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. The privacy of your health information is important to us. This privacy notice is being provided to you as a requirement of a federal law: The Health Insurance Portability and Accountability Act (HIPAA). This Privacy Notice describes how we may use and disclose your Protected Health Information (“PHI”) to carry out services, payment, and health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control of your PHI in some cases. Your PHI means any written and oral health information about you, including demographic data that can be used to identify you. In situations where Indiana law is more stringent than what is required by the HIPAA privacy regulation, the state law takes precedent.

1. Services: We may disclose your PHI to coordinate services with other service providers, including, but not limited to, physicians, nurses, psychiatrists, clergy, social workers, and psychologists only with your written permission. Disclosures for services purposes are not limited to the minimum necessary standard because Counselors and other health care providers need access to the full record and/or full and complete information in order to provide quality care. This may include appointment reminders and health related benefits or services.  We may disclose your PHI for our use in training or supervising Counselors to help them improve their skills in counseling, as well as research purposes.

2. Payment: We may disclose demographic information (your address, telephone number, gender, place of employment), diagnosis, and dates of service, and fees to your insurance provider in order to obtain payment. We may also disclose information necessary to determine eligibility for benefits or to demonstrate the necessity of the services.

3. Individuals involved in your care or payment for your care: We cannot acknowledge whether someone is, in fact, a client, either presently, in the past, or scheduled for a future appointment without that person’s written permission specifying to whom disclosure is allowed and what exactly is to be disclosed (except by an emergency contact that you have given express permission in the Intake Form or if we are concerned about your safety).

4. Subpoena, Lawsuits, Legal Disputes: If you are involved in a lawsuit or dispute, we will disclose your PHI only if properly ordered to do so by a court or administrative order, and even then, we are required to notify you before doing so, so that you may notify your legal counsel.  I may disclose your PHI for our use in defending myself in legal proceedings instituted by you. Additional investigations that require disclosure may include by the Secretary of Health and Human Services to investigate my compliance with HIPAA, or for certain health oversight activities such as audits, or as required by a coroner who is performing duties authorized by law, or under workers’ compensation laws.

5. Safety.  We may be required to disclose your PHI to help avert a serious threat to the health and safety of others, or for law enforcement purposes, including reporting crimes occurring on my premises.  We are required to disclosure your PHI for public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s (including your own) health or safety. 

6. Right to request confidential communications: You have the right to specify how we communicate with you, including where and whether we can leave messages. Once you have provided written permission with 30 days’ notice to release your protected information, you may withdraw your permission at any time. Other than our counseling notes, you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We may have to charge a reasonable, cost-based fee for doing so at 35-cents per page.  If you are requesting copies of records with the intent of securing a summary for an outside entity, we are happy to provide such a summary for a $50.00 fee (except as stated in our court policy). You have the right to request a list of instances in which I have disclosed your PHI for purposes other than payment or health care operations, or for which you provided me with authorization (you will be charged at cost for requests over once per year).  

If you believe your privacy or other ethical standards have been violated and you have not received a satisfactory response from us, you have a right to file a formal complaint with the Indiana Professional Licensing Agency. You will not be penalized for filing a complaint. More information about HIPAA law and other related information can be found on the American Counseling Association web site: www.counseling.org.