THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Services and Programs We Provide
Origins Family Counseling is a healthcare practice involved in the provision of mental health, behavioral, and relationship counselingservices.
Our Pledge Regarding Health Information
We understand that health information about you and your health care is personal and are committed to protecting health information about you. Origins creates a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records related to your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information kept about you, as well as certain obligations we have regarding the use and disclosure of your health information. Origins is required by law to:
1. Make sure that protected health information (“PHI”) that identifies you is kept private.
2. Give you this notice of our legal duties and privacy practices with respect to health information.
3. Follow the terms of the notice that is currently in effect.
4. We 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 our office, and on our website
How We May Use and Disclose Health Information About You
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, each of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations:
Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. Origins 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. 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, for the purpose of assisting the clinician in diagnosis and treatment of your mental health condition.
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.
Public Safety
Health records may be released to certain agencies for the public interest and safety for public health activities, judicial and administrative proceedings, law enforcement purposes, serious threats to public safety, essential government functions, military, and when complying with worker’s compensation laws, law enforcement purposes, serious threats to public safety, essential government functions, military, and when complying with worker’s compensation laws. Please note that certain public safety concerns including National Security Investigations require that we produce records and are not allowed to notify you as the patient that the records were requested or provided.
Lawsuits and Disputes
If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order (subpoena). We 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. If your attorney or another attorney in a suit you are involved in sends a subpoena for records or court testimony, Origins attorney may take any of the following actions:
1. Review these requests to determine if a valid Authorization to Disclose PHI has been completed by the patient or patient’s legal representative and advise provider to obtain the necessary Authorizations of patient or patient’s legal representative is agreeable to this disclosure. Please note that in the case of children, a valid Authorization to Disclose PHI must be signed by all parents who have legal rights to consent to treatment.
2. Contact the attorney who issued the subpoena to notify them of Origin’s fee retainer and fees associated with court testimony and record production.
3. If it is determined that releasing the information or testifying would pose an imminent threat or danger to the patient, we would hire the services of our attorney to assist Origins in filing a motion to quash the subpoena.
Prenatal Exposure to Controlled Substances
Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful.
In the Event of a Client’s Death
In the event of a client’s death, the spouse or parents of a deceased client have a right to access their child’s or spouse’s records.
Professional Misconduct
Professional misconduct by a health care professional must be reported by other health care professionals. In cases in which a professional or legal disciplinary meeting is being held regarding the health care professional’s actions, related records may be released in order to substantiate disciplinary concerns.
Minors/Guardianship
Parents or legal guardians of non-emancipated minor clients have the right to access the client’s records.
Collection Activities
When payment for services are the responsibility of the client, or a person who has agreed to providing payment, and payment has not been made in a timely manner, collection agencies may be utilized in collecting unpaid debts. The specific content of the services (e.g., diagnosis, treatment plan, progress notes, testing) is not disclosed. If a debt remains unpaid it may be reported to credit agencies, and the client’s credit report may state the amount owed, the time frame, and the name of the clinic or collection source.
Telephone Contact
In the event in which the clinic or mental health professional must telephone the client for purposes such as appointment cancellations or reminders, or to give/receive other information, efforts are made to preserve confidentiality. Please notify us in writing where we may reach you by phone and how you would like us to identify ourselves. For example, you might request that when we phone you at home or work, we do not say the name of the clinic or the nature of the call, but rather the mental health professional’s first name only. If this information is not provided to us (below), we will adhere to the following procedure when making phone calls: First we will ask to speak to the client (or guardian) without identifying the name of the clinic. If the person answering the phone asks for more identifying information we will say that it is a personal call. We will not identify the clinic (to protect confidentiality). If we reach an answering machine or voice mail we will follow the same guidelines.
Appointment Reminders/Sharing of Mobile Data
1. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. Information sharing to subcontracts in support services, such as customer services is permitted. These customer service activities are limited to text appointment reminders sent through our third party text reminder service, Twilio and are initiated through our secure Electronic Health Record software, Insync.
2. Participation in text appointment reminders is optional and you may choose to opt out at any time by logging into your patient portal and indicating you do not wish to receive text appointment reminders. Additionally, you may contact our office at (317) 6494311and ask that you be removed from text appointment reminders if you prefer to speak to someone directly to have this feature removed from your account.
3. Messaging and data rates apply. Please see your unique mobile data and messaging plans for more details about costs of receiving text messages.
4. Text appointment reminders are sent 2 days prior to your scheduled appointments and frequency of messages will be dependent on how often you are scheduled for appointments.
5. Carriers are not liable for delayed or undelivered messages.
Your Rights
1. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that Origins has about you. We 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 you may be charged a reasonable, cost-based fee for doing so
2. You have the right to cancel a previously signed Authorization for Disclosure of PHI by providing us a written notice. If you desire to have your information sent to a location different than our address on file, you must provide this information in writing.
3. You have the right to request a list of instances in which Origins has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided Origins with an Authorization. Origins will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list Origins will give you will include disclosures made in the last six years unless you request a shorter time. Origins will provide the list to you at no charge, but if you make more than one request in the same year, Origins will charge you a reasonable cost-based fee for each additional request.
4. The Right to Choose How Origins Sends PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
5. 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.
6. You have the right to ask Origins not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and may say “no” if your provider believes it would affect your health care treatment 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 in full out-of-pocket.
7. 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 your provider correct the existing information or add the missing information. The provider may say “no” to your request, but will tell you why in writing within 60 days of receiving your request.
8. 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 email. And, even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it.
Uses and Disclosures Which Require Your Authorization
1. Psychotherapy Notes.
Some providers may keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501. These are private notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: Diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date. Disclosure of the contents of these notes to any party requires your Authorization unless the use or disclosure is:
a. For use in treating you.
b. For use in training or supervising mental health practitioners to help them improve their skills ingroup, joint, family, or individual counseling or therapy.
c. For use in defending provider in legal proceedings instituted by patient or patient’s representative.
d. For use by the Secretary of Health and Human Services to investigate provider’s compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law. representative.
h. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes:
Origins will not use or disclose your PHI for marketing purposes.
3. Sale of PHI
Origins will never sell your PHI.
4. Appointment reminders and Health Related Benefits or Services.
Origins may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer. You have the right to opt out of these reminders and notices by contacting the office at 317-649-4311 to request to opt out.
Uses and Disclosures Which 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, although our preference is to obtain an Authorization from you before doing so. (See Lawsuits and Disputes Section Above)
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. 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.
8. For workers’ compensation purposes. Although Origins will make every effort to obtain an Authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
Complaints
If you have any complaints or questions regarding these procedures, please contact our office at (317) 6494311. We will get back to you in a timely manner.