HIPAA Privacy Notice and Hope in Healing Counseling and Wellness, LLC Privacy Practices
This notice describes how Personal Health Information (PHI) about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Hope in Healing Counseling and Wellness, LLC (HHCW) has adopted this Privacy Practice Policy to comply with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) as amended by the Health Information Technology for Economic and Clinical Health Act (“HITECH Act”) and the Department of Health and Human Services (“DHHS”) security and privacy regulations as well as to fulfill my duty to protect the confidentiality, integrity, and availability of PHI as required by Minnesota State law, the Minnesota Board of Marriage and Family Therapy, and professional ethics. This notice describes your rights and how your PHI may be used and disclosed. The Privacy Rule also requires me to keep all PHI about you confidential; unless you sign a release of information or specified by rule or law.
Your Rights ~ When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You have the right to:
- Get an electronic or paper copy of your Medical Record/PHI (You can ask to see or get an electronic or paper copy of your medical record and other health information I have about you. Ask me how to do this.)
- I will provide a copy or a summary of your health information, usually within 30 days of your request.
- If you ask to see or receive a copy of your record for purposes of reviewing current medical care, I may not charge you a fee.
- If you request more than one copy or copies of your patient records of past medical care, or for certain appeals, I may charge you specified fees.
- Ask me to correct/amend your medical record:
- You can ask me to correct health information about you that you think is incorrect or incomplete. Ask me how to do this. I may say “no” to your request, but I will tell you why in writing within 60 days.
- Request confidential communications:
- You can ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address. I will say “yes” to all reasonable requests.
- Ask me to limit what I use or share:
- You can ask me not to use or share certain (PHI) for treatment, payment, or HHCW’s operations. I am not required to agree to your request, and I may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask me not to share that information for the purpose of payment or HHCW operations with your health insurer. I will say “yes” unless a law requires me to share that information. Minnesota Law requires consent for disclosure of treatment, payment, or operations information.
- Get a list of those with whom I have shared information:
- You can ask for a list (accounting) of the times I have shared your PHI (who I shared it with, and why) for the last six years.
- I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any disclosures you asked me to make). I will provide one accounting a year for free but will charge a reasonable cost-based fee if you ask for another one within 12 months.
- Get a copy of this privacy notice:
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
- File a complaint if you feel your rights are violated:
- You can complain if you feel I have violated your rights by contacting me.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting: www.hhs.gov/ocr/privacy/hipaa/complaints/
- If you would like to file a complaint, I will help you in this process. There will be no retaliation against you for filing a complaint.
Your Choices ~ For certain health information, you can tell me your choices about what I share. If you have a clear preference for how I share your information in the situations described below, talk to me. Tell me what you want me to do and I will follow your instructions.
- In these cases, you have both the right and choice to tell me to:
- Share information with your family, close friends, or others involved in your care (with a HHCW signed release of information).
- Share information in a disaster relief situation.
- If you are not able to tell me your preference, for example if you are unconscious, I may go ahead and share your information if I believe it is in your best interest. I may also share your information when needed to lessen a serious and imminent threat to health or safety.
I will never share without permission. In these cases I will never share your information unless you give me written permission:
- Marketing purposes.
- Sale of your information.
- Fundraising efforts.
- Most sharing of psychotherapy notes.
HHCW’s USES AND DISCLOSURES:
How do I typically use or share your PHI? I typically use or share your PHI in the following ways. (I need your consent before I disclose PHI for treatment, payment, and operations purposes, unless the disclosure is to a related entity, or the disclosure is for a medical emergency and I am unable to obtain your consent due to your condition or the nature of the medical emergency.)
- Treat you :
- I can use your health information and share it with other professionals who are treating you only if I have your consent. I can only release your PHI to health care facilities and providers outside my network with your consent. If it is an emergency and you are unable to provide consent due to the nature of the emergency, I may share your information. I may also share your health information with a provider in my network. For example: I may consult another psychotherapist about your overall treatment (with your written consent).
- Run my organization:
- I can use and share your PHI to run my practice, improve your care, and contact you when necessary. I am required to obtain your consent before I release your health records to other providers for their own health care operations.
- Bill for your services:
- I can use and share your PHI to bill and get payment from health plans/insurance or other entities only if I obtain your consent. Example: I will give information about you to your health insurance plan so it will pay for my services.
HOW ELSE CAN I USE OR SHARE YOUR PHI? I am allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. I have to meet many conditions in the law before I can share your information for these purposes.
- Help with public health and safety issues ~ I can share health information about you for certain situations such as:
- Preventing disease.
- Helping with product recalls.
- Reporting adverse reactions to medications.
- Reporting suspected abuse, neglect, or domestic violence.
- Preventing or reducing a serious threat to anyone’s health or safety.
- Do research ~ I can use or share your information for health research if you do not object.
- Comply with the law ~ I will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I am complying with federal privacy law.
- Respond to organ and tissue donation requests ~ I can share health information about you with organ procurement organizations only with your consent.
- Work with a medical examiner or coroner ~ I can share health information with a coroner, medical examiner when an individual dies. I need consent to share information with a funeral director.
- Address workers’ compensation, law enforcement, and other government requests ~ I can use or share health information about you:
- For workers’ compensation claims with your consent.
- For law enforcement purposes or with a law enforcement official with your consent unless required by law.
- With health oversight agencies for activities authorized by law.
- For special government functions such as military, national security, and presidential protective services with your consent, unless required by law.
- Respond to lawsuits and legal actions ~ I can share health information about you in response to a court or administrative order.
- Maintain privacy & security.
- I am required by law to maintain the privacy and security of your protected health information.
- Inform of breach:
- I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- Follow notice practices:
- I must follow the duties and privacy practices described in this notice and give you a copy of it. I will not use or share your information other than as described here unless give me written consent. If you tell me, you may change your mind at any time. Let me know in writing if you change your mind.
OTHER STATE LAWS ~ In Minnesota:
- I need your consent before I disclose protected health information for treatment, payment, and operations purposes, unless the disclosure is to a related entity, or the disclosure is for a medical emergency and I am unable to obtain your consent.
- I do not release substance abuse records without your written consent.
CHANGES TO THE TERMS OF THIS NOTICE:
- I can change the terms of this notice and the changes will apply to all information I have about you. The new notice will be available upon request in our office and on our web site: www.hopeinhealing.org
- Questions: If you have any questions about this notice, disagree with a decision about access to your records, or have other concerns about your privacy rights, please let me know.
Complaints: You may file a complaint with Stacy Nunne, MA, LMFT, SEP, RN.
HHCW’s Privacy Officer: Stacy Nunne MA, LMFT, SEP, RN 952-215-5208, PO Box 892, Chanhassen, MN 55317, e-mail: email@example.com. If you need assistance in filing a complaint, please let me know and I will assist you. Filing a complaint will not affect the quality of the services you receive and you will not be retaliated against for filing a complaint.
If you are not satisfied with the outcome of your complaint or if you wish to file a complaint outside of Hope in Healing Counseling and Wellness, LLC, you may file you complaint with the Department of Health and Human Services Office for Civil Rights: U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, Phone: 1-877-696-6775, http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html.
As a Licensed Marriage and Family Therapist in the State of Minnesota and a member of the American Association of Marriage and Family Therapy, it is the practice of Stacy Nunne, MA, LMFT, SEP, RN to adhere to more stringent privacy requirements for disclosures without an authorization.
This notice applies to:
Hope in Healing Counseling and Wellness, LLC, 600 West 78th Street, Suites 10A-C Chanhassen, MN 55317, PO Box 892, Chanhassen, MN 55317, Phone: 952-215-5208, Fax: 888-974-6441, e-mail: firstname.lastname@example.org, website: www.hopeinhealing.org. Effective date: (revised 11-15-17).
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html