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.
CLARITY CHILD GUIDANCE CENTER HAS A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION
We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of the Notice of Privacy Practice currently in effect. We reserve the right to change those terms and any changes made will be effective for all medical information we maintain. A copy of a revised notice will be available from our web site at www.claritycgc.org.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgement of receipt of this notice. Our intent is to make sure you are aware of the possible uses and disclosures of your protected health information (PHI) and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signature acknowledgment. Even if you decline to provide a signed acknowledgment, we will continue to provide your treatment, and will use and disclose your PHI as described in this Notice of Privacy Practices.
ORGANIZED HEALTHCARE AGREEMENTS
Clarity Child Guidance Center (CCGC) participates in quality improvement and assessment activities as part of an Organized Health Care Arrangement (OHCA) where the providers work jointly to help improve the quality of your care. The covered entities participating in the OHCA agree to abide by the terms of this notice with respect to protected health information (PHI) created or received by the covered entity as part of its participation in the OHCA. The covered entities of CCGC include:
- Southwest Psychiatric Physicians
- The University of Texas Health Science Center San Antonio
- Genoa, a QoL Healthcare Company
The covered entities participating in CCGC will share PHI with each other as necessary to carry out treatment, payment, or health care operations relating to the OHCA, and as otherwise permitted by applicable law.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We will record your information in various formats, including electronic and paper medical records. We may also make audio and/or video recordings, including recording telephone conversations, of your interactions with our care providers. To the extent such recordings contain your PHI, will be use and disclosed only for the purposes described herein. We may use and disclose your PHI for the following purposes:
- For Treatment – We may use your PHI to provide or arrange for your care and may disclose your PHI to physicians, nurses, medical students and other health care personnel who provide you with health care services or are involved in your care.
- To obtain Payment for Treatment – We may use and disclose your PHI, for example to insurance companies, in order to bill and collect payment for the treatment and services provided to you.
- For Health Care Operations – We may disclose your PHI in order to operate our facility. For example, we may use your PHI in order to review and improve our operations and evaluate the performance of our health care professionals and employees, and may provide your PHI to our accountants, attorneys, consultants, and other vendors to help them provide service to us or in order to make sure we’re complying with the law that affects us.
- Persons Involved in Your Care – We may use or disclose your PHI to parents, guardians, governmental agencies, and others who may be involved in your care or payment for your care, as allowed by HIPAA.
- Exception to Consent Requirement – We may disclose your PHI to others without your consent in certain situations. For example, your consent is not required if you need emergency treatment, as long as we try to get your consent after treatment or we try to get your consent but you are unable to communicate with us and we think you would consent if you were able to.
- Informational - We may contact you regarding news about mental health, our organization and fundraising needs, and certain permitted marketing activities. Clarity Child Guidance Center is a non-profit agency and relies on the help of those in our community. However, you have the right to elect not to receive any further fundraising and marketing communications.
- Affiliated Covered Entities – PHI will be made available to personnel at affiliated locations as necessary to carry out treatment, payment and health care operations.Providers at different locations may have access to PHI to assist in your treatment.
- Health Information Exchange/Regional Health Information Organization – Federal and state laws permit us to participate in organizations with other healthcare providers, insurers and/or other healthcare industry participants to share your health information for goals such as, but not limited to: improving the accuracy and increasing the availability of your health records; decreasing the time needed to access your health information; aggregating data for quality of care improvement purposes; and other purposes permitted by law.
- Electronic Disclosures of Medical Information – Under Texas law, we are required to provide notice to you if your medical information is subject to electronic disclosure.This Notice serves as general notice that we may disclose your medical information electronically for treatment, payment, or health care operations or as otherwise authorized or required by state or federal law.
- Psychotherapy Notes. Psychotherapy notes are very specific types of notes recorded by a mental health professional documenting or analyzing the contents of conversation during counseling sessions and kept separate from the rest of the medical record.As defined by the HIPAA Privacy Rule, an individual has no right to access this information, except for very limited uses and disclosures permitted by law.A decision to deny access to this record cannot be appealed.In most instances we are not allowed to disclose psychotherapy notes to other parties without your consent.
CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR CONSENT
We may use and disclose your PHI without your consent or authorization for the following reasons:
- When a disclosure is required by Federal, State, or Local law, Judicial or Administrative proceeding, or Law enforcement – For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence, or when ordered in a judicial or administrative proceeding.
- For Public Health Activities – For example, we will provide information about various communicable diseases to government officials in charge of collecting that information.
- For Health Oversight Activities- For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider .
- For Research Purpose – In certain circumstances, we may provide PHI in order to conduct medical research.
- To Avoid Harm (Criminal Activity) – In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to the law enforcement personnel or persons we believe are able to prevent or lessen such harm.
- For specific Government functions – We may disclose PHI of military personnel in certain situations. And we may also disclose information for national security purposes.
- For Worker’s Compensation – We may disclose your PHI to comply with laws regarding worker’s compensation.
- Appointment reminders and health related benefits or services – We may disclose PHI to provide information about referral resources, or give you information about treatment alternatives, or other health benefits we offer.
- Inmates – We may disclose your PHI if you are an inmate of a correctional facility.
ALL OTHER USES AND DISCLOSURES REQUIRE YOUR PRIOR WRITTEN AUTHORIZATION
In any other situation not described in this notice or allowed by law, we will ask for your written authorization before using or disclosing your PHI. We must have your authorization prior to any disclosures of psychotherapy notes, most uses of your PHI for marketing purposes, and any sale of your PHI. You may revoke your authorization in writing at any time by contacting our Privacy Officer in our facility at the address set forth below.
WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
- Requesting Restrictions – You have the right to ask us to limit our use or disclose your PHI. We will consider your request, but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them, except in emergency situations. You may revoke your restriction at any time, by contacting the facility’s Privacy Officer; however, revocation will not affect disclosures already made.
- Inspect and get copies – In most cases, you have the right to inspect and/or get copies of your PHI and billing records that we have created to make decisions about your care. You must put in a written request to either inspect or receive copies. We will respond to your written request for copies within 15 business days and 30 business days to inspect your PHI, unless stored in another location it will be 60 days. We may charge for copies.You have a right to receive a copy of this Notice or Privacy Practices upon request.You do not have a right to access or receive copies of psychotherapy notes.
- Confidential Communication – You may ask that we communicate with you in a particular way, or at a certain location, to maintain your confidentiality. Your request must be in writing and must specify an alternate way that we can contact you confidentially. You may revoke your request at any time, by contacting the facility’s Privacy Officer.
- Amendment – You may request us to amend your PHI if you believe that it is incorrect or incomplete. Your request must be in writing and must include a reason to support the amendment. We will respond within 60 days of receiving your request. Your request may be denied if we believe that the information is complete and accurate, if not created by us, or not part of our records.
- Accounting of Disclosures – You may request a list of certain non-routine disclosures that we have made of your PHI over the previous 6yrs. This does not include disclosures we make for your treatment, to receive payment for our services, or for our normal business operations as noted in this notice. Your request must be in writing, you may not request an accounting for dates of services prior to April 14, 2003. Your first request within a 12 month period is free, but we may charge for additional requrests within the same 12-month period.
- Out-of-Pocket Payments – If you paid out-of-pocket in full for a specific item or service, you have the right to require that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations.
- File a Complaint – If you feel that we have violated your privacy rights, you may file a complaint directly with the facility’s Privacy Officer. You may also file a complaint with the Secretary of the Department of Health and Human Services; go to http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html for how to file a privacy complaint with Office of Civil Rights. We cannot retaliate against you or refuse you treatment for filing a complaint.
In most instances, we will notify you of an unauthorized disclosure or other breach of your unsecured medical, billing or personal information.
PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you have any questions about this notice or any complaints about our privacy practice, you may contact our Privacy Officer at 8535 Tom Slick, San Antonio, TX, 78229 or you can call 210-616-0300. You may also e-mail your questions or complaints to email@example.com.
NOTICE TO PATIENT: Destruction of Medical Records
In accordance with Texas Health and Safety Code, Section 241.103, this notice is given to you regarding the destruction of medical records.
It is the policy of Clarity Child Guidance Center to authorize the disposal of any medical records on or after the tenth (10th) anniversary of the date on which you, the patient, were last treated at this facility. If you, the patient, are younger than 18 years of age when you were last treated, Clarity Child Guidance Center may authorize the disposal of medical records relating to you, the patient, on or after your twentieth (20th) birthday, or after the tenth (10th) anniversary of the date on which you were last treated, whichever date is later.
Clarity Child Guidance Center will not destroy medical records that relate to any matter that is involved in litigation if the hospital knows the litigation has not been fully resolved.
ACKNOWLEDGEMENT OF RECEIPT
By signing the Electronic Signature Cover Page, you acknowledge that you have received this Notice of Privacy Practices, and you consent to the use and disclosure of your medical information as set forth herein.