PFCS Privacy
Notice Of Privacy Practices
This Notice describes how medical information about you may be used and disclosed by this agency. Medical information may include information about your physical health and/or mental health. This Notice also describes how you may get access to that information. Please review it carefully. You should read this Notice before signing the Consent for Treatment, Payment and Health Care Operations form.
I. Our Duty to Safeguard Your Protected Health Information
Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered "Protected Health Information" (PHI). We are required by law to protect your PHI. We are also required to give you this Notice, which explains 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 or disclosure.
We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, you may request a copy of the new notice from Personal & Family Counseling Services, and it will also be posted on our website at www.personal-family-counseling.com.
II. How We May Use and Disclose Your Protected Health Information
We use and disclose PHI for a variety of reasons. Listed below are some examples of when we would use or disclose your PHI, and whether or not your authorization is required.
Uses and Disclosures Requiring Authorization: For uses and disclosures regarding treatment and payment, we are required to have your written authorization. Like consents, you can revoke authorizations at any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization.
You have the following rights relating to your protected health information:
To request restrictions on uses/disclosures: 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. If we do agree to any restrictions on our use/disclosure of your PHI, we will put the agreement in writing and abide by it except in emergency situations. If your PHI is released in an emergency situation, we will request that the health care provider receiving the PHI not use it for any purpose other than to provide your emergency treatment.
We cannot agree to limit uses/disclosures that are required by law.
To inspect and copy your PHI: Unless your access is restricted for clear and documented treatment reasons, you have a right to see your PHI if you put your request in writing. Clear treatment reasons means that, in the counselor is professional judgment, access is reasonably likely to endanger the life or physical safety of the individual or another person. We will respond to your request within 30 days. If we deny 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 but may be waived, depending on your circumstances. You have a right to choose what portions of your information you want copied and to have prior information on the cost of copying. Portions of your PHI that may not be copied are psychotherapy notes, information prepared for legal proceedings or in response to legal orders, and/or information maintained by clinical laboratories (such as results of blood tests ordered by a physician to monitor levels of prescription medications).
To request amendment of your PHI: If you believe 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 may deny the request if we determine that the PHI is: correct and complete; not created by us and/or not part of our records, or; 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 that you provide, added to your PHI. If we approve the request for amendment, we will change the PHI and inform you and others who need to know about the change.
To find out what disclosures have been made: You have a right to get a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure for which you gave consent. The list also will not include any disclosures made for national 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. For additional lists, a charge for copying may be imposed but may be waived, depending on your circumstances.
To receive this notice: You have a right to receive a paper copy of this Notice and/or an electronic copy by email upon request.
IV. How to Complain about our Privacy Practices:
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the persons listed in Section V Below. You also may file a written complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201. PFCS will not intimidate, threaten, coerce, discriminate against, or take any other retaliatory action against any person who makes a complaint about suspected violations of the privacy rights of PFCS clients.
V. Contact Person for Information, or to Submit a Complaint:
If you have questions about this Notice, please contact Gregg Martini at (330) 343-8171, e-mail gmartini@pfcs1.org. If you have complaints about our privacy practices, please contact the Client Rights Officer, Pam Trimmer, LPCC, LSW at (330) 343-8171, e-mail ptrimmer@pfcs1.org.
VI. Effective Date: This Notice is effective beginning April 14, 2003.
I. Our Duty to Safeguard Your Protected Health Information
Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered "Protected Health Information" (PHI). We are required by law to protect your PHI. We are also required to give you this Notice, which explains 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 or disclosure.
We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, you may request a copy of the new notice from Personal & Family Counseling Services, and it will also be posted on our website at www.personal-family-counseling.com.
II. How We May Use and Disclose Your Protected Health Information
We use and disclose PHI for a variety of reasons. Listed below are some examples of when we would use or disclose your PHI, and whether or not your authorization is required.
Uses and Disclosures Requiring Authorization: For uses and disclosures regarding treatment and payment, we are required to have your written authorization. Like consents, you can revoke authorizations at any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization.
- For treatment: With your written authorization, we may disclose your PHI to other health care personnel who are involved in providing your health care.
- To obtain payment: With your written authorization, we may use/disclose your PHI in order to bill and collect payment for your health care services. For example, we would release portions of your PHI to Medicaid, Medicare, MACSIS, the local ADAMHS Board, and/or a private insurer to get paid for services that we delivered to you. If you choose to not give written authorization to release PHI to insurers or other third-party payers, you willingly accept responsibility for the total cost of all services provided.
- Appointment reminders: Unless you provide us with alternative instructions, we may send to your home appointment reminders and other materials related to your treatment at PFCS. Unless you provide us with alternative instructions, we may also leave messages on your home telephone answering machine or voicemail service.
- To choose how we contact you: You have the right to ask that we send you information at an alternative address or by an alternative means. We must agree to your request when we determine that it is reasonably easy for us to do so.
- Emergency Treatment: We may disclose your PHI if needed for emergency treatment if it is not reasonably possible to obtain your consent prior to the disclosure and we think that you would give consent if able.
- When required by law: We may disclose 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 PHI to authorities that monitor compliance with these 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 to another agency, such as the ADAMHS Board, responsible for monitoring the health care system for such purposes as reporting or investigating major unusual incidents.
- Relating to decedents: In the event of your death, PFCS may disclose PHI to coroners, medical examiners or funeral directors.
- To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.
- For specific government functions: We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for national security reasons, such as protection of the President.
- For health care operations: We may use/disclose your PHI in the course of operating Personal & Family Counseling Services. For example, we may use your PHI to evaluate the quality of services we provide, or disclose your PHI to our accountant or attorney for audit or legal purposes.
- Uses and Disclosures Requiring You to have an Opportunity to Object: In certain situations, we may disclose your PHI if we inform you about the disclosures in advance and you do not object. However, if there is an emergency situation and you cannot be given an opportunity to object, disclosure may be made if it is consistent with your prior expressed wishes and disclosure is determined to be in your best interests. You must be informed and given an opportunity to object to further disclosure as soon as you are able to do so.
You have the following rights relating to your protected health information:
To request restrictions on uses/disclosures: 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. If we do agree to any restrictions on our use/disclosure of your PHI, we will put the agreement in writing and abide by it except in emergency situations. If your PHI is released in an emergency situation, we will request that the health care provider receiving the PHI not use it for any purpose other than to provide your emergency treatment.
We cannot agree to limit uses/disclosures that are required by law.
To inspect and copy your PHI: Unless your access is restricted for clear and documented treatment reasons, you have a right to see your PHI if you put your request in writing. Clear treatment reasons means that, in the counselor is professional judgment, access is reasonably likely to endanger the life or physical safety of the individual or another person. We will respond to your request within 30 days. If we deny 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 but may be waived, depending on your circumstances. You have a right to choose what portions of your information you want copied and to have prior information on the cost of copying. Portions of your PHI that may not be copied are psychotherapy notes, information prepared for legal proceedings or in response to legal orders, and/or information maintained by clinical laboratories (such as results of blood tests ordered by a physician to monitor levels of prescription medications).
To request amendment of your PHI: If you believe 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 may deny the request if we determine that the PHI is: correct and complete; not created by us and/or not part of our records, or; 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 that you provide, added to your PHI. If we approve the request for amendment, we will change the PHI and inform you and others who need to know about the change.
To find out what disclosures have been made: You have a right to get a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure for which you gave consent. The list also will not include any disclosures made for national 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. For additional lists, a charge for copying may be imposed but may be waived, depending on your circumstances.
To receive this notice: You have a right to receive a paper copy of this Notice and/or an electronic copy by email upon request.
IV. How to Complain about our Privacy Practices:
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the persons listed in Section V Below. You also may file a written complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201. PFCS will not intimidate, threaten, coerce, discriminate against, or take any other retaliatory action against any person who makes a complaint about suspected violations of the privacy rights of PFCS clients.
V. Contact Person for Information, or to Submit a Complaint:
If you have questions about this Notice, please contact Gregg Martini at (330) 343-8171, e-mail gmartini@pfcs1.org. If you have complaints about our privacy practices, please contact the Client Rights Officer, Pam Trimmer, LPCC, LSW at (330) 343-8171, e-mail ptrimmer@pfcs1.org.
VI. Effective Date: This Notice is effective beginning April 14, 2003.