Rights and Protections
PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW I, YOUR PROVIDER, MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. A copy of the full HIPAA Manual is available for on-site review upon your written request.
I. My RESPONSIBILITIES: I reserve the right to change this Notice of Privacy Practices and to make any new Notice of Privacy Practices effective for all protected health information that are maintained in accordance with A.R.S. § 12-2297 and all applicable federal and state guidelines. Any new Notice of Privacy Practices adopted will be posted at https://ironwoodcounseling.com and can be made available in the office, upon your request.
II. WHAT IS PROTECTED HEALTH INFORMATION (PHI)?
Protected health information ("PHI") is demographic and individually identifiable health information that will or may identify the patient and relates to the patient's past, present, or future physical or mental health or condition and related health care services.
III. USES AND DISCLOSURES OF INFORMATION
Under federal law, my business associates and I are permitted to use and disclose personal health information without authorization for treatment, payment, and health care operations (TPO).
IV. WHAT DOES "HEALTH CARE OPERATIONS" INCLUDE?
Health care operations include activities including communications among health care providers; conducting quality assessment, and improvement activities, evaluating the qualifications, competence, and performance of healthcare professionals; training future healthcare professionals; other related services that may be a benefit to you such as case management and care coordination; contracting with insurance companies; conducting medical review and auditing services; compiling and analyzing information in anticipation of, or for use in, legal proceedings; and general administrative and business functions.
V. HOW IS MEDICAL INFORMATION USED?
I use medical records as a way of recording health information, planning care and treatment, and as a tool for routine healthcare operations. Your insurance company may request information such as procedure and diagnosis information that I, as well as my business associates, are required to submit in order to bill for treatment I provide to the patient. Other health care providers or health plans reviewing your records must follow the same confidentiality laws and rules required of us. Patient records are a valuable tool used by researchers in finding the best possible treatment for diseases and medical conditions. All researchers must follow the same rules and laws that other health care providers are required to follow to ensure the privacy of patient information. Information that may identify patients will not be released for research purposes to anyone without written authorization from the patient or the patient's parent or legal guardian.
VI. HOW MEDICAL INFORMATION MAY BE USED FOR TREATMENT, PAYMENT, OR HEALTHCARE OPERATIONS
* Medical information may be used to justify needed patient care services, (i.e., lab tests, prescriptions, treatment protocols, research inclusion criteria).
* I will use medical information to establish a treatment plan.
* I may disclose protected health information to another provider for treatment (i.e. referring physicians, specialists, providers, therapists, etc.)
* My business associates and I may submit claims to your insurance company containing medical information, and we may contact their utilization review department to receive pre-certification (prior approval for treatment).
* My business associates and I will submit only the minimum amount of information necessary for this purpose.
* I may use the emergency contact information you provided to contact you if the address of record is no longer accurate.
* My business associates and I may contact you to remind you of your appointment by calling, emailing, or texting you.
* I may contact you to discuss treatment alternatives or other health related benefits that may be of interest.
VII. WHY DO I HAVE TO SIGN A CONSENT FORM?
When you, as the patient or guardian of a patient, sign a consent form, you are giving permission to use and disclose protected health information for the purposes of treatment, payment, and health care operations. This permission does not include psychotherapy notes, psychosocial information, alcoholism and drug abuse treatment records, and other privileged categories of information which require a separate authorization. A separate release of information (ROI) will need to be signed to have protected health information released for any reason other than treatment, payment, or healthcare operations, except as allowed or required by law.
VIII. WHAT ARE PSYCHOTHERAPY NOTES?
Psychotherapy notes are notes recorded (in any medium) by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session that are separated from the rest of the patient's medical record. Psychotherapy notes exclude medication prescription and monitoring, counseling session start and stop times, 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.
IX. WHAT IS PSYCHOSOCIAL INFORMATION?
Psychosocial information is information provided regarding your social history and counseling or psychiatric services you have received before treatment with me.
X. WHY DO I HAVE TO SIGN A SEPARATE AUTHORIZATION FORM?
In order to release patient protected health information for any reason other than treatment, payment, and health care operations, or other situations as allowed or required by law, I must have an authorization signed by the patient or the parent or guardian of the patient that clearly explains how they wish the information to be used and disclosed. The following are examples of releases of information that require a separate authorization; this is not an all-inclusive list:
* Psychosocial information
* Use of information in scientific and educational publications, presentations, and materials.
* Records requests for attorney (excepting as required by law), financial assistance, disability claims, etc.
* To ensure the tracking of the release of all records, I have a protocol in place with my business associates for the release of records. A release of information (ROI) will be required, and the standard process will be followed in all situations, including the release to the client or the parent/guardian.
* Payment assistance from clergy, or otherwise
XI. CAN I CHANGE MY MIND AND REVOKE AN AUTHORIZATION?
You may change your mind and revoke an authorization, except (1) to the extent that we have relied on the authorization up to that point, (2) the information is needed to maintain the integrity of the research study, or (3) if the authorization was obtained as a condition of obtaining insurance coverage. All requests to revoke an authorization should be in writing.
XII. SHARING INFORMATION WITH BUSINESS ASSOCIATES
There are some services provided through contracts with business associates. Examples include billing services and transcription services. When these services are contracted, we may disclose your health information to the business associate so they can perform the job we have contracted them to do. They are required to follow the same rules and laws that other health care providers are required to follow to ensure the privacy of patient information.
XIII. WHEN IS MY AUTHORIZATION/CONSENT NOT REQUIRED?
The law requires that some information may be disclosed without your authorization in the following circumstances:
* If there is good reason to believe you are threatening serious bodily harm to yourself or others. If I believe you are threatening serious bodily harm to another, I may be required to take protective actions, which may include notifying the potential victim, notifying the police, or seeking appropriate hospitalization. If a client threatens harm to him/herself or another, I may be required to seek hospitalization for the client, or to contact family members or others who can provide protection
* In case of an emergency
* When there are communication or language barriers
* When required by law
* When there are risks to public health
* To conduct health oversight activities
* To report suspected child abuse or neglect or abuse/neglect to other disabled persons
* To specified government regulatory agencies
* In connection with judicial or administrative proceedings
* For law enforcement purposes
* To coroners, funeral directors, and for organ donation
* In the event of a serious threat to health or safety
* To the extent necessary, to make a claim on a delinquent account via a collection agency.
* To the extent necessary for Treatment, Payment, Health Care Operations (TPO) with your insurance.
XIV. When Disclosure May be Required
* Disclosure may be required in a legal proceeding by or against you. If you place your mental status at issue in litigation initiated by you, the defendant may have the right to obtain the psychotherapy records and/or testimony by me. Additionally, in couples and family therapy, confidentiality and privilege do not apply between the couple or among family members, unless otherwise agreed upon. I will not release records to any outside party unless authorized to do so by all adult family members who are/were part of the treatment. In all situations, I will use my clinical judgment when sharing such information.
* There are times when I may find it beneficial to consult with colleagues as part of a peer-consultation practice for mutual professional consultation. Your name and unique identifying characteristics will not be disclosed. The consultant is also legally bound to keep the information confidential.
X. YOUR PRIVACY RIGHTS
The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
1. You have the right to inspect and copy your health information. This means you may inspect and obtain a copy of your PHI that is contained in a "designated record set" for as long as I maintain the PHI as required by law. A designated record set contains medical and billing records and any other records used in making decisions about your healthcare. I, with due cause, have the right to refuse you to inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and certain PHI that is subject to laws that prohibit access to that PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have the right to have this decision reviewed. Please contact me if you have questions about access to your medical record; this is not something my business associates can address.
2. You have the right to request a restriction of your health information. This means you may ask me to restrict or limit the medical information my business associates or I use or disclose for the purposes of treatment, payment, or healthcare operations. Please note that by doing so, claims may be denied. If we are unable to process your claim, or if it is denied, you will be responsible for payment in full, based on my fee for service rates listed in the FEES section of this agreement. We are not required to agree to a restriction that you may request. I will notify you if I deny your request. If I do agree to the requested restriction, I may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment, or as otherwise permitted by law. Requests for a restriction must be made in writing to me.
3. You have the right to request to receive confidential communications by alternative means or at alternative locations.
4. I will accommodate reasonable requests; however, my business associates and I may also condition this accommodation by asking you for an alternative address or other method of contact. We will not request an explanation from you as the basis for the request. Requests must be made in writing to me.
5. You have the right to request amendments to your health information. This means you may request an amendment of PHI about you in a designated record set for as long as I maintain this information. In certain cases, I may deny your request for an amendment. If I deny your request, you have the right to file a statement of disagreement with me; I may prepare a rebuttal to your statement and will provide you with a copy of this rebuttal. If you wish to amend your PHI, please contact me. Requests for amendment must be in writing.
6. You have the right to request an accounting of certain disclosures of your PHI. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Privacy Notice. I am not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, to family or friends involved in your care, or certain other disclosures I am permitted to make without your authorization. The request for an accounting must be made in writing to me. The request should specify the time period sought for the accounting. Accounting requests may not be made for periods of time in excess of six years or as otherwise designated by law. Please allow up to 30 days for this request to be completed.
7. You have the right to receive a paper copy of this Notice of Privacy Practices upon request.
XV. WHAT IF I HAVE A QUESTION/COMPLAINT?
If you have questions regarding your privacy rights, please contact me, your provider, at 480-988-5003. If you believe your privacy rights have been violated, you may file a WRITTEN complaint by contacting the practice's Privacy Officer at administrator@ironwoodcounseling.com, or the Arizona Department of Economic Security. You will not be penalized for filing a complaint.
Arizona Department of Economic Security
Division Privacy Officer
c/o Chief Privacy Officer
Department of Economic Security
1789 W. Jefferson Street
Mail Drop 1292
Phoenix, AZ 85005
Phone (480) 647-3108
FAX (602) 542-6000
InfoBreach@azdes.gov
https://des.az.gov/how-do-i/health-insurance-portability-and-accountability-act
https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html
https://des.az.gov/digital-library/hipaa-privacy-complaints form PPP-1063A.doc
https://des.az.gov/digital-library/hipaa-privacy-complaints