Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
IHCA (IHCA) is required by law to provide you with this notice that explains our privacy practices with regard to your medical information and how we may use and disclose your protected health information for treatment, payment, and for health care operations, as well as for other purposes that are permitted or required by law. You have certain rights regarding the privacy of your protected health information and we also describe those rights in this notice.
WHO WILL FOLLOW THIS NOTICE
This notice describes IHCA practices regarding the use of your medical information and that of:
Any healthcare professional authorized to enter information into your medical chart or medical record, including without limitation, mental health providers, technicians, and psychologists.
All employees, staff and other personnel who may need access to your information.
Ways in Which IHCA May Use and Disclose Your Protected Health
The following paragraphs describe different ways that we use and disclose your protected health information. We have provided an example for each category, but these examples are not meant to be exhaustive. All of the ways we are permitted to use and disclose your health information fall within one of these categories.
Treatment. IHCA will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. We will also disclose your health information to other health care providers who may be treating you. Additionally, we may from time to time disclose your health information to another physician whom we have requested to be involved in your care. For example – we would disclose your health information to a specialist to whom we have referred you for a diagnosis to help in your treatment, with written consent.
Payment. IHCA may often provide services for reimbursement through 3rd party payers such as insurance. If we agree to provide services through a 3rd party, we will use and disclose your protected health information to obtain payment for the health care services we provide you. For example — IHCA may include information with a bill to a third-party payer that identifies you, your diagnosis, procedures performed, and supplies used in rendering the service.
Health Care Operations. IHCA will use and disclose your protected health information to support the business activities of our practice. For example – We may use medical information about you to review and evaluate our treatment and services or to evaluate our staff’s performance while caring for you. In addition, we may disclose your health information to third party business associates who perform billing, consulting, or transcription, or other services for our practice.
Other Ways IHCA May Use and Disclose Your Protected Health Information:
Appointment Reminders. We will use and disclose your protected health information to contact you as a reminder about scheduled appointments or treatment.
Treatment Alternatives. We will use and disclose your protected health information to tell you about or recommend possible alternative treatments or options that may be of interest to you. We will not disclose personal information about you but may seek outside consultations to provide the best possible care.
Others Involved in Your Care. We will use and disclose your protected health information to a family member, a relative, a close friend, or any other person you identify that is involved in your medical care or payment for care, with additional consent.
Research. We will use and disclose your protected health information to researchers, provided the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information., with additional consent.
As Required by Law. We will use and disclose your protected health information when required to by federal, state, or local law.
To Avert a Serious Threat to Public Health or Safety. IHCA will use and disclose your protected health information to public health authorities permitted to collect or receive the information for the purpose of controlling disease, injury, or disability. If directed by that health authority, we will also disclose your health information to a foreign government agency that is collaborating with the public health authority.
Worker’s Compensation. We will use and disclose your protected health information for worker’s compensation or similar programs that provide benefits for work-related injuries or illness.
Inmates. We will use and disclose your protected health information to a correctional institution or law enforcement official if you are an inmate of that correctional institution or under the custody of the law enforcement official. This information would be necessary for the institution to provide you with health care; to protect the health and safety of others; or for the safety and security of the correctional institution.
Your Health Information Rights
Although your health record is the physical property of IHCA, the information belongs to you. You have the right to:
A Paper Copy of This Notice. You have the right to receive a paper copy of this notice upon request. You may obtain a copy in our office lobby at your next visit or by calling and asking us to mail you a copy.
Inspect and Copy. You have the right to inspect and copy the protected health information that IHCA maintain about you in our designated record set for as long as we maintain that information. This designated record set includes your medical and billing records, any other records we use for making decisions about you. We may charge you a fee for the costs of copying, mailing, or other supplies used in fulfilling your request. We may deny access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. If you wish to inspect or copy your medical information, you must submit your request in writing to our Privacy Officer:
Attention: Vickie Covington, LPC; Privacy Officer,
#4 Shackelford Plaza Suite 100, Little Rock, AR 72211
You may mail your request, or bring it to our office. IHCA will have 30 days to respond to your request for information that we maintain at our practice site. If the information is stored off-site, we are allowed up to 60 days to respond but must inform you of this delay.
Request Amendment. You have the right to request that IHCA amend your medical information if you feel that it is incomplete or inaccurate. You must make this request in writing to our practice manager, stating exactly what information is incomplete or inaccurate and the reasoning that supports your request.
We are permitted to deny your request if it is not in writing or does not include a reason to support the request. We may also deny your request if:
The information was not created by us, or the person who created it is no longer available to make the amendment.
The information is not part of the record which you are permitted to inspect and copy.
The information is not part of the designated record set kept by this practice or if it is the opinion of the opinion of the health care provider that the information is accurate and complete.
Request Restrictions. You have the right to request a restriction of how IHCA use or disclose your medical information for treatment, payment, or health care operations. For example – you could request that we not disclose information about a prior treatment to a family member or friend who may be involved in your care or payment for care. Your request must be made in writing to our practice manager. We are not required to agree to your request if we feel it is in your best interest to use or disclose that information. If we do agree, we will comply with your request except for emergency treatment.
An Accounting of Disclosures. You have the right to request a list of the disclosures of your health information IHCA has made outside of our practice that are not for treatment, payment, or health care operations. You request must be in writing and must state the time period for the requested information. You may not request information for any dates prior to June 3, 2013, nor for a period of time greater than five years (our legal obligation to retain information). Your first request for a list of disclosures within a 12-month period will be free. If you request an addition list within 12-months of the first request, we may charge you a fee for the costs of providing the subsequent list. We will notify you of such costs and afford you the opportunity to withdraw your request before any costs are incurred.
Request Confidential Communications. You have the right to request how IHCA communicates with you to preserve your privacy. For example – you may request that we call you only at your work number, or by mail at a special address or postal box. Your request must be made in writing and must specify how or where we are to contact you. We will accommodate all reasonable requests.
File a Complaint. If you believe IHCA have violated your medical information privacy rights, you have the right to file a complaint with our practice or directly to the Arkansas Division of Consumer Affairs. To file a complaint with IHCA, you must make it in writing within 180 days of the suspected violation. Provide as much detail as you can about the suspected violation and send it to our Privacy Officer.
Uses or Disclosures Not Covered
Uses or disclosures of your health information not covered by this notice or the laws that apply to us may only be made with your written authorization. You may revoke such authorization in writing at any time and IHCA will no longer disclose health information about you for the reasons stated in your written authorization. Disclosures made in reliance on the authorization prior to the revocation are not affected by the revocation.
For More Information
If you have questions or would like additional information, you may contact our Privacy Officer at email@example.com
Technology/ Telehealth and Social Media:
1.There are benefits, limitations and boundaries of using social media. Your therapist will not become your Facebook friend or friend or follower on any social media. There are some benefits to using social media such as connecting in a positive way to family or friends. However, what you post of social media can be used against you in a court of law, or by others, so think before you post.
2. Clients and therapists or employees of counseling/therapy agencies are not allowed to post, text messages, emails or any other confidential information on any social media or public website. This is considered a Hipaa violation. If a client does so, it could be grounds for immediate termination of therapy services. This could also be considered defamation of character against the therapist and could be subject to penalty by law.
3. Therapy sessions are not allowed to be recorded or videoed in any way. If it is found that sessions are recorded or videoed and/or published to social media there will be a 2000.00 per hour fee charged to the client. This practice is considered a violation of the therapists right of privacy as well as the clients.
4. No telehealth/technology assisted sessions are allowed while the client is driving or other distracting activities or otherwise incapacitated in anyway. This is considered unsafe and unethical. The client is expected to be at a safe and secure location to connect safely via assisted technology assisted with the therapist to have undivided therapeutic time with the therapist to benefit fully from the therapeutic services.
5. All clients participating in Telehealth sessions must be present physically in the state of Arkansas. This is per Arkansas State Law and per the Arkansas Licensing Board.
6. I understand that if my counselor believes I would be better served by another form of intervention (e.g., face-to-face services), I will be referred to a mental health professional associated with any form of psychotherapy, and that despite my efforts and the efforts of my counselor, my condition may not improve, and in some cases may even get worse. I understand this evaluation will take place at EACH session and I/my surroundings will be assessed for appropriateness at each time.
7. I understand that the current email system my provider uses is not encrypted, therefore not confidential, and should limit my communication to the provider via email. For scheduling and other inquiries I should call In Sync Counseling and ask to speak with my provider.
8. I understand the alternatives to counseling through telehealth as they have been explained to me, and in choosing to participate in telehealth, I am agreeing to participate using video and/or audio conferencing technology. I also understand that at my request or at the direction of my counselor, I may be directed to “face-to-face” psychotherapy. I understand my sessions will not be recorded, nor will I record my counselor for any reason unless first disclosed and each party has granted permission to proceed with the recording. This will then be documented in my record.
9. I understand that I may expect the anticipated benefits such as improved access to care, convenience, ease of communication, flexibility in scheduling, check-in sessions, and reduction of travel but that no results can be guaranteed or assured.
10. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Others may also be present during the consultation other than my counselor in order to operate the video equipment. The above-mentioned people will all maintain confidentiality of the information obtained. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following:
(1) Omit specific details of my medical history that are personally sensitive to me,
(2) Ask non-clinical personnel to leave the telehealth room, and/or
(3) Terminate the consultation at any time
11. I understand that my express consent is required to forward my personally identifiable information to a third party.
10. I understand that I have a right to access my medical information and copies of my medical records in accordance with the laws pertaining to the state in which I reside.
12. In Sync Counseling complies with HITECH laws and in the event of a breach will notify me of my rights, steps taken related to the breach, and how to protect my privacy.
13. I understand that different states have different regulations for the use of telehealth. In Arkansas, telehealth may only be conducted between certified office locations. I understand that, in Arkansas, I am not able to connect from an alternative location for the provision of audio-/video-/computer-based psychotherapy services.
14. I understand that no data is saved or sold to third-party companies as a means to sell or solicit personal client information. The data is encrypted on a HIPPA compliant system.
15. By signing this document, I agree that certain situations, including emergencies and crises, are inappropriate for audio-/video-/computer-based psychotherapy services. If I am in crisis or in an emergency, I should immediately call 9-1-1 or seek help from a hospital or crisis-oriented health care facility in my immediate area. I understand that should technology failure occur that I will be given referrals for someone who can assist me or provided with in-person sessions.