45 E. Vine Street♦Murray, UT 84107♦Phone: 801-266-4643♦Fax: 801-266-4775
These are your HIPAA rights, please take with you if you would like Notice of Privacy Practice
Effective February 1, 2011
This Notice describes how Health Information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
4 Healing Center and Animals 4 Healing (hereafter referenced as “The Companies”) are dedicated to maintaining the privacy of your personal health information, and your therapist will follow strict Federal and State laws and ethical guidelines to maintain your confidentiality. After you have read this Notice of Privacy Practice, please sign the accompanying Receipt and Acknowledgement of Notice form located on the Client Information page.
HOW THE COMPANIES WILL USE YOUR PROTECTED HEALTH INFORMATION (PHI).
When you participate in psychotherapy, your therapist may use your health information for treatment, to bill for payment of services, and conduct normal business functions known as healthcare operations.
Examples of how your therapist will use your information include:
• TREATMENT: Your therapist will keep records of the care and treatment provided to you to deliver quality of care.
• PAYMENT: Your therapist will keep billing records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment from you, your insurance company, or other third party. Your therapist may also contact your insurance company to verify coverage for your care or to obtain pre-approval or authorization of services.
• HEALTH CARE OPERATIONS: Your therapist will use health information to conduct required business duties such as scheduling appointments and other administrative functions to improve the quality of my care.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
The Health Insurance Portability and Accountability of Act demands that all HIPAA covered businesses prevent unauthorized access to “Protected Health Information” or PHI. PHI includes patients’ names, addresses, and all information pertaining to the patients’ health and payment records. According to the Department of Health and Human Services, “HIPAA Rules apply to covered entities and business associates.” Complete compliance with HIPAA guidelines requires implementation of basic and advanced security measures. Basic security includes benchmark-based password creation and use, personnel education and training, limited access to PHI, data encryption, use of firewalls, antivirus software, and digital signatures. With increasing adoption of electronic medical records and cloud-based software-as-service (SaaS), advanced security measures are necessary.
You have the right to:
– Request that your therapist uses a specific telephone number or address to communicate with you.
– Request restrictions on how your therapist will use and share your health information (PHI). Your therapist will consider all requests for restrictions carefully but is not required to agree to any restriction.
– Inspect and copy your PHI, including health information and billing records. Fees may apply. Under limited circumstances, your therapist may deny you access to a portion of your health information and you may request a review of the denial. **
– Request corrections and/or amendments to your health information. **
– File a complaint if you believe your privacy rights have been violated. **
– Obtain a written copy of this notice and additional information about my privacy practices.
– Request an accounting of certain disclosures of your health information made by us. The accounting does not include disclosures made for treatment, payment, and healthcare operations and disclosures required by law. **
– Request that any employee of The Companies communicate with you through use of a phone and/or SMS text messaging. Please be aware that phones, voicemails, and SMS messaging are inherently non-secure and noncompliant with safety and privacy regulations under HIPAA. Messages containing electronic protected health information (ePHI) can be read by anyone, forwarded to anyone remain unencrypted on telecommunication providers’ servers, and stay forever on sender’s and receiver’s phones. In addition, senders cannot authenticate the recipient of phone calls, voicemails, SMS messages (i.e. senders cannot be certain that the message has been sent to and opened by the right person). Phone calls cannot be guaranteed to be secure because it is unknown if they are only between the intended people and not recorded. **
– Request that any employee of The Companies communicate with you through e-mail. The Companies e-mails are secured through Microsoft in order to provide an additional layer of online safety by offering HIPAA compliant security for users of The Companies. Please keep in mind, even with any added security, that communications via email may not be secure. Although it is unlikely, there is a possibility that information you include is an email can be intercepted and read by other parties besides the person to whom it is addressed. **
MY RESPONSIBILITIES REGARDING YOUR PRIVACY
– Provide this notice that describes the ways that your therapist may use and share your PHI.
– Maintain the privacy of your Protected Health Information.
– Follow the terms of this notice as currently in effect.
Your therapist reserves the right to make changes to this notice at any time and make the new privacy practices effective for all information your therapist maintains. Current notices will be posted at The Companies and you may ask your therapist for a copy.
SHARING YOUR HEALTH INFORMATION
There are limited situations when your therapist is required or permitted to disclose health information without your signed authorization. These situations include:
– To protect victims of abuse, neglect or domestic violence.
– To prevent serious threats to public health or safety.
– For health oversight activities such as investigations, audits, and inspections.
– For lawsuits and similar proceedings.
– When otherwise required by law.
– For Workers Compensation or similar programs if you file a claim.
– For specialized government functions such as intelligence and national security.
CONTACT 4 HEALING CENTER / ANIMALS 4 HEALING
If you would like further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that your therapist made about access to your health information, contact your therapist at The Companies by telephone or mail at the above address. Your therapist will study all complaints and will not retaliate against you for filing a complaint. You may also file a written complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services.
**Requests marked with asterisks (**) must be made in writing. Ask for the appropriate form.