THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AN DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Protected Health Information (PHI), including in an electronic form, is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services. This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with all applicable laws and your rights regarding how you may gain access to and control your PHI.
Use and Disclosures of Protected Health Information (PHI)
- Treatment - We may use or disclose your PHI to provide, coordinate and manage your health Care and any related services. This includes the coordination or management of Your health care with a third party. For example, PHI may be provided to a Physician to whom you have been referred to ensure that the physician has the Necessary information to diagnose or treat you.
- Payment - We may use or disclose your PHI to verify insurance and coverage and to process Claims and collect fees.
- Health Care Operations - We may use or disclose your PHI in order to support the business activities of the Counseling practice. These activities include, but are not limited to, quality Assessment of treatment processes and business activities, staff training and Certification, and compliance with licensing and other credentialing bodies.
- Other Uses and Disclosures - We may use or disclose your PHI for emergencies, criminal damage, treatment Alternatives and appointment scheduling. In addition we may also use or disclose your PHI as required by law, including mandated reports of Child/Elder Abuse and National Security.
Client Rights
- Right to Release Your Medical Records - With a signed written authorization, you have the right to have your Medical Record released to others, including other healthcare professionals. Once an authorization is signed, it can be revoked in writing. Revocation does not apply to information released base don prior valid authorizations.
- Right to Inspect your Medical Record and Copy Medical Billing Records - You have the right to inspect your medical record and receive copies of medical billing records as requested. It is up to the discretion of the therapist what sections of the medical record may be reviewed, and sections may be withheld if it is determined to be detrimental to the client. Charges for making copies and mailing sections of the medical record may apply.
- Right to Add Information or Amend your Medical Record - You have the right to request to amend your medical record or to file a “disagreement statement” outlining what you disagree with and why. This will then be placed in your medical record. These requests must be made in writing and are up to the discretion of the therapist.
- Right to Accounting of Disclosures - You have the right to receive an accounting of certain disclosure we have made, if Any, regarding your PHI.
- Right to Request Restrictions on Uses and Disclosures of your Medical Record - You have the right to request a restriction of the use and disclosure of your PHI. This must be done in writing and must be specific regarding what information to restrict and who it should b restricted from. The therapist has the right to refuse the request.
- Right to Complain - If you have complaints or concerns about how your PHI is being used, contact Jill Perry at 724-494-6750. If you do not feel satisfied at that time, you have the right to complain to the U.S. Department of Health and Human Services. There will be no retaliation by this office for filing a complaint.
Updated 4/2020
