This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
If you have any questions about this Notice please contact our Privacy Contact: Douglas Heckenkamp
"Protected Health Information" (PHI) is information about you, including demographic information, which may identify you and relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information.
Our Responsibilities
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you or asking for one at the time of your next appointment.
Uses and Disclosures
How we may use and disclose Medical Information about you.
Following are examples of the types of uses and disclosures of your PHI that the therapist’s office is permitted to make once you have signed our consent form.
- Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your PHI. For example, we would disclose your PHI, as necessary to other physicians who may be treating you such as your referring physician or a specialist who you may be referred out to while under the care of our facility.
- Payment: Your PHI will be use, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we provide you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services for medical necessity, and undertaking utilization review activities. For example, to obtain pre-authorization for services your relevant PHI will be disclosed to the health plan.
- Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of your therapist’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities.
Uses and Disclosures OF PHI Based Upon Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, unless permitted or required by law as described below.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of your PHI, then your therapist may, using professional judgement, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care or location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts.
Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens, your therapist shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment.
Communication Barriers: We may use and disclose your PHI if your therapist attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the therapist determines, using professional judgment, that you intend to consent to the use or disclosure under the circumstances.
As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:
- Public Health
- Communicable Diseases
- Health Oversight
- Abuse or Neglect
- Food and Drug Administration
- Legal Proceedings
- Law Enforcement
- Coroners, Funeral Directors, and Organ Donation
- Criminal Activity
- Military Activity and National Security
- Workers’ Compensation
- Inmates
Your Health Information Rights:
Although you health record is the physical property of the practice practitioner or facility that compiled it, you have the right to:
Inspect and Copy Your PHI: You may inspect and obtain a copy of your PHI that is contained in medical and billing records and any other records used for making decisions about you for as long as we maintain the PHI. However, under federal law, you may not inspect or copy the following records; psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. Depending on circumstances, a decision to deny access may be contested. Please contact our Privacy Contact if you have questions about access to your medical record.
Request a Restriction of Your PHI: This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described previously. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Your therapist is not required to agree to a restriction that you request. If your therapist believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If the restriction is agreed upon, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you may wish to request with your therapist. You may request a restriction by stating that request in a formal letter and delivered in person to our Privacy Contact: Douglas Heckenkamp.
Request to Receive Confidential Communications from Us by Alternative Means or At an Alternative Location: We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Contact.
Right to Have Your Therapist Amend Your PHI: This means you may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of such rebuttal. Please contact our Privacy Contact if you have questions about amending your record.
Right to Receive an Accounting of Certain Disclosures We Have Made, if any, of Your PHI: This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
Complaints
You may complain directly to our office or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with our office by notifying our privacy contact of your complaint in writing. We will not retaliate against you for filling a complaint.
You may contact our Privacy Contact the receptionist at (720) 733-3655. You can also contact us in person at our office for further information about the complaint process. This notice was published and becomes effective on April 14, 2003.