NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Dunham Counseling Center, Ltd. and its’ independent associated therapists are required to give you this Notice of Privacy Practices to comply with the regulations established under federal law (the Health Insurance Portability and Accountability Act – HIPAA). This notice, effective April 14, 2003, is intended to describe your rights, and to inform you about the ways in which Dunham Counseling Center, Ltd. and its’ associated therapists disclose your Protected Health Information (PHI) and obligations we have when using and disclosing your protected health information. For details please read on.
Your records at Dunham Counseling Center, Ltd. and those maintained by independent therapists associated with Dunham Counseling Center, Ltd. contains personal information about you. This information about you may identify you and that which relates to your past, present or future physical or mental health condition and related health care services is referred to as Protected Health Information (PHI). We at Dunham Counseling Center, Ltd. respect your confidentiality and are committed to protecting your personal information and will only volunteer information that we are required to disclose under state and federal law, and/or with your signed consent.
We are required to abide by the terms of this Privacy Practice Notice. We reserve the right to change the terms of our Privacy Practice Notice at any time. Any new Privacy Practice Notice will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Privacy Practice Notice by sending a copy to you in the mail upon request or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEATH INFORMATION ABOUT YOU
For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your counseling and related services. This includes associates’ consultation and clinical supervision within Dunham Counseling, and utilization review procedures under your insurance plan. We may not disclose PHI to any other individual, social agency, governmental agency, treatment professional or lay person except as mandated by law without your written authorization.
For Payment. We may use and disclose PHI so that we can receive payment for treatment services provided to you. This will only be done with your authorization. Examples of payment related activities are making a determination of eligibility or coverage for insurance benefits, processing appropriate identifying data for credit card utilization, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services we will only disclose the minimum amount of PHI necessary for purpose of collection, such as dates of services, attempts to secure payment. No personal history data would be shared.
For Health Care Operations. We may use or disclose, as needed, your PHI in order to support the running of our office including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties and perform various business activities (e.g. billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will not be disclosed without your written authorization.
Required By Law.
Illinois law is more protective of certain information than the Privacy Rule. Under HIPAA, the more protective law is the controlling law. Accordingly Dunham Counseling Center, Ltd. and its’ associated independent therapists will not disclose your information relating to treatment for mental health, developmental disabilities, alcoholism, drug dependence without in each case obtaining your authorization unless otherwise permitted or required by Illinois or federal law. Where you give authorization, you may revoke it at any time.
The Privacy Rule and Illinois law allows us to use or disclose your protected health information/patient health records without your authorization or informed consent for the limited reasons described below:
- As Required by Law. We are permitted to disclose your PHI when required to do so by federal, state or local law.
- Victims of Abuse, Neglect, or Domestic Violence. The Privacy Rule authorizes us to notify the appropriate government authority if a therapist believes a client has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
- Disputes, Lawsuits, Administrative Proceedings. If you are involved in a lawsuit or dispute, the Privacy Rule allows us to disclose your confidential PHI in response to a court administrative order. We may also disclose your PHI 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 that is required by law. Illinois law may require a court order for the release of client health care records in these circumstances, and may be considered more protective of your privacy than the Privacy Rule.
- Law Enforcement. The Privacy Rule allows us to disclose protected health information if asked to do so by a law enforcement official in the following circumstances:
- In response to a court order, subpoena, warrant, summons or similar process.
- To identify or locate a suspect, fugitive, material witness or missing person.
- About the victim of a crime if, under certain limited circumstances, Dunham Counseling Center, Ltd. is unable to obtain the person’s agreement.
- About a death Dunham Counseling Center, Ltd. believes may be the result of criminal conduct.
- About criminal conduct at Dunham Counseling Center, Ltd.
- In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Illinois law generally requires a court order for the release of client health records in these circumstances, and may be considered more protective of your privacy than the Privacy Rule.
- Specialized Government Functions. In certain circumstances, the Privacy Rule authorizes us to use or disclose your PHI to facilitate specified government functions:
- Military and Veterans. Dunham Counseling Center, Ltd. may disclose the PHI of armed forces personnel as required by military command authorities for the proper execution of a military mission.
- National Security and Intelligence Activities. We may disclose your PHI to authorized federal officials for intelligence, counter intelligence, and other national security activities authorized by law.
- Protective Services for the President and others. We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.
- Medical Suitability Determinations. We may disclose your PHI to the Department of State for use in making medical suitability determinations.
- Workers’ Compensation. Dunham Counseling Center, Ltd. may release your PHI for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Other Uses of Medical Information. Other uses and disclosures of information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose information about you, you may revoke that permission in writing at any time. If you revoke permission, we will no longer use or disclose the medical information about you for the reasons covered in your authorization. You understand that we are unable to take back any disclosure we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Appointment Reminders. We may call, write or email to remind you of scheduled appointments, to inquire about your interest in continuing counseling or if you haven’t scheduled an appointment nor notified us of the termination of your counseling. Also, we email/or mail a periodic newsletter to all clients and former clients of Dunham Counseling Center, Ltd. unless you inform us you do not wish to receive any such publications.
Your Rights Regarding your PHI
You have the following rights regarding PHI that we maintain about you. To exercise any of these rights, please submit your request in writing to Dunham Counseling Center, Ltd at 616 W. 5th Ave., Suite B, Naperville, IL 60563 or email at email@example.com.
Right to Access to Inspect and Copy
You have the right to inspect and copy a designated set of your Dunham Counseling Center, Ltd. and/or separately maintained therapist records. This designated set typically includes counseling and billing records, but may not include the therapist’s personal psychotherapy notes.
Right to Amend
You have the right to request an accounting of certain disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
Right to Request Restrictions
You have the right to request a restriction or limitation on the use of disclosure of your PHI for treatment, payment or health care operation. We are not required to agree to your request. A request for restrictions must be in writing, directed to Dunham Counseling Center, Ltd. and should include (1) what information you want to limit; (2) whether you want to limit its use, disclosure or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communication
You have the right to request that we communicate with you in a certain way or at a certain location. For instance, you may ask that we phone you at home or by cell phone, rather then at work
Right to a Copy of this Notice.
You have a right to a copy of this notice.
If you believe Dunham Counseling Center, Ltd. or your specific therapist has violated your privacy rights, you have the right to file a complaint in writing to Dunham Counseling or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201.
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