DAVE HARMON & ASSOCIATES, INC. - Notice of Privacy Practices - Effective January, 1, 1999
THIS NOTICE DESCRIBES HOW MEDICAL II\IFORMATION 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, please, contact our Privacy Officer/Clinical Director, whose name and telephone number is at the bottom of this two (2) page notice.
Our Duty to Safeguard Your Protected Health Information
Individually identifiable information about your past, present, and/or future health or condition, the provision of health care to you, or payment for the health ,care is considered "Protected Health Information (PH!"). We extend certain protections to your PHI and give you this Notice about our privacy practices that explain how, when and why we may use or disclose' your PHI. Except in specified circumstances, we must USE or disclose only the minimum necessary PHI to accomplish the purpose of the use of disclosure.
We follow the privacy practices described in this Notice. We reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, we will post a new Notice in our facilities.
,How We May Use and Disclose Your Protected Health Information.
We may use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHC for purposes of treatment, payment or operations. For uses beyond that, we must have your written authorization unless the law permits or requires us to make the use or disclosure without your authorization. If we disclose your- PHI to an outside entity in order for that entity to perform a function on our behalf, we must have in place an agreement from the outside entity that it will extend the same degree of privacy protection to your information, as we must apply to your PHI. However, the law provides that we are permitted to make some uses/disclosures without your consent or authorization. The following offers more description and examples of PHC or potential uses/disclosures of your PHI..
Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations. Generally, we may use or disclose your PHI as follows:
For Treatment: We may disclose your PHI to doctors, nurses, and other health care personnel who are involved in providing your health care. For example, your PHI will be shared among the staff members at Dave Harmon & Associates, Inc. Your PHI may also be shared with outside entities performing ancillary services relating to your treatment, for example for consultation purposes or other health agencies involved in provision and/or coordination of your care.
To Obtain Payment: We may use/disclose your PHI in order to bill and collect payment for your' health care services. For example, we may contact your ' employer and/or release portions of your PHI to the local Health Insurer/Third Party Mental Health Administrator, Private insurer, collection agency, etc., to get paid for services we, delivered to you.
For Health Care Operations: We may use/disclose your PHI in the course of operating your Mental Health, Substance Abuse, Sex Offender, Domestic Violence and Family or Children's Programs. For example, we may take your photograph for DNA Testing for identification purposes, use your PHI in evaluating the quality of services provided. or disclose your HPI to our accounting department Clr ,attorney for audit purposes. Appointment Reminders: Unless you provide us with alternative instructions we may call your phone numbers and send appointment reminders and other similar materials to your home.
Uses and Disclosures Requiring Authorization:
For uses and disclosures beyond treatment, payment and operations purposes we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below. Authorizations can be revoked any time to stop future use/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization.
Uses and Disclosures of PHI from Mental Health Records Not Requiring Consent or Authorization:
The law provides that we may use/disclose your PHI from mental health records without consent or authorization in the following circumstances:
When required by law: We may disclose your PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, or relating to suspected criminal activity, or in response to a court order. We must also disclose your PHI to authorities that monitor compliance with the privacy requirements.
For public health activities: We may disclose PHI when we are required to collect information about disease or' injury, or to report vital statistics to the public health authority.
For health oversight activities: We may disclose PHI for the protection and advocacy agency, or another agency responsible for monitoring the health CClre system for such purposes as reporting or investigation of unusual incidents.
Related to decedents: We may disclose a PHI, relating to an individual's death, to coroners upon request.
For research purposes: In certain circumstances and under supervision of the Clinical Director, we may disclose your PHI to researchers in order to assist with psychiatric/substance abuse research.
To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose your PHI as necessary to law enforcement or other person who can reasonably prevent 01' lessen the threat of harm.
For specific government functions: We may disclose I~HI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for nation security reasons, such as protection of the President.
Uses and Disclosure of your PHI from Alcohol and Other I)rug Records Not Requiring Consent or Authorization:
The law provides that we may use/disclose your PHI from alcohol and other drug records without consent or authorization in the following circumstances:
When required by law: We may disclose PHI when a law requires that we report information about suspected child abuse and neglect, or when a crime has been committed on the program permission or against program personnel, or in response to a court order.
Related to decedents: We may disclose PHI relating 1'0 an individual's death if state or federal law requires the information for collection of vital statistics or inquiry into cause of death.
For research purposes: In certain circumstances, and under supervision of the Clinical Directc1r, we may disclose PHI to researchers in order to assist with psychiatric/substance abuse research.
To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose: PHI to law enforcement when a threat is made to commit a crime on the program premises or against program personnel.
Uses and Disclosures Requiring You to have an Opportunity to Object:
In the following situations, we may disclose a limited amount of your PHI if we inform you about the disclosure in advance and you do not object, as long as the disclosure is not otherwise prohibited by law. However, if there is an emergency situation and you cannot be given your opportunity to object, disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interest. You must be informed and given an opportunity to object to further disclosure of your PHI as soon as you are able to do so.
To families, friends or other medical personnel involved in your care: We may share with these people information directly related to their involvement in your care or payment for your care. We may also share your PHI with these people to notify them about your location, general condition or death.
Your Rights: Regarding Your Protected Health Information:
You have the following rights relating to your protected health information:
To request on uses/disclosure: You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do agree to any restrictions on our PSI disclosure of your PHI, we will put the agreement in writing and abide by it except in emergency situations. We cannot agree to limit use/disclosures that are required by law.
To choose how we contact you: You have the right to ask that we send you information to an alternative address or by an alternative means. We must agree to your request as long as it is reasonably easy for us to do so.
To inspect and copy your PHI: Unless your access is restricted for clear and document treatment reasons, you have the: right to see your protected health information upon your written request. We will respond to your request within 30 days. If we deny your access, we will give you written reasons for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed, depending upon your circumstances. You have the right to choose what portions of your information you want copied and to have prior information on the cost of copying.
To request amendment of your PHI: If you believe that there is a mistake or missing information in our record of your PHI, you may request, in writing, that we correct or add to the record. We will respond within 60 days of receiving your request. We mal' deny the request if we determine that the PHI is: (i) correct and complete, (ii) not created by us and/or not part of our records, or; (iii) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request ,and denial, along with any statement in response to that you provide, appended to your PHI. If we approve the request for amendment, we will change the PHI and so inform you, and notify others that need to know about the changes in the PHI.
To find out what disclosures have been made: You have the right to get a list of when, to whom, for what purposes and what content of your PHI has been released other than instances of disclosure; for treatment, payment, and operations; to security purposes, to law enforcement officials or correctional facilities or before April 14, 2003. We will respond to your written request for such a list within 60 days of receiving it. Your request can relate to disclosures going as far back as six years. There will be: no charge for up to one such list each year. There may be a charge for more frequent requests.
To receive this notice: You have a right to receive a paper copy of this upon request.
How to Complain about our Privacy Practices:
If you feel we may have violated your privacy rights, or if you disagree with a decision we have made about access to your PHI, you have the right to file 11 complaint with the person listed below. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services at, 200 Independence Ave., SW Room 509F, HHH Building, Washington" D.C. 20201, 1-·800-368-1019. We will take no retaliatory action against you if you make such a complaint:.
The Contact Person for Information. or to Submit a Complaint:
If you have questions about this Notice or any complaints about our privacy practices, please contact: Dave or Margaret Harmon. Privacy Officers of Dave Harmon & Associates, Inc., 4010 Dupont Circle, Ste. 226, Louisville, KY 40207, 1-502-896-8006 or 1-502-377-7720.
Dave Harmon & Associates
4010 Dupont Circle #226
Louisville, Ky 40207-4847