Psychological & Behavioral Consultants
Notice of Policies and Practices to Protect the Privacy of Your Health Information
THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Uses and Disclosures for Treatment, Payment and Health Care Operations
Your therapist may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
"PHI" refers to information in your health record that could identify you.
"Treatment, Payment, and Health Care Operations"
– Treatment is when your therapist provides, coordinates, or manages your health care and other services related to your health care. An example of treatment would be when your therapist consults with another health care provider, such as your family physician or another psychologist.
– Payment is when your therapist obtains reimbursement for your healthcare. Examples of payment are when your therapist discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
– Health Care Operations are activities that relate to the performance and operation of my practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
"Use" applies only to activities within my office such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
"Disclosure" applies to activities outside of my office, such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
Your therapist may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An "authorization" is written permission above and beyond the general consent that permits only specific disclosures. In those instances when your therapist is asked for information for purposes outside of treatment, payment or health care operations, your therapist will obtain an authorization from you before releasing this information. Your therapist will also need to obtain an authorization before releasing your Psychotherapy Notes. "Psychotherapy Notes" are notes your therapist has made about your conversation during a private, group, joint, or family counseling session, which your therapist has kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) your therapist has already relied upon and acted on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage. The law provides the insurer the right to contest the claim under the policy.
III. Uses and Disclosures with Neither Consent nor Authorization
Your therapist may use or disclose PHI without your consent or authorization in the following circumstances:
Health Oversight Activities – If your therapist receives a subpoena or other lawful request from the Department of Health or the Michigan Board of Psychology, your therapist must disclose the relevant PHI pursuant to that subpoena or lawful request.
Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment or the records thereof, such information is privileged under state law, and your therapist will not release information without your written authorization or a court order. The privilege does not apply when you are being evaluated, where the evaluation is court ordered. You will be informed in advance if this is the case.
Serious Threat to Health or Safety – If you communicate to your therapist a threat of physical violence against a reasonably identifiable third person and you have the apparent intent and ability to carry out that threat in the foreseeable future, your therapist may disclose relevant PHI and take the reasonable steps permitted by law to prevent the threatened harm from occurring. If your therapist believes that there is an imminent risk that you will inflict serious physical harm on yourself, your therapist may disclose information in order to protect you.
Worker’s Compensation – your therapist may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.
IV. Patient's Rights and Psychologist;s Duties
Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of PHI. However, your therapist is not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are in therapy. On your request, your therapist will send your bills to another address.)
Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in your therapist's mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Your therapist may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, your therapist will discuss with you the details of the request and denial process.
Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Your therapist may deny your request. On your request, your therapist will discuss with you the details of the amendment process.
Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, your therapist will discuss with you the details of the accounting process.
Right to a Paper Copy – You have the right to obtain a paper copy of this notice from your therapist upon request, even if you have agreed to receive the notice electronically.
Your therapist is required by law to maintain the privacy of PHI and to provide you with a notice of your therapist's legal duties and privacy practices with respect to PHI.
Your therapist reserves the right to change the privacy policies and practices described in this notice. Unless your therapist notifies you of such changes, however, your therapist is required to abide by the terms currently in effect.
If your therapist revises their policies and procedures, they will post a notice in their office to alert you to the revisions, and will make available to you a copy of the newly revised policies and procedures.
If you are concerned that your therapist has violated your privacy rights, or you disagree with a decision your therapist has made about access to your records, you may contact your therapist at their office, 2535 E. Mt. Hope Ave. Lansing, MI 48910-1913, or call them at (517-372-2535).
You may also send a written complaint to the Bureau of Health Services of Michigan, Complaint and Allegation Section, P.O. Box 30670, Lansing, MI 48909-8170. (517)241-2389.
This notice will go into effect on April 14, 2003.