Notice of Privacy Practices | Protect Your Privacy Today

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Uses and Disclosures of Protected Health Information (PHI)

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(Becic Counseling Services, LLC). 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. I use a secure, encrypted, and HIPAA compliant platform(SimplePractice) for the storage and transmissions of ePHI, as well as a HIPAA compliant fax service(Faxage) and Phone system(RingCentral) for communications outside of platform.
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 am also required by law to provide you with adequate notice of your rights and my legal duties if I create or maintain records protected by 42 C.F.R. Part 2.
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. 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.

I may use or disclose your PHI for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, the following are some definitions:

· PHI – information in your health record that could identify you

· Treatment – when I provide, coordinate and manage your health care and other services related to your health care

· Payment – when I obtain reimbursement for your health care.

· Health care operations – activities that relate to the performance and operation of Becic Counseling Services, LLC.

· Use – activities within my practice such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. I share an office with other providers and may at times, employ support staff. In those cases when I may employ a support staff, I may need to share information for purposes such as billing, scheduling, and quality assurance. All professionals and staff are bound by the same rules of confidentiality and have training in privacy rules and have agreed not to release any information outside of the practice without permission of a professional staff member.

· If your records are protected under 42 C.F.R. Part 2, certain uses and disclosures permitted by HIPAA for treatment, payment, and health care operations are materially limited by the stricter standards of those regulations. Furthermore, information disclosed pursuant to these rules may be subject to redisclosure by the recipient and may no longer be protected by federal privacy standards.

· Disclosure – activities outside of my offices, such as releasing, transferring or providing access to information about you to other parties. I may find it helpful to share information with your primary care physician or other health and mental health professionals who are currently treating you. Your signature on this agreement is written, advance consent for me to release information to these professionals. A record of these disclosures will be kept in your clinical record. 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. Other professionals are also legally bound to keep the information confidential. Please let me know if you would prefer that I do not consult with other mental health professionals about your case.

· 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. USES AND DISCLOSURES REQUIRING AUTHORIZATION

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when authorization is obtained. An authorization is written permission above and beyond the general consent that permits only specific disclosures. In those instances when I am asked for information for purposes outside of treatment, payment and health care operations, I will obtain an authorization from you before releasing this information.

Psychotherapy Notes. I will also need to obtain a separate authorization before we can release your “psychotherapy notes”. “Psychotherapy notes” are notes I have made about our conversations during private, group, joint or family counseling sessions, which I have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke all authorizations (of PHI or psychotherapy notes) at any time, provided that you are aware that the cancellation does not include any disclosures occurring prior to the date of revocation. 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:

For my use in treating you.

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.

For my use in defending myself in legal proceedings instituted by you.

For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

Required by law and the use or disclosure is limited to the requirements of such law.

Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

Required by a coroner who is performing duties authorized by law.

Required to help avert a serious threat to the health and safety of others.

Becic Counseling Services, LLC reserves the right to change the terms of this notice and to make new provisions effective for all PHI that is maintained. We will provide you with a revised notice by sharing the revisions with you. You may not revoke an authorization to the extent that (1) We have relied on that authorization or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under policy.

Substance Use Disorder (SUD) Counseling Notes. I may also maintain “SUD counseling notes,” which are notes recorded by a substance use disorder provider documenting the contents of a counseling session. Any use or disclosure of these notes requires your separate written authorization, which cannot be combined with a consent for other types of records. You can revoke your consent at any time except to the extent that I have already acted upon it to disclose these notes in accordance with your initial authorization.

Marketing Purposes: As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

Sale of PHI: As a psychotherapist, I will not sell your PHI in the regular course of my business.

IV. USES AND DISCLOSURES WITH NEITHER CONSENT OR AUTHORIZATION

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

Child Abuse.

If I know or suspect that a child under 18 or a cognitively impaired, developmentally disabled or physically impaired person under 21 has suffered or faces threat of suffering any physical or mental harm or condition of a nature that reasonably indicates abuse or neglect. Under these circumstances, I am required by law to report that knowledge or suspicion to the appropriate(Oregon or Idaho) Department of Health and Welfare or local police.

Elder/Dependent Adult Abuse.

If I have reasonable cause to believe that the elder/dependent adult is being abused, neglected or exploited, or is in a condition which is the result of aforementioned, I am required by law to immediately report such belief to the appropriate(Oregon or Idaho)Department of Health and Welfare Adult Protection Agency.

Judicial or Administrative Proceedings.

If you are involved in a court proceeding and a request is made for information concerning evaluation, diagnosis or treatment, such information is protected by counselor – client privilege. I cannot provide any information without you or your legal representative’s written consent. However, if I am court-ordered to disclose information, I am required to provide it. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would likely order me to disclose information.

Serious Threat to Health/Safety.

If I believe you pose a clear and substantial risk of imminent serious harm to yourself or someone else, I may disclose relevant confidential information to public authorities, the potential victim, other professions, and/or your family to protect against such harm. If you communicate an explicit threat of serious harm to yourself or others, and I believe you have the intent and ability, then I are required by law to: 1) take steps to hospitalize you on an emergency basis, 2) establish and undertake a treatment plan to eliminate the possibility that you will carry out the threat and initiate consultation for a second opinion risk assessment with another mental health professional, 3) communicate to a law enforcement agency and, if feasible, to the potential victim(s) or victim’s parent or guardian if a minor, all of the following information: a) nature of the threat, b)your identity, and c) the identity of the potential victim(s).

Worker’s Compensation.

If you file a worker’s compensation claim, I may be required to give your mental health information to relevant parties and officials.

If the Client Is a Minor.

Both parents have access to the minor client’s complete clinical record, including counseling notes, unless there is a court order prohibiting one of the parents from access. This does not apply to a minor in Oregon who is a minimum of 14 years of age and therefore does not need parental consent for treatment.

Government Agency Request (i.e. Medicaid).

At times, I may be required to provide information for health oversight activities in order to fulfill the requirements of Medicaid.

If a Client Files a Complaint or Lawsuit.

Becic Counseling Services may disclose relevant information regarding that patient in order to defend itself.

Presenting Disguised Material in Seminars, Classes, Scientific Writings.

In this situation all identifying information and PHI is removed and client anonymity is maintained.

10.

Your Health Insurance Plan.

Your carrier has the right to review your clinical records for any services you’ve asked them to pay for. Unless treatment is being paid for by a Workers Compensation plan, a health insurance company is

not entitled to see psychotherapy notes, which are detailed notes we may make concerning what has been discussed in therapy. However, they are entitled to see PHI in your clinical record, including information about session dates, symptoms, diagnosis, overall progress toward goals, past treatment records from other providers, billing records and any reports that have been sent or received on your behalf.

11.

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.

12.

Per OBLPCT rules, I have a Custodian of Record who is a Licensed Attorney in Oregon and Idaho who is responsible for contacting you if something happens to me (illness or death). This attorney does not have ongoing access to your file, but will have access to your name, phone number, and email should something happen to me.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

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 (via Release of Information form, or ROI). The opportunity to consent may be obtained retroactively in emergency situations.

VI. CLIENT’S RIGHTS

Right to Request Restrictions.

You have the right to request restrictions on certain uses and disclosures of PHI about you. However, we are not required to agree to a restriction you request.

Right to Receive Confidential Communication by Alternative Means and Locations.

You have the right to request and receive confidential communication of PHI by alternate means and locations (i.e. if you don’t want family to know you are seeing a counselor, you can have bills sent to an alternate address).

Right to Inspect and Copy.

Other than “psychotherapy notes,” You have the right to inspect and/or obtain a copy of you or your minor child’s PHI and counseling notes in your counselor’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. There will be a charge for records returned from offsite locations and copies made.

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 counselor may deny your request.

Right to an Accounting.

You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization.

Right to a Paper Copy.

You have the right to obtain a paper copy of the Privacy Notice from your counselor upon request, even if you agreed to receive the Notice electronically.

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.

VII. COUNSELORS DUTIES

1. I am required by law to maintain the privacy of PHI and to provide you notice of our legal duties and privacy practices with respect to PHI.

2. Becic Counseling Services, LLC will comply with all state laws (Oregon and Idaho), where a state law offers more rigorous protection for Protected Health Information (PHI) than HIPAA, the state law will prevail.

3. I reserve the right to change privacy policies and practices described here. It is our duty to notify you of such changes.

4. If I revise our policies and procedures, I will make you aware of them for you to inspect.

VIII. COMPLAINTS

Complaints should first be addressed with Becic Counseling Services, LLC. However, if you are concerned that we have violated your privacy rights or you disagree with a decision I have made about access to your records, you may contact the appropriate Department of Occupational Licenses.

Uses and Disclosures of Protected Health Information (PHI)

Becic Counseling Services

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