Notice of Privacy Practices
Your Information. Your Rights.
This notice describes how information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.
When it comes to your counseling record, you have certain rights. This section explains your rights and some of our responsibilities.
Get an electronic or paper summary of your counseling record • You can request to see or receive an electronic or paper summary of your counseling record, provided all adults included in your counseling agree to this. Ask us how to do this.
• We will provide a summary of your information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
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Ask us to limit what we use or share • You can ask us not to use or share certain information for treatment, payment, or our operations.
• We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
• We will say “yes” unless a law requires us to share that information.
Get a copy of this privacy notice • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you • If you have given someone power of attorney over your records, or if someone is your legal guardian, that person can exercise your rights and make choices about your counseling information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting us as follows:
Clinical Director, Susan Fetcho; or Executive Director, Drew Carberry, at the address and phone number at the top of page 1 of this notice.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
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For certain information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to: • Share information with your family, close friends, or others involved in your care (with your written, signed consent)
• Share information in a disaster relief situation
• Contact you to ask for your support in matters of pending policy or legislation
• Contact you for fundraising efforts
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission: • Marketing purposes
• Most sharing of counseling notes
In the case of fundraising: • We may contact you for fundraising efforts, but you can tell us not to contact you again.
How do we typically use or share your information? We typically use or share your information in the following ways.
Treat you • We can use your information and share it with other professionals who are providing medical, educational or other services to you, only when we have obtained your written consent to do so. Examples: We coordinate a behavioral plan with a child’s school counselor; we discuss your medication response with your psychiatrist.
Run our organization • We can use and share your information to run our practice, improve your care,
and contact you when necessary. Example: Your information may be shared in a staff case conference in order to improve the quality of our service to you.
Bill for your services • We can use and share your information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
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How else can we use or share your information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and
research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues • We can share information about you for certain situations such as:
• Preventing the spread of communicable disease
• Reporting adverse reactions to medications
• Reporting suspected abuse or neglect
• Preventing or reducing a serious threat to anyone’s health or safety
Do research • We can use or share your information for counseling research, with your consent and with your identity protected.
Comply with the law • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• In cases of child custody disputes, we will share information as the law requires.
Address workers’ compensation, law enforcement, disability claims and other government requests • We can use or share information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• With government organizations requesting information on disability claims
• For special government functions such as military, national security, and presidential protective services
• We can share information about you in response to a court or administrative order, or in response to a subpoena. (Note: It is our practice to use all legal means at our disposal to avoid releasing confidential client information to a court, if we believe that is against a client’s best interest and/or if the client does not wish to have that information released. Only when all reasonable legal means of resistance have been exhausted would your information be released.)
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• We are required by law to maintain the privacy and security of your protected information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and offer you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• We adhere to HIPAA Privacy Practices, as well as to privacy/confidentiality guidelines established in the American Counseling Association Code of Ethics.
For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. You will be advised when these terms change. A new notice will be available upon request, in our office, and on our web site.
This Notice of Privacy Practices applies to the following organizations:
Lighthouse, Inc., Youth and Family Services, and all authorized business associates of Lighthouse, Inc.