NOTICE OF PRIVACY PRACTICES

HOPE HARBOR THERAPY, LLC

104 S. 4th St.

Suite 206

Manhattan, KS 66502

(785) 347-5036

This Notice of Privacy Practices is effective as of 06/15/2023.

NOTICE OF PRIVACY PRACTICES

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

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. 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.

·       Let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

·       Not use or share your information other than as described here unless you tell me that I can in writing. If you tell me that I can, you may change your mind at any time. Let me know in writing if you change your mind.

·       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 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. For each category of uses or disclosures I will explain what I mean and try to give some examples. 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.

For Treatment:  I may use your personal health information to provide you with treatment. 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. I may give your health information to other doctors, nurses, technicians, medical students, or other staff personnel who are involved in taking care of you.  For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. Payment:  I may use and disclose your health information about the treatment you receive from me to bill and get payment from individuals, health plans, or other entities.  For example, we may give information to your health insurance plan about your treatment so that your plan will pay for your services.  However, if you pay out of pocket for your treatment and make a specific request that we not send information to your health plan, we will not send that information to your health plan except under certain circumstances.  I may also use and disclose your health information to obtain payment from third parties that may be responsible for the costs of your treatment, such as family members.

Health Care Operations: I may use and disclose your health information to operate my practice, improve your care, and contact you when necessary.  For example, I may use your health information to see how well I am doing in helping my clients (including investigation of complaints); to help reduce health care costs; to develop questionnaires and surveys; to help with care management; for training purposes; and to conduct cost management and business planning activities. I may disclose your health information to other health care providers and entities to assist in their health care operations under certain circumstances.

Business Associates:  I may disclose your health information to my contracted business associates in order to carry out specific tasks related to the Facility’s health care operations.  When I do this, the business associate agrees in the contract to protect your health information and to use and disclose such health information only to the extent the Facility would be able to do so.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1.     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. The opportunity to consent may be obtained retroactively in emergency situations.

2.     Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and most use or disclosure of such notes requires your Authorization.

3.     Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes. From time to time, I may use endorsements of clients for  marketing purposes. You will not be included without your express written authorization after review of the quotation provided to you for your review and approval.

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

IV. CERTAIN 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:

1.     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.

2.     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.

3.     For health oversight activities, including audits and investigations.

4.     For judicial and administrative proceedings, including responding to a court or administrative order.

5.     For law enforcement purposes, including reporting crimes occurring on my premises.

6.     To coroners or medical examiners, when such individuals are performing duties authorized by law.

7.     For research purposes, including studying and comparing the mental health of clients who received one form of therapy versus those who received another form of therapy for the same condition.

8.     Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.

9.     For workers’ compensation purposes.

10. 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. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1.     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.

2.     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.

3.     The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone), or to send mail to a different address, and I will agree to all reasonable requests.

4.     The Right to See and Get 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.

5.     The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for six years prior to the date you ask, who we shared it with, and why. 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 all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). If you request a list of disclosures, I will provide the list to you once every 12 months at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.

6.     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 from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.

7.     The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

8.     The Right to Choose Someone to Act for You.  If you have given someone a durable health care power of attorney that is currently in effect or if someone is your legal guardian, that person may exercise your rights and make choices about your health information.  I will make sure the person has this authority and can act for you before we take any action.

9.     File a Complaint If You Feel Your Rights Are Violated. You can file a complaint if you feel I have violated your rights by contacting me using the contact information on page 1. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. I will not retaliate against you for filing a complaint.