Many Pathways Counseling PLLC
Phone: 331-210-1005
Email: callmytherapist@outlook.com
EFFECTIVE DATE OF THIS NOTICE This notice went into effect on
6/10/2022
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION:
I understand that health information about you and your health care is
personal. I am committed to protecting health information about you. I create a
record of the care and services you receive from me. I need this record to
provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care
generated by this mental health care practice. This notice will tell you about
the ways in which I may use and disclose health information about you. I also
describe your rights to the health information I keep about you,
and describe certain obligations I have regarding the use and disclosure
of your health information. I am required by law to:
•
Make sure that protected health information
(“PHI”) that identifies you is kept private.
•
Give you this notice of my legal duties and
privacy practices with respect to health information.
•
Follow the terms of the notice that is currently
in effect.
•
I can change the terms of this Notice, and such
changes will apply to all information I have about you. The new Notice will be
available upon request, in my office, and on my website.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that I use and disclose health
information. For each category of uses or disclosures I will explain what I
mean and try to give some examples. Not every use or disclosure in a category
will be listed. However, all of the ways I am
permitted to use and disclose information will fall within one of the
categories.
For Treatment Payment, or Health Care Operations: Federal
privacy rules (regulations) allow health care providers who have direct
treatment relationship with the patient/client to use or disclose the
patient/client’s personal health information without the patient’s written
authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your
protected health information for the treatment activities of any health care
provider. This too can be done without your written authorization. For example,
if a clinician were 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 the clinician in diagnosis and treatment of your mental health
condition.
Disclosures for treatment purposes are not limited to the
minimum necessary standard. Because therapists 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
providers with a third party, consultations between health care providers and
referrals of a patient for health care from one health care provider to
another.
Lawsuits and Disputes: If you are involved in a lawsuit, I
may disclose health information in response to a court or administrative order.
I may also disclose health information about your child in response to a
subpoena, discovery request, or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you about the
request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1. Psychotherapy
Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR §
164.501, and any use or disclosure of such notes requires your Authorization
unless the use or disclosure is:
a. For my use in treating you.
b. For my use in training or supervising mental health practitioners to help
them improve their skills in group, joint, family, or individual counseling or
therapy.
c. For my use in defending myself in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate my
compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of
such law.
f. Required by law for certain health oversight activities pertaining to the
originator of the psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.
2. Marketing
Purposes. As a psychotherapist, I will not use or disclose your PHI for
marketing purposes.
3. Sale
of PHI. As a psychotherapist, I will not sell your PHI in the regular course of
my business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR
AUTHORIZATION.
Subject to certain limitations in the law, I can use and disclose your PHI
without your Authorization for the following reasons:
1.
When disclosure is required by state or federal
law, and the use or disclosure complies with and is limited to the relevant
requirements of such law.
2.
For public health activities, including
reporting suspected child, elder, or dependent adult abuse, or preventing or
reducing a serious threat to anyone’s health or safety.
3.
For health oversight activities, including
audits and investigations.
4.
For judicial and administrative proceedings,
including responding to a court or administrative order, although my preference
is to obtain an Authorization from you before doing so.
5.
For law enforcement purposes, including
reporting crimes occurring on my premises.
6.
To coroners or medical examiners, when such
individuals are performing duties authorized by law.
7.
For research purposes, including studying and
comparing the mental health of patients who received one form of therapy versus
those who received another form of therapy for the same condition.
8.
Specialized government functions, including,
ensuring the proper execution of military missions; protecting the President of
the United States; conducting intelligence or counter-intelligence operations;
or, helping to ensure the safety of those working within or housed in
correctional institutions.
9. For
workers’ compensation purposes. Although my preference is to obtain an
Authorization from you, I may provide your PHI in order to
comply with workers’ compensation laws.
10 Appointment reminders and health related benefits or services. I may use and
disclose your PHI to contact you to remind you that you have an appointment
with me. I may also use and disclose your PHI to tell you about treatment
alternatives, or other health care services or benefits that I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE
OPPORTUNITY TO OBJECT.
1. Disclosures
to family, friends, or others. I may provide your PHI to a family member,
friend, or other person that you indicate is involved in your care or the
payment for your health care, unless you object in whole or in part. The
opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1.
The Right to Request Limits on Uses and
Disclosures of Your PHI. You have the right to ask me not to use or disclose
certain PHI for treatment, payment, or health care operations purposes. I am
not required to agree to your request, and I may say “no” if I believe it would affect your health care.
2.
The Right to Request Restrictions for
Out-of-Pocket Expenses Paid for In Full. You have the right to request
restrictions on disclosures of your PHI to health plans for payment or health
care operations purposes if the PHI pertains solely to a health care item or a
health care service that you have paid for out-of-pocket in full.
3.
The Right to Choose How I Send PHI to You. You
have the right to ask me to contact you in a specific way (for example, home or
office phone) or to send mail to a different address, and I will agree to all
reasonable requests.
4.
The Right to See and Get Copies of Your PHI.
Other than “psychotherapy notes,” you have the right to get an electronic or
paper copy of your medical record and other information that I have about you.
I will provide you with a copy of your record, or a summary of it, if you agree
to receive a summary, within 30 days of receiving your written request, and I
may charge a reasonable, cost based fee for doing so.
5.
The Right to Get a List of the Disclosures I
Have Made.You have the right to request a list of
instances in which I have disclosed your PHI for purposes other than treatment,
payment, or health care operations, or for which you provided me with an
Authorization. I will respond to your request for an accounting of disclosures
within 60 days of receiving your request. The list I will give you will include
disclosures made in the last six years unless you request a shorter time. I
will provide the list to you at no charge, but if you make more than one
request in the same year, I will charge you a reasonable cost
based fee for each additional request.
6.
The Right to Correct or Update Your PHI. If you
believe that there is a mistake in your PHI, or that a piece of important
information is missing from your PHI, you have the right to request that I
correct the existing information or add the missing information. I may say “no”
to your request, but I will tell you why in writing within 60 days of receiving
your request.
7. The
Right to Get a Paper or Electronic Copy of this Notice. You have the right get
a paper copy of this Notice, and you have the right to get a copy of this
notice by e-mail. And, even if you have agreed to receive this Notice via
e-mail, you also have the right to request a paper copy of it.