NOTICE OF PRIVACY POLICIES AND CLIENT RIGHTS
This notice describes how Indy Child Therapist, LLC (ICT) will use and disclose a client’s Protected Health Information (PHI) and the rights the client has regarding this PHI. You may print a copy of this notice or request one from Indy Child Therapist, LLC.
WHAT HEALTH INFORMATION IS PROTECTED
We are committed to protecting the privacy of information we gather about you while providing health related services. Some examples of protected health information are:
information indicating that you are a client receiving health related services from ICT
information about your health condition (such as a diagnosis you may have)
information about health care services you have received or may receive in the future
information about your health care benefits under an insurance plan
when combined with:
demographic information (such as your name, address, or insurance status);
unique numbers that may identify you (such as your social security number, your phone number, or your driver’s license number); or
other types of information that may identify who you are.
REQUIREMENT FOR WRITTEN AUTHORIZATION
We will obtain your written authorization before using your health information or sharing it with others outside of ICT , except as we describe in this Notice. Uses and disclosures of health information that require your written authorization include: most uses and disclosures of psychotherapy notes (where appropriate), most uses and disclosures of protected health information for marketing purposes, and disclosures that constitute a sale of protected health information.
Uses and disclosures of your protected health information by us not described in this Notice will be made only with your written authorization. If you provide us with written authorization, you may revoke that written authorization at any time, except to the extent that we have already relied upon it. To revoke a written authorization, please obtain an authorization revocation form from ICT. You may also initiate the transfer of your records to another person by completing a written authorization form.
HOW WE MAY USE & DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR WRITTEN AUTHORIZATION
There are some situations when we do not need your written authorization before using your health information or sharing it with others. They are:
Treatment, Payment, and Health Care Operations.
ICT may use your health care information or share it with others (including case consultations with other licensed professionals outside of ICT) in order to provide health care services to you, obtain payment for those services, and run ICT’s normal business operations. In some cases, we may also disclose your health information for payment activities and certain business operations of another health care provider or payor. Below are further examples of how your information may be used and disclosed for treatment, payment, and normal business operations without your written authorization.
Appointment Reminders and Treatment Alternatives, Benefits, and Services
In the course of providing treatment for you, we may use your health information to contact you about your health care services, case management, or to remind you about an appointment for treatment or services. We may also use your health information in order to recommend possible treatment alternatives or health related benefits, including making referrals to other providers.
Victims of Abuse, Neglect, or Domestic Violence
We may release your health information to a public health authority that is authorized to receive reports of abuse, neglect, or domestic violence.
To Avert a Serious and Imminent Threat to Health or Safety
We may use your health information or share it with others when necessary to prevent a serious and imminent threat to your health or safety, or the health or safety of another person or the public. In such cases we will only share your information with someone able to prevent the threat. We may also disclose your health information to law enforcement officers if you tell us that you participated in a violent crime that may have caused serious physical harm to another person, or if we determine that you escaped from lawful custody (such as a prison or mental health institution).
Business Associates
We may disclose your health information to contractors, agents, and other business associates who need the information in order to assist us with obtaining payment or carrying out our business operations. If we do disclose your health information to a business associate, we will have a written contract to ensure that our business associate protects the privacy of your health information.
Completely De-identified or Partially De-identified Information
We may use and disclose your health care information if we have removed any information that has the potential to identify you so that the health information is “completely de-identified.” We may also use and disclose “partially de-identified” health information about you if the person who will receive the information signs an agreement to protect the privacy of the information as required by federal and state law. Partially de-identified health information will not contain any information that would directly identify you (such as your name, street address, social security number, phone number, fax number, electronic mail address, website address, or license number).
Incidental Disclosures
While we will take reasonable steps to safeguard the privacy of your health information, certain disclosures of your health information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your health information. For example, during the course of treatment session, other Clients in the treatment area may see or overhear discussion of your health information.
Other disclosures may include for emergency treatment, as required by law, public health activities, lawsuits/disputes, to law enforcement, decedents, organ/tissue donations, research, workman’s compensation, and to authorized federal officials for national security reasons.
CLIENT’S RIGHTS
Clients can ask to see/get a copy of their health & claim records. Requests will be provided within 30 days.
Clients can ask for health and claim records if they need to be corrected or completed. Requests for changes to a claim can be denied in writing within 60 days,
Clients can request that they be contacted with confidential information in a specific way such as home or office, or an address different from their home address.
Clients can request ICT to limit the information that they share.
Clients can request a list of all disclosures for the past six years.
Clients can appoint a power of attorney or a legal guardian to make decisions about their personal health information.
Clients can file a complaint if their rights feel violated Clients can make complaints via mail, phone, or web. Mail: U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W., Washington, D.C. 20201, Phone: 1-877-696-6775, Web: www.hhs.gov/ocr/privacy/hipaa/complaints/
Clients have the right to be notified following a breach of unsecured PHI
To exercise your client rights, please contact:
Indy Child Therapist, LLC c/o Jessica Hood
7002 Graham Rd Ste. 211
Indianapolis, IN 46220
or via phone at 317-683-0031.