HIPAA NOTICE OF PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective March 26, 2013

Provider will only release your information in accordance with state and federal laws and the ethics of the counseling profession.

This notice describes my policies related to the use and disclosure of client’s healthcare information.

Use and disclosure of protected health information for the purposes of providing services: Providing treatment services, collecting payment, and conducting healthcare operations are necessary activities for quality care. State and federal laws allow for the use and disclosure of protected health information for these purposes without your consent.

The following are examples of how protected health information is used and disclosed for the purposes of providing services. Refer to your informed consent for a more detailed explanation.

TREATMENT
• Provide, manage or coordinate care
• Referral sources
• Personal sources
• Verify insurance and coverage

PAYMENT
• Billing and collections
• Review of insurance procedures
• Certification

HEALTHCARE OPERATIONS
• Review of business activities
• Staff training

OTHER USES AND DISCLOSURES WITHOUT YOUR CONSENT
• Medical reporting
• Appointment scheduling
• Treatment alternatives
• As required by law

Client Signature ___________________________ Date ___________

Counselor Signature ________________________ Date ___________