NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you
or your dependent may be used and disclosed and how you can
access this information. Please review it carefully.
The Therapy Place is committed to keeping your
personal health information private and secure. We protect
your personal health information by maintaining safeguards
that meet or exceed applicable state law and the requirements
of the Health Insurance Portability and Accountability Act
of 1996 (“HIPAA”). If you are a parent or guardian
of a dependent under the care of our clinic, this notice applies
to your dependent’s health records and references to “You”
in this notice refer to you in your capacity as parent or
guardian.
Uses and Disclosures of Personal Health Information
The Therapy Place will not use or disclose
your health information without your authorization, except
as described in this notice. When you become our patient,
you will be asked to sign a consent form allowing us to use
your personal information for treatment, payment, and health
care operations. For example:
- Treatment. We will use your information to create
a case record, determine the best course of treatment, coordinate
your care, consult with other professionals as necessary,
or make referrals. - Payment. We will use your information to determine
eligibility under health plans, manage our billing and claims
procedures, and collect payment from you or third-party payers. - Health care operations. We will use your information
to assess the care and outcomes of treatment and to improve
the quality of our services.
The Therapy Place may also use your personal health
information where required or permitted by law. These situations
include:
- Emergencies. In an emergency, we may use or disclose
health information to notify a family member, personal representative,
or person responsible for your care, to determine your location
and condition. - As required by law. We may notify authorities of alleged
abuse or neglect; risk or threat of harm to self or others;
information required for public health, law enforcement, or
national security purposes; information in response to a subpoena,
judicial order, or similar legal process; information required
by agencies responsible for oversight or regulation of health
care providers; information pertaining to our compliance with
HIPAA requirements. - Research. We may disclose your protected health information
to researchers if an institutional review board or privacy
board has approved the research protocols to ensure protection
of your privacy. - Appointment Reminders and Alternative Treatments. We
may use your information to contact you about an upcoming
appointment or inform you about treatment alternatives.
In all other situations, we will use or disclose your health
information only with your written authorization. If you sign
an authorization, you have the right to revoke the authorization
to prevent future uses and disclosures.
Your Rights as Patient
You have the following rights with respect to your protected
health information:
- Restrictions. You may request restrictions on how
we use or disclose your health information; your request will
be considered but we are not legally obligated to agree to
your requested restriction. - Confidentiality. You may request that your health information
be communicated to you in a confidential manner, such as sending
mail to an address other than your home. - Access. You may inspect and copy your protected health
information or request a summary of your health information;
if you request copies of your records or a summary, you may
be charged reasonable fees for these services. - Amendment. If you believe information in our records
is incorrect, you may request an amendment to your health
information. - Accounting of Disclosures. You have the right to receive
an accounting of disclosures of your protected health information.
Our Duties
The Therapy Place has the following obligations with respect
to your privacy and this notice:
- We are required by law to maintain the privacy of
protected health information and to provide our patients with
notice of our privacy practices. - We are required to abide by the terms of this notice
while it is in effect. - We reserve the right to change the terms of this privacy
notice and make the revised notice applicable to all health
records maintained by our office. If we change our privacy
notice, we will post a copy in our lobby, and we will make
the changes available to patients on request.
Complaints
If you believe your privacy rights have been violated in
any way, you may file a complaint in writing with the Director
of The Therapy Place. We will attempt to resolve
your complaint promptly. You also have the right to file a
complaint with the Secretary of the U.S. Department of Health
and Human Services. We will not retaliate against you for
filing a complaint under any circumstances.
Effective Date
This notice is effective April 14, 2003.
Questions
Any questions or concerns relating to your privacy rights
should be directed to the Director of The Therapy Place, Lynn
Kopfmann, at 952-885-0418.