ASSOCIATED REHABILITATION CONSULTANTS
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.
This Notice is effective as
of September 17, 2002.
We are required by law to
maintain the privacy of protected health information, and must inform you of our
privacy practices and legal duties. You have the right to obtain a paper copy of
this Notice upon request.
We are required to abide by
the terms of the Notice of Privacy Practices that is most current. We reserve
the right to change the terms of the Notice at any time. Any changes will be
effective for all protected health information that we maintain. The revised
Notice will be posted in the waiting room and on our web site. You may request
a copy of the revised Notice at any time.
We have designated a
Privacy Officer to answer your questions about our privacy practices and to
ensure that we comply with applicable laws and regulations. The Privacy Officer
also will take your complaints and can give you information about how to file a
complaint.
Our Privacy Officer is
William R. Irvin, M. Ed. NCC CRC LPCC LMHC ATP. You can contact the Privacy
Officer at (502) 426-5106.
Use and disclosure of
your protected health information that we may make to carry out treatment,
payment, and health care operations.
We may use information in
your record to provide counseling to you. We may disclose information in your
record to help you get health care services from another provider, a hospital,
etc. For example, if we want an opinion about your condition from a
specialist, we may disclose information to the specialist to obtain that
consultation.
We may use or disclose
information from your record to obtain payment for the services you receive.
For example, we may submit your diagnosis with a health insurance claim in
order to demonstrate to the insurer that the service should be covered.
We may use or disclose
information from your record to allow “health care operations.” These
operations include activities like reviewing records to see how care can be
improved, contacting you with information about treatment alternatives, and
coordinating care with other providers. For example, we may use information
in your record to train our staff about your condition and its treatment.
Your rights
You may ask us to
restrict the use and disclosure of certain information in your record that
otherwise would be allowed for treatment, payment, or health care operations.
However, we do not have to agree to these restrictions.
You have a right to
receive confidential communications from us. For example, if you want to
receive bills and other information at an alternative address, please notify
us.
You have a right to
inspect the information in your record, and may obtain a copy of it. This may
be subject to certain limitations and fees. Your request must be in writing.
If you believe
information in your record is inaccurate or incomplete, you may request
amendment of the information. You must submit sufficient information to
support your request for amendment. Your request must be in writing.
You have the right to
request an accounting of disclosures made by us.
You have the right to
complain to us about our privacy practices (including the actions of our staff
with respect to the privacy of your health information). You have the right
to complain to the Secretary of the Department of Health and Human Services
about our privacy practices. You will not face retaliation from us for making
complaints.
Except as described in
this Notice, we may not make any use or disclosure of information from your
record unless you give your written authorization. You may revoke a written
authorization at any time, but this will not affect any use or disclosure made
by us before the revocation. In addition, if the authorization was obtained as
a condition of obtaining insurance coverage, the insurer may have the right to
contest the policy or a claim under the policy even if you revoke the
authorization.
Use or disclosure of
your protected health information that we are required to make without
your permission:
In certain circumstances,
we are required by law to make a disclosure of your health information. For
example, state law requires us to report suspected abuse or neglect. Also, we
must disclose information to the Department of Health and Human Services, if
requested, to prove that we are complying with regulations that safeguard your
health information. If you have been referred by the Court (“court ordered”),
you can assume that the Court wishes to receive some type of report or
evaluation. You should discuss with us exactly what information may be
included in a report to the Court before you disclose any confidential
material. In such instances, you have a right to tell us only what you want us
to know. If you are involved in litigation of any kind and inform the Court of
the services that you received from us (making your mental health an issue
before the Court), you may be waiving your right to keep your records
confidential. You may wish to consult your attorney regarding such matters
before you disclose that you have received counseling/treatment. If you
threaten to harm either yourself or someone else and we believe your threat to
be serious, we are obligated under the law to take whatever actions seem
necessary to protect people from harm. This may include divulging confidential
information to others and would only be done under unusual circumstances where
someone’s life appeared to be in danger. There may be other rare instances in
which you waive your rights to have your records protected. If you are
involved in any current or potential legal difficulties, we suggest that you
discuss such matters with your attorney before informing others of the
services you have received here. In summary, we make every reasonable effort
to safeguard the personal information which you may share with us. There are,
however, certain instances when we may be obligated under the law to release
such information to others. If you have any questions about confidentiality,
please discuss them with us.
Use or disclosure of
your protected health information that we are allowed to make without
your permission
There are certain
situations where we are allowed to disclose information from your record
without your permission. In these situations, we must use our professional
judgment before disclosing information about you. Usually, we must determine
that the disclosure is in your best interest, and may have to meet certain
guidelines and limitations.
If you receive mental
health care, including treatment for substance abuse, information related to
that care may be more protected than other forms of health information.
Communications between a counselor and client in treatment are privileged and
may not be disclosed without your permission, except as required by law. For
example, counselors still must report suspected abuse, and may have to breach
confidentiality if you appear to pose an imminent danger to yourself or
others, in order to reduce the likelihood of harm to you or others.
We may report births and
deaths to public health authorities, as well as certain types of diseases,
injuries, adverse drug reactions, and product defects. We may disclose
information from your record to a medical examiner or coroner. We may
disclose information to funeral directors to allow them to carry out their
duties upon your death. We may disclose information from your record to
facilitate organ, eye, or tissue donation and transplantation.
We may assist in health
oversight activities, such as investigations of possible health care fraud.
We may disclose
information from your record as authorized by workers’ compensation laws.
We may disclose
information from your record if ordered to do so by a court, grand jury, or
administrative tribunal. Under certain conditions, we may disclose
information in response to a subpoena or other legal process, even if a court
does not order this.
We may disclose
information from your record to a law enforcement official if certain criteria
are met. For example, if such information would help locate or identify a
missing person, we are allowed to disclose it.
If you tell us that you
have committed a violent crime that caused serious physical harm to the
victim, we may disclose that information to law enforcement officials.
However, if you reveal that information in a counseling or psychotherapy
session, or in the course of treatment for this sort of behavior, we may not
disclose the information to law enforcement officials.
We may use or disclose
information from your record for research under certain conditions.
Under certain conditions,
we may disclose information for specialized government purposes, such as the
military, national security and intelligence, or protection of the President.
We may contact you to
provide appointment reminders as a courtesy. However, you are responsible for
remembering your appointment.
ASSOCIATED REHABILITATION
CONSULTANTS
7321 New LaGrange Road, Suite 203
Louisville KY 40222-6873
(502) 426-5106
Web Site:
http://www.associatedrehab.com
E Mail to: BillIrvin4@cs.com
