HIPAA Notice of Privacy Policies and Practices
Horizons Counseling Services, Inc.
Federal and State laws governing confidentiality can be quite complex. This Notice explains some specific Patient Rights that you have under these laws. We will maintain a Clinical Record file on your case, which is the property of Horizons. You may examine and/or receive a copy of your file if you request it in writing and the request is signed by you and dated not more than 60 days from the date it is submitted. There may be a charge for writing reports or for copying materials.
Please note: If you are being seen in couples, group, or family therapy, Ohio laws concerning confidentiality are not clear. Horizons will not release information to other parties without your written permission except when allowed or required to do so by State or Federal law, unless a court order requires us to release information about your case.
Horizons may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
· “PHI” refers to information in your health record that could identify you.
· “Treatment, Payment and Health Care Operations”:
o Treatment is when Horizons provides, coordinates and manages your health care and other services related to your health care.
o Payment is when Horizons obtains reimbursement for your healthcare. Horizons uses collections agencies, an accountant, and technical support service for our billing software. As required by HIPAA, these businesses have signed contracts with us in which they promise to maintain the confidentiality of protected health information except as specifically allowed in the contract or otherwise required by law. If you wish, we can provide you with the names of these organizations and a blank copy of the contract.
o Health Care Operations are activities that relate to the performance and operation of Horizons Counseling Services, Inc.
· “Use” means activities within Horizons’ practice such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. Your therapist practices with other mental health professionals and also employs secretarial staff. In most cases, your therapist needs to share information with secretarial staff for purposes such as billing, scheduling, and quality assurance. Also, Horizons’ clinical staff routinely consult with each other concerning our clients. Please let your therapist know if you would prefer that other clinical staff not be consulted about your case. All of the professional staff are bound by the same rules of confidentiality, and all secretarial staff have training in privacy rules and have agreed not to release any information outside of the practice without permission of a professional staff member.
· “Disclosure” means activities outside of our office, such as releasing, transferring, or providing access to information about you to other parties. Your therapist may find it helpful to share information with your primary care physician or other health and mental health professionals who are currently treating you. Your signature on this Agreement is written, advance consent for us to release information to these professionals. A record of these disclosures will be kept in your Clinical Record. q Check here if do NOT wish us to release any information to other mental health and health professionals who are currently treating you. Your therapist may occasionally find it helpful to consult other health and mental health professionals about a case. During consultations, your therapist makes every effort to avoid revealing the identity of patients. The other professionals are also legally bound to keep the information confidential. The therapist will note all consultations in your Clinical Record.
· Uses and Disclosures Requiring Authorization
Your therapist may use or disclose PHI for purposes outside of treatment, payment, and health care operations when authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when your therapist is asked for information for purposes outside of treatment, payment and health care operations, she/he will obtain an authorization from you before releasing this information. Your therapist will also need to obtain a separate authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes your therapist has made about your conversations during a private, group, joint, or family counseling session, which your therapist has kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) Your therapist has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.
· Uses and Disclosures Requiring Neither Consent Nor Authorization
Your therapist may use or disclose PHI without your consent or authorization in the following circumstances:
o Child Abuse: If your therapist knows or suspects that a child under 18 years of age or a mentally retarded, developmentally disabled, or physically impaired person under 21 years of age has suffered or faces a threat of suffering any physical or mental wound, injury, disability, or condition of a nature that reasonably indicates abuse or neglect, she/he is required by law to report that knowledge or suspicion to the Ohio Public Children Services Agency, or a municipal or county peace officer.
o Elder Abuse: If your therapist has reasonable cause to believe that an elder is being abused, neglected, or exploited, or is in a condition which is the result of abuse, neglect, or exploitation, she/he is required by law to immediately report such belief to the County Department of Job and Family Services.
o Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information concerning your evaluation, diagnosis or treatment, such information is protected by the psychologist-client (or social work-client) privilege law. Horizons cannot provide any information without your (or your personal or legal representative’s) written authorization. However, if a court orders Horizons to disclose information, we are required to provide it. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order us to disclose information.
o Serious Threat to Health or Safety: If your therapist believes that you pose a clear and substantial risk of imminent serious harm to yourself or another person, she/he may disclose your relevant confidential information to public authorities, the potential victim, other professionals, and/or your family in order to protect against such harm. If you communicate to your therapist an explicit threat of inflicting imminent and serious physical harm or causing the death of one or more clearly identifiable victims, and your therapist believes you have the intent and ability to carry out the threat, then she/he is required by law to take one or more of the following actions in a timely manner: 1) take steps to hospitalize you on an emergency basis, 2) establish and undertake a treatment plan calculated to eliminate the possibility that you will carry out the threat, and initiate arrangements for a second opinion risk assessment with another mental health professional, 3) communicate to a law enforcement agency and, if feasible, to the potential victim(s), or victim's parent or guardian if a minor, all of the following information: a) the nature of the threat, b) your identity, and c) the identity of the potential victim(s).
o Worker’s Compensation: If you file a worker’s compensation claim, your therapist may be required to give your mental health information to relevant parties and officials.
o If the client is a minor: Both parents have access to the minor client’s complete Clinical Record, including Psychotherapy Notes, unless there is a court order prohibiting one of the parents from access.
o If a government agency (such as Medicare) is requesting the information for health oversight activities, Horizons may be required to provide it to them.
o If a client files a complaint or lawsuit against Horizons or any of its staff, Horizons may disclose relevant information regarding that patient in order to defend itself.
o Horizons staff may present disguised case material in seminars, classes, or scientific writings; in this situation, all identifying information and Protected Health Information is removed and client anonymity is maintained.
o Your health insurance plan has the right to review your Clinical Records for any services you have asked them to pay for. Unless your treatment is being paid for by a Workers Compensation plan, a health insurance company is not entitled to see Psychotherapy Notes, which are detailed notes your therapist may make concerning what you have talked about in therapy. However, they are entitled to see PHI in your clinical record, including information about dates of therapy, symptoms, your diagnosis, your overall progress towards those goals, any past treatment records that we receive from other providers, reports of any professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier.
· Client Rights:
o Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, your therapist is not required to agree to a restriction you request.
o Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. For example, if you don’t want family members to know you are seeing a therapist, you can have your bills sent to an alternate address.
o Right to Inspect and Copy – You have the right to inspect and/or obtain a copy of your, or your minor child’s, PHI and psychotherapy notes in your therapist’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. There will be a charge for records returned from remote/off site locations and for copies made.
o Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Your therapist may deny your request.
o Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described on page 6 of this Notice).
o Right to a Paper Copy – You have the right to obtain a paper copy of the Privacy Notice from your therapist upon request, even if you have agreed to receive the Notice electronically.
· Therapist's Duties:
o Your therapist is required by law to maintain the privacy of PHI and to provide you with a notice of their legal duties and privacy practices with respect to PHI.o Horizons reserves the right to change the privacy policies and practices described in this notice. Unless your therapist notifies you of such changes, however, the therapist is required to abide by the terms currently in effect.
o If Horizons revises their policies and procedures, they will be posted in the waiting room for your inspection, at your convenience.
If you are concerned that your therapist has violated your privacy rights, or you disagree with a decision your therapist made about access to your records, you may contact Susan Radbourne, Ph.D., (440) 845-9011. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. Dr. Radbourne can provide you with the appropriate address upon request.
[1] Horizons reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that is maintained. Horizons will provide you with a revised notice by posting the revisions in the waiting room for your inspection.