NEBRASKA MENTAL HEALTH
CENTERS P. C.
Notice of Policies and
Practices to Protect the Privacy of Our Patient’s 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.
We 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 we provide, coordinate or manage your health care and other services
related to your health care. An example of treatment would be when we consult
with another health care provider, such as your family physician or another
psychologist.
- Payment
is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose 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
our [office, clinic, practice group, etc.], such as sharing, employing,
applying, utilizing, examining, and analyzing information that identifies you.
·
“Disclosure” applies to activities
outside of our [office, clinic, practice group, etc.], such as releasing,
transferring, or providing access to information about you to other parties.
We
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 we
are asked for information for purposes outside of treatment, payment or health
care operations, we will obtain an authorization from you before releasing this
information. We will also need to
obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes we have
made about our conversation during a private, group, joint, or family
counseling session, which we 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 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) 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 the policy.
We
may use or disclose PHI without your consent or authorization in the following
circumstances:
·
Child Abuse – When we have reasonable cause to
believe that a child has been subjected to abuse or neglect, or if we observe a
child being subjected to conditions which would reasonably result in abuse or
neglect, we must report this to the proper law enforcement agency or to the
Nebraska Department of Health and Human Services.
·
Adult and Domestic Abuse – When we have reasonable cause to
believe that a vulnerable adult has been subjected to abuse or if we observe
such an adult being subjected to conditions which would reasonably result in
abuse, we must report this to the appropriate law enforcement agency or the
Nebraska Department of Health and Human Services.
“Vulnerable
adult” shall mean any person
eighteen years of age or older who has a substantial mental or functional
impairment or for whom a guardian has been appointed under the Nebraska Probate
Code
·
Health Oversight Activities – For the purpose of any investigation,
the Director of Health and Human Services or the Director of Regulation and
Licensure (the board which licenses us to practice) may subpoena relevant
records from us.
·
Judicial and Administrative Proceedings – If you are involved in a court
proceeding and a request is made for information about your diagnosis and
treatment and the records thereof, such information is privileged under state
law, and we will not release information without the written authorization from
you or your personal or legally-appointed representative, or a court order. The
privilege does not apply when you are being evaluated for a third party (e.g.
state agency) or where the evaluation is court-ordered. We will inform you in advance if this is the
case.
·
Serious Threat to Health or Safety – If you communicate to us a serious
threat of physical violence against a reasonably identifiable victim or
victims, we must communicate such threat to the victim or victims and to a law
enforcement agency.
·
Worker’s Compensation – If you file a worker’s compensation
claim, we must, on demand, make available records relevant to that claim to
your employer, the insurance carrier, the worker’s compensation court, and to
you.
Patient's
Rights:
·
Right to Request Restrictions –You have the right to request
restrictions on certain uses and disclosures of protected health
information. However, we are 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 seeing us. On your
request, we 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 and psychotherapy notes in our mental health and
billing records used to make decisions about you for as long as the PHI is
maintained in the record. We may deny your access to PHI under certain
circumstances, but in all cases, you may have this decision reviewed. On your
request, we 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. We may
deny your request. On your request, we
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 for which you have neither provided
consent nor authorization (as described in Section III of this Notice). On your request, we will discuss with you
the details of the accounting process. (as of April 14, 2003)
·
Right to a Paper Copy – You have the right to obtain a paper
copy of the notice from me upon request, even if you have agreed to receive the
notice electronically.
Psychologist’s
Duties:
·
We are
required by law to maintain the privacy of PHI and to provide you with a notice
of our legal duties and privacy practices with respect to PHI.
·
We reserve
the right to change the privacy policies and practices described in this
notice. Unless we notify you of such changes, however, we are required to abide
by the terms currently in effect.
·
If we
revise our policies and procedures, we will notify you by U.S. mail.
If you are
concerned that we have violated your privacy rights, or you disagree with a
decision we made about access to your records, you may contact Kelly Prather,
Practice Administrator at 402-483-6990.
You may also
send a written complaint to the Secretary of the U.S. Department of Health and
Human Services. The person listed above
can provide you with the appropriate address upon request.
This notice will
go into effect on 4-14-03
We reserve the
right to change the terms of this notice and to make the new notice provisions
effective for all PHI that we maintain.
We will provide you with a revised notice by U.S. mail and on our
website at www.nmhc-clinics.com.