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NOTICE OF PRIVACY POLICIES AND HIPAA PRACTICES AND COMPLIANCE REGARDING CONFIDENTIALITY OF CLIENT RECORDS AND DISSEMINATION OF INFORMATION

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THIS NOTICE DESCRIBES HOW MENTAL HEALTH AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

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Southern Adirondack Mental Health Counseling Services, PLLC (hereafter referred to as SACS) is dedicated to maintaining the privacy of your individually identifiable health information (hereafter referred to as Protected Health Information, or PHI). SACS and all of therapists at SACS are required by law to maintain the confidentiality of health information that identifies you. According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we are also required by law to provide you with this notice of our legal duties and the privacy practices concerning your PHI. We must follow the terms of the Notice of Privacy Practices that we have in effect at the time.

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Please review this Notice of Privacy Policies and Practices and Compliance with HIPAA Regarding Confidentiality of Client Records and Dissemination of Information. It is the policy of SACS to:

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  • fully comply with the requirements of the HIPAA General Administrative Requirements, the Privacy and Security Rules

  • provide every patient who receives services with a copy of this Notice of Privacy Policies and Practices

  • ask the patient to acknowledge receipt when given a copy of this Notice of Privacy Policies and Practices

 

Protected health information (PHI) refers to any information that is created or received by SACS, and relates to:

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  • individual’s past, present or future physical or mental health conditions and related care services

  • individual’s past, present, or future payment for the provision of health care to an individual

  • any information that can identify the individual

  • information where there is a reasonable basis to believe the information can be used to identify the individual

 

PHI includes any such information described above that SACS transmits or maintains in any form, including Psychotherapy Notes. HIPAA and federal law regulate the use and disclosure of PHI when transmitted electronically.

 

Your Privacy Rights as Our Client:

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Please review carefully and ask us any questions you have.

 

Get a list of those with whom we’ve shared information. You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). Upon request, we will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for additional accountings within one 12-month window.

 

Get a copy of this privacy notice. You can ask for a paper copy of this notice at any time. We will provide you with a copy promptly.

 

Choose someone to act for you. If you have given someone medical power of attorney or if you have a legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

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Uses and Disclosures Not Requiring Consent:

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Providing treatment services, collecting payment and conducting healthcare operations are necessary activities for quality care. State and federal laws allow us to use and disclose your health information for these purposes. In most cases, we are limited to disclosing the minimum information necessary to accomplish these purposes. To help clarify these terms, here are some examples:

  • Treatment is when we use and disclose health information to provide, coordinate or manage your health care and other services related to your health care. If we decide to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist me in the diagnosis or treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard, because physicians 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 among health care providers or by a health care provider with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.

  • Payment is when we use and disclose health information to obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

  • Health Care Operations refers to the use and disclosure of health information for activities that relate to the performance and operation of my practice. Examples of health care operations are review of treatment procedures or business operations, quality assessment and improvement activities, and staff training.

 

Uses and Disclosures Requiring Authorization

We may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when we are asked for information for purposes outside of treatment, payment or health care operations, we will obtain an authorization from you before releasing this information. We will also obtain an authorization from you before using or disclosing PHI in a way that is not described in this Notice. You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.

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Uses and Disclosures with Neither Consent nor Authorization

We may use or disclose PHI without your consent or authorization in certain circumstances, including, but not limited to:

  • Child or At-Risk Adult Abuse: If we have reasonable cause to know or suspect that a child has been subjected to abuse or neglect or an at-risk adult has been mistreated, self-neglected, or financially exploited or is at imminent risk of mistreatment, self-neglect, or financial exploitation, then we must report this to the appropriate authorities.

  • Health Oversight Activities: If the New York state licensing board or an authorized professional review committee is reviewing my services, we may disclose PHI to that board or committee.

  • Judicial and Administrative Proceedings: If you are involved in a court proceeding where you are being evaluated for a third party or where the evaluation is court ordered, we may disclose PHI to the court. You will be informed in advance if this is the case.

  • Serious Threat to Health or Safety: If you communicate to me a serious threat of imminent physical violence against a specific person or persons, including those identifiable by association with a specific place, we have a duty to notify any person or persons specifically threatened, as well as a duty to protect by taking other appropriate action. If we believe that you are at imminent risk of inflicting serious harm on yourself, we may disclose information necessary to protect you. In either case, we may disclose information in order to initiate hospitalization.

  • Business Associates: We may enter into contracts with business associates to provide billing, legal, auditing, and practice management services that are outside entities. In those situations, protected health information will be provided to those contractors as is needed to perform their contracted tasks. Business associates are required to enter into an agreement maintaining the privacy of the protected health information released to them.

  • In Compliance with Other State/Federal Laws and Regulations: PHI may be disclosed when the use and disclosure is allowed under other sections of Section 164.512 of the Privacy Rule and the state’s confidentiality law. This includes certain narrowly-defined disclosures to law enforcement agencies, to a health oversight agency (such as HHS), to a medical examiner, for public health purposes relating to disease or FDA-regulated products, or for specialized government functions (fitness for military duties, eligibility for VA benefits, etc.)

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Terms of Notice of Privacy Practices

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The terms of this notice apply to all records containing your PHI that are created or retained by SACS. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that SACS has created or maintained in the past, and for any of your records created or maintained in the future. SACS is required to abide by the terms of this Notice and any amended notice that may follow. SACS reserves the right to change the terms of this notice and to make new Notice provisions for all PHI that it maintains. 

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