Confidentiality
& HIPAA
This notice describes how your Personal Health Information (PHI) may be used and disclosed. Please review it carefully.
My Pledge To You…
I understand that your health information is personal; I am committed to protecting your health information about
you. I create a record of the care and services you receive from me; I need this to provide you with quality care and to comply with legal and insurance requirements. This notice applies to all records of your care generated by me, as your mental health care provider. This notice will explain how I may use and disclose your health information. It also contains information about your rights regarding your health information and describes certain obligations I have regarding using and disclosing your health information.
You have the right to receive a paper copy of this notice.
I am required by law to:
- Protect your Protected Health Information (“PHI”).
- Give you this notice of my legal duties and privacy practices with respect to health information.
- Notify you that I can change the terms of this Notice, and that 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.
The Legal Stuff…
How I may use and disclose health information about you:
For Treatment Payment or Health Care Operations
Federal privacy rules (regulations) allow healthcare providers and insurers who have a direct treatment relationship with you, the patient/client, to use or disclose the PHI without a patient’s written authorization to carry out the healthcare provider’s treatment, payment, or healthcare operations. I may also disclose your protected health information for the treatment activities of any in-house healthcare provider(s).
Disclosures for Treatment Purposes Are Not Limited to the Minimum Necessary Standard
Therapists and other health care providers need access to the entire record and/or complete information 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 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 my child in response to a subpoena, discovery request, or another 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.
Specific Uses and Disclosures Require Your Authorization
- 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:- For my use in treating you.
- 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 a coroner who is performing duties authorized by law.
- Required to help avert a serious threat to the health and safety of others.
Specific 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:
- When disclosure is required by state or federal law, the use or disclosure complies with and is limited to the relevant requirements of such law.
- 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.
- For judicial and administrative proceedings, including responding to a court or administrative order – my preference is to obtain Authorization from you before doing so.
- For law enforcement purposes, including reporting crimes occurring on my premises.
- To coroners or medical examiners when such individuals perform duties authorized by law.
- For workers’ compensation purposes. Although my preference is to obtain Authorization from you, I may provide your PHI to comply with workers’ compensation laws.
- 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.
You Have the Following Rights Regarding Your PHI
- 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.
- 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 if the PHI pertains solely to a health care item or service you paid for out-of-pocket in full.
- The Right to See and obtain 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. Psychotherapy notes are considered the property of the therapist and may not be included in the release of records.
- The Right to Get a List of the Disclosures 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 for which you provided me with 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 may charge you a reasonable cost-based fee for each additional request.
- 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, you have the right to request that I correct the existing information or add the missing information, except for corrections to psychotherapy notes. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
Complaints
You may file appropriate complaints without fear of retaliation to Kenneth J Nelan, LPC, dba Counseling at Sacred Wandering (under Sacred Wandering), 10134 N Port Washington Rd, Suite G, Mequon, WI. 53092, 414-433-9193.
The Secretary of the U.S. Dept. of Health and Human Services also receives complaints about privacy violations. The HHS Office For Civil Rights (OCR) is responsible for enforcement and is intended to aid providers and others in complying with all pertinent regulations.
You may find more information at: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-forconsumers/index.html
