categories.
For Treatment Payment, or Health Care Operations: Federal
privacy rules (regulations) allow health care providers who have direct
treatment relationship with the patient/client to use or disclose the
patient/client’s personal health information without the patient’s written
authorization, to carry out the health care provider’s own treatment, payment
or health care operations. BSSC may also disclose your protected health
information for the treatment activities of any health care provider. This too
can be done without your written authorization. For example, if a clinician
were to consult with another licensed health care provider about your
condition, BSSC would be permitted to use and disclose your person health
information, which is otherwise confidential, in order to
assist the clinician in diagnosis and treatment of your mental health
condition.
Disclosures for treatment purposes are not limited to the
minimum necessary standard: Because therapists and other health care providers
need access to the full record and/or 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.
Lawsuits and Disputes: If you are involved in a lawsuit, BSSC
may disclose health information in response to a court or administrative order.
BSSC may also disclose health information about your child in response to a
subpoena, discovery request, or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you about the
request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1.
Psychotherapy Notes: BSSC does keep “psychotherapy notes” as
that term is defined in 45 CFR § 164.501, and any use or disclosure of such
notes requires your Authorization unless the use or disclosure is: a. For
BSSC’s use in treating you. b. For use in training or supervising mental health
practitioners to help them improve their skills in group, joint, family, or
individual counseling or therapy. c. For BSSC use in defending self in legal
proceedings instituted by you. d. For use by the Secretary of Health and Human
Services to investigate my compliance with HIPAA. e. Required by law and the
use or disclosure is limited to the requirements of such law. f. Required by
law for certain health oversight activities pertaining to the originator of the
psychotherapy notes. g. Required by a coroner who is performing duties
authorized by law. h. Required to help avert a serious threat to the health and
safety of others.
2.
Marketing Purposes: BSSC will not use or disclose your PHI for
marketing purposes.
3.
Sale of PHI: BSSC will not sell your PHI in the regular course
of business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR
AUTHORIZATION: Subject to certain limitations in the law, BSSC can use and
disclose your PHI without your Authorization for the following reasons:
1.
When disclosure is required by state or federal law, and the use
or disclosure complies with and is limited to the relevant requirements of such
law.
2.
For public health activities, including reporting suspected
child, elder, or dependent adult abuse, or preventing or reducing a serious
threat to anyone’s health or safety.
3.
For health oversight activities, including audits and
investigations.
4.
For judicial and administrative proceedings, including
responding to a court or administrative order, although BSSC’s preference is to
obtain an Authorization from you before doing so.
5.
For law enforcement purposes, including reporting crimes
occurring on BSSC premises.
6.
To coroners or medical examiners, when such individuals are
performing duties authorized by law.
7.
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.
8.
Specialized government functions, including, ensuring the proper
execution of military missions; protecting the President of the United States;
conducting intelligence or counter-intelligence operations; or, helping to
ensure the safety of those working within or housed in correctional
institutions.
9.
For workers’ compensation purposes. Although BSSC’s preference
is to obtain an Authorization from you, BSSC may provide your PHI in order to comply with workers’ compensation laws.
10.
Appointment reminders and health related benefits or services.
BSSC may use and disclose your PHI to contact you to remind you that you have
an appointment. BSSC may also use and disclose your PHI to tell you about
treatment alternatives, or other health care services or benefits that BSSC
offers.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE
OPPORTUNITY TO OBJECT:
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1.
The Right to Request Limits on Uses and Disclosures of Your PHI.
You have the right to ask BSSC not to use or disclose certain PHI for
treatment, payment, or health care operations purposes. BSSC is not required to
agree to your request, and BSSC may say “no” if it is believed it would affect
your health care.
2.
The Right to Request Restrictions for Out-of-Pocket Expenses
Paid for In Full. You have the right to request restrictions on disclosures of
your PHI to health plans for payment or health care operations purposes if the
PHI pertains solely to a health care item or a health care service that you
have paid for out-of-pocket in full.
3.
The Right to Choose How BSSC Sends PHI to You. You have the
right to ask BSSC to contact you in a specific way (for example, home or office
phone) or to send mail to a different address, and BSSC will agree to all
reasonable requests.
4.
The Right to See and Get Copies of Your PHI. Other than
“psychotherapy notes,” you have the right to get an electronic or paper copy of
your medical record and other information that BSSC has about you. BSSC will
provide you with a copy of your record, or a summary of it, if you agree to
receive a summary, within 30 days of receiving your written request. BSSC may
charge a reasonable, cost-based fee for doing so.
5.
The Right to Get a List of the Disclosures BSSC Have Made. You
have the right to request a list of instances in which BSSC has disclosed your
PHI for purposes other than treatment, payment, or health care operations, or
for which you provided BSSC with an Authorization. BSSC will respond to your
request for an accounting of disclosures within 60 days of receiving your
request. The list BSSC will give you will include disclosures made in the last
six years, unless you request a shorter time. BSSC will provide the list to you
at no charge, but if you make more than one request in the same year, BSSC will
charge you a reasonable cost-based fee for each additional request.
6.
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 BSSC correct the
existing information or add the missing information. BSSC may say “no” to your
request, but BSSC will tell you why in writing within 60 days of receiving your
request.
7.
The Right to Get a Paper or Electronic Copy of this Notice. You
have the right get a paper copy of this Notice, and you have the right to get a
copy of this notice by e-mail. And, even if you have agreed to receive this
Notice via e-mail, you also have the right to request a paper copy of it.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on 10/01/2018.
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.