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 it carefully.
As a client of KEYSTONE FAMILY COUNSELING you are entitled to receive notice about our privacy practices and how we may use and disclose your personal health information indifferent circumstances. This notice explains how we may use and disclose your personal health information, the choices and rights you have about how your personal health information may be used and disclosed, and our obligations to protect the privacy of your personal health information. KEYSTONE FAMILY COUNSELING provides professional services including, but not limited to: testing and evaluations, consulting, psycho-educational training, individual, marriage, family, and group therapy. These services are provided in accordance with the standards of care adopted from time-to-time. To meet your needs, KEYSTONE FAMILY COUNSELING employees and contractors must share your health information with other health care providers, treatment facilities, and insurance companies
Our Responsibilities: KEYSTONE FAMILY COUNSELING is required to maintain the privacy of your personal health information and to provide you with a notice about our legal duties and privacy practices with respect to your personal health information. We are also required to accommodate reasonable requests you make to communicate personal health information by alternative means or at alternative locations. Any time we use or disclose your personal health information, we must follow the terms of this notice.
Uses and Disclosures for Treatment, Payment and Health Care
Operations: How We Use And Disclose Your Protected Health Information. After making a good faith effort to provide you with this notice, we may use your personal health information to provide you treatment, to obtain payment for your treatment and for our internal health care operations. We may use and disclose your personal health information for such purposes in the following ways:
For Treatment: We may use and disclose your personal health information to plan, provide and coordinate your health care services. For example, we may share the results of our treatmentwith other physicians who have been responsible for your care for additional follow-up and treatment.
For Payment: We may use and disclose your personal health information to obtain payment for health care services we have provided to you. For example, we may need to send a copy of the visit note for proper payment to be determined by your insurance company.
For Health Care Operations: We may use or disclose your protected health information for our health care operations. For example, we may use or disclose your personal health information to perform risk assessments and other administrative tasks to monitor the quality of care we provide.
Uses and Disclosures with Authorization: For uses and disclosures of your personal health information not involving treatment, payment or health care operations, we will receive your written authorization prior to using or disclosing any personal health information (unless we are required or permitted by law to use or disclose your information as set forth below). You have the right to revoke any authorization previously granted.
Uses and Disclosures without Authorization
We may use and disclose your personal health information without obtaining your consent or authorization, in the following situations:
Business Associates: There are some services we provide through contracts with our business associates. In such situations, we may disclose your personal health information to our business associates so they can perform the job we asked them to do. We require all business associates to appropriately safeguard your information, in accordance with applicable law.
Notification of Family or Close Friends: We may use or disclose your personal health information to notify a family member,personal representative or another person responsible for your care, provided you have the opportunity to agree or object to the disclosure. If you are unable to agree or object, we may disclose this information as necessary if we determine that it is in your best interest based upon our professional judgment. In all cases, we will only disclose the health information that is directly relevant to that person’s or persons’ involvement with your health care.
Required by Law: We may use or disclose your personal health information to the extent we are required by law to do so. The use or disclosure will be made in full compliance with the applicable law governing the disclosure.
Public Health Activities: We may disclose your personal health information for public health activities to a public health authority authorized by law to collect or receive information for the purpose of controlling disease, injury or disability. We may also disclose your health information to a public authority authorized to receive reports of child abuse or neglect.
Health Oversight Activities: We may make disclosures of your personal health information to a health oversight agency charged with overseeing the health care industry. Disclosures will be made only for activities authorized by law. Judicial and Administrative Proceedings: We may disclose your personal health information in the course of any judicial or administrative hearing in response to an order of a court or administrative tribunal, or in response to a subpoena, discovery request or other lawful process where we receive satisfactory assurance that appropriate precautions have been taken. In all cases, we will take reasonable steps to protect the confidentiality of your health information.
Law Enforcement: We may disclose your personal health information for a law enforcement purpose to law enforcement officials in compliance with and as limited by applicable law.
Victims of Abuse, Neglect or Domestic
Violence: We may disclose personal health information about an individual whom we reasonably believe to be a victim of abuse, neglect or domestic violence to a government authority, including a social service or protective service agency authorized by law to receive reports of child abuse, neglect or domestic violence. Any such disclosures will be made in accordance with and limited to the requirements of the law.
Limited Government Functions: We may disclose your personal health information to certain government agencies charged with special government functions, as limited by applicable law. For example, we may disclose your health information to authorized federal officials for the conduct of national security activities, as required by law.
Health and Safety: We may disclose your personal health information to prevent or lessen a serious threat to a person(s) or the public’s health and safety. In all cases, disclosures will only be made in accordance with applicable law and standards of ethical conduct.
Workers Compensation: We may disclose your personal health information in accordance with workers compensation laws.
Receive Further Information. You have the right for additional information about our privacy practices, your privacy rights, or disagree about a decision we made about your personal health information, or if you believe that your privacy rights have been violated. The contact person will provide you with the information you need to file a complaint.
Inspect and Copy Your Health Information. Upon written request, you have the right to access and obtain a copy of your health information maintained by us.
Amend Your Health Information. You have the right to request in writing that we amend health information maintained in your health record. We will comply with your request in the event that we determine the information that would be amended is false, inaccurate or misleading.
Request Additional Restrictions on Uses and Disclosures of
Your Health Information. You have the right to request in writing that we place additional restrictions on how we use or disclose your personal health information. While we will consider any request for additional restrictions, we are not required to agree to your request.
Request an Accounting of Disclosures. You have a right to request in writing an accounting of certain disclosures made by us of your personal health information. For each disclosure, the accounting will include the date the information was disclosed, to whom, the address of the person or entity that received the disclosure (if known), and a brief statement of the reason for the disclosure.
Request Confidentiality in Certain Communications. You have the right to request to receive your health information by alternative means of communication or at alternative locations. We will accommodate any such reasonable written request(s) made on your behalf.
Changes to Notice. We reserve the right to change our privacy practices and to alter this notice according to those changes. In the event our notice changes, we will update your privacy notice upon your next visit or mail you a copy if requested.