THIS NOTICE DESCRIBES
HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
IT CAREFULLY.
I. Disclosures for Treatment,
Payment, and Health Care Operations
The MHC may disclose your protected
health information (PHI), for treatment, payment,
and health care operations purposes with your
written authorization. To help clarify these
terms, here are some definitions:
- PHI refers to information
in your file that could identify you (any
information with your name or other description
of you.)
- Treatment, Payment and
Health Care Operations
– Treatment is when the MHC provides,
coordinates or manages your health care. An
example of treatment would be when someone
from the MHC consults with another health
care provider, such as your family physician
or another clinician.
– Payment is when the MHC obtains
reimbursement for your healthcare. Examples
of payment are when the MHC shares your PHI
with your health insurer to obtain payment
for your health care or to determine eligibility
or coverage.
– Health Care Operations are activities
that relate to the performance and operation
of the MHC. Examples of health care operations
are quality assessment and improvement activities
or business-related matters such as audits
and administrative services.
- Disclosure applies
to activities outside of the MHC, such as
releasing, or providing access to information
about you to people outside of the MHC.
- Authorization is
your written permission to disclose confidential
mental health information. All authorizations
to disclose must be on a specific MHC release
form.
II. Other Uses and Disclosures
Requiring Authorization
The MHC may disclose PHI for
purposes other than treatment, payment, or health
care operations when your appropriate authorization
is obtained. In those instances when we are
asked for information for purposes other than
treatment, payment, or health care operations,
we will obtain an authorization from you before
releasing this information. We will also need
to obtain an authorization before releasing
your Psychotherapy Notes. Psychotherapy
Notes are notes your clinician may have
made about your conversation during a private,
group, joint, or family counseling session,
which he or she has kept separate from the rest
of your record. These notes are given a greater
degree of protection than PHI.
You may cancel all such authorizations
(of PHI or Psychotherapy Notes) at any time,
provided each request to cancel authorization
is in writing. You may not cancel an authorization
to the extent that (1) The MHC has relied on
that authorization; or (2) if the authorization
was obtained as a condition of obtaining insurance
coverage, the law provides the insurer the right
to contest the claim under the policy.
III. Uses and Disclosures
without Authorization
The MHC may disclose PHI without
your consent or authorization in the following
circumstances:
- Serious Threat to Health
or Safety – If your clinician believes
disclosure of PHI is necessary to protect
you or another individual from a risk of imminent
and serious physical injury, he or she may
disclose the PHI to the appropriate individuals.
- Child Abuse – If
your clinician knows or has reasonable cause
to suspect that a child known to him or her
in a professional capacity has been or is
in immediate danger of being a mentally or
physically abused or neglected child, he or
she must immediately report such knowledge
or suspicion to the appropriate authority.
- Dependent Adult Abuse
– If your clinician believes that an elderly
or disabled adult is in need of protective
services because of abuse or neglect by another
person, he or she must immediately report
this belief to the appropriate authorities.
- Court Proceedings
– If you are involved in a court proceeding
and a request is made for information about
the professional services the MHC provided
you, such information is privileged under
D.C. law, and we will not release information
without the written authorization of you or
your legally appointed representative or a
court order. The privilege does not apply
when you are being evaluated for a third party
or where the evaluation is court ordered.
You will be informed in advance if this is
the case.
IV. Client’s Rights
and Clinician’s Duties
Client’s Rights:
- Right to Request Restrictions
– You have the right to request restrictions
on certain uses and disclosures of protected
health information (PHI). However, your clinician
is not required to agree to a restriction
you request.
- Right to Receive Confidential
Communications by Alternative Means and at
Alternative Locations – You have the
right to request and receive confidential
communications of PHI by alternative means
and at alternative locations. (For example,
you may not want a family member to know that
you are seeing me. On your request, the MHC
will send your bills to another address.)
- Right to Inspect and
Copy – You have the right to inspect
or obtain a copy (or both) of PHI in our mental
health and billing records used to make decisions
about you for as long as the PHI is maintained
in the record. Your clinician may deny your
access to PHI under certain circumstances,
but in some cases you may have this decision
reviewed. You may be denied access to Psychotherapy
Notes if your clinician believes that a limitation
of access is necessary to protect you from
a substantial risk of imminent psychological
impairment or to protect you or another individual
from a substantial risk of imminent and serious
physical injury. Your clinician will notify
you or your representative if he or she does
not grant complete access. On your request,
your clinician will discuss with you the details
of the request and denial process.
- Right to Amend –
You have the right to request an amendment
of PHI for as long as the PHI is maintained
in the record. Your clinician may deny your
request. On your request, he or she will discuss
with you the details of the amendment process.
- Right to a Listing
– You generally have the right to receive
a listing of disclosures of PHI. On your request,
your clinician will discuss with you the details
of this process.
Clinician’s Duties:
- The MHC is required by law
to maintain the privacy of PHI and to provide
you with a notice of our legal duties and
privacy practices with respect to PHI.
- The MHC reserves the right
to change the privacy policies and practices
described in this notice. Unless we notify
you of such changes, however, we are required
to abide by the terms currently in effect.
V. Complaints
If you are concerned that someone
at the MHC has violated your privacy rights,
or you disagree with a decision made about access
to your records, you may contact Dr. Lauri Rush,
Director of the Mental Health Center, at 202-651-6080
(v/tty).
You may also send a written
complaint to the Secretary of the U.S. Department
of Health and Human Services. The person listed
above can provide you with the appropriate address
upon request.
VI. Effective Date,
Restrictions and Changes to Privacy Policy
This notice will go into effect
on April 15, 2003.
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