Notice of Privacy Practices and Confidentiality
InTouch & Motion, is providing this document to you subsequent to the Health Insurance Portability and Accountability Act (HIPAA). This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.
Rights Regarding Your Health Information
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Right to Receive Appropriate Treatment. We strive to offer treatment that is appropriate and helpful, and you have the right to terminate treatment if you are not satisfied.
Right to Request How We Contact You. You can ask us to communicate with you about your health and related issues in a particular way, at a certain place that is more private for you, or to send mail to a different address. We will say “yes” to all reasonable requests.
Right to Release Your Medical Records. You may complete an Authorization for the Release of Information form if you wish your records to be released to another provider. You have the right to revoke this authorization in writing at any time, with the exception of any communications made prior to the revocation.
Right to See and Copy Your Records. You have the right to look at the health information we have about you, such as your medical and billing records. You can get a copy of these records. A fee may be associated with this service. Your request must be in writing.
Right to Correct Your Medical Records. If you believe the information in your record is incorrect or missing important information, you can ask us to make changes (called amending) to your health information. You must make this request in writing to your psychotherapist/creative arts therapist. In your request, you must tell us the reason(s) you want to make the changes. We have the right to deny your request under certain circumstances and we’ll tell you why in writing within 60 days.
Right to Limit What We Use or Share. You have the right to ask us to limit what we tell people involved in your care or the payment for your care, such as family members and friends. You may request that we not share information with your insurance company, in which case you would be responsible to pay in full for the services provided. You must make your request in writing. While we do not have to agree to your request, if we do agree, we will keep our agreement except if it is against the law, or in an emergency, or when the information is necessary to treat you.
Right to Get a list of those with whom we’ve shared information.You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Right to be Notified of a Breach in Confidentiality. We make every effort to maintain security of confidential information at all times. It is unlikely that a breach will occur, but, in such a case, you will be promptly notified.
Right to a Copy of this Notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
Ask Questions or File a Complaint. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with the InTouch & Motion Founder, Amanda Mitchell LCPC BC-DMT, and she may be contacted at 773-850-9046 or at firstname.lastname@example.org. If you are not satisfied with the response to your complaint, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. Filing a complaint will not change the health care we provide to you, and we will not retaliate in any way.
For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to: share information with your family, close friend, or other person that you indicate are involved in your health care or payment of your health care, share information in a disaster relief situation, and/or include your information in a hospital directory, unless you object in whole or in part. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission: Marketing purposes, sale of your information, and most sharing of psychotherapy notes.
In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
Our office has always and will continue to maintain the highest standards regarding our client(s)’ personal information. We will only release healthcare information about you in accordance with federal and state laws and ethics of the psychotherapy, counseling, and creative art therapy professions. However, there are a few exceptions. Of course, we will keep your health information private, but there are uses and disclosures of your information that do not require your consent as well as times when the law requires us to use or share it. This may include:
Treatment. We may need to use or disclose (send, share, release) health information about you to provide, manage or coordinate your care and related services. This may include communications with consultants, potential referral sources, etc. In all cases, this requires your written consent, including a signed Authorization for Release of Information Form.
Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities.
Emergencies. Information will be shared to address an immediate emergency.
Public Health Activity. When there is a serious threat to your health and safety or the health and safety of another individual or the public. We will only share information with a person or organization which is able to help prevent or reduce threat, as well as alert any other person who may be in danger.
Do research. We can use or share your information for health research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Criminal Activity. We may disclose health information about you if a crime is committed on our premises or against our personnel or associates, or if we believe someone is in immediate danger.
Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director who is performing duties authorized by law, when an individual dies.
Child/Elder/Dependent Adult Abuse or Neglect. By state law, we are required to report information about you that may be related to the suspicion of child and/or elder abuse or neglect. By state law, we are required to report information about you that may be related to the suspicion of child abuse or neglect, as well as abuse or neglect of adults 60 or older and/or people with disabilities.
Judicial and Administrative Proceedings. We may disclose personal health information in relation to some lawsuits and legal or court proceedings in response to a valid court or administrative order, in response to a subpoena, or other lawful process.
National Security, Intelligence Activities. As authorized by law and in cases of national security, we may release health information about you to authorized federal officials.
Workers’ compensation, law enforcement, and other government requests. We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.
Business Associates. InTouch & Motion may disclose minimum necessary health information to business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. All business associates sign business associate agreements that govern how they use and protect your health information.
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
To Submit any written requests or to discuss privacy practices and your rights regarding your health information in more detail, please contact Amanda E. Mitchell, LCPC, BC-DMT at 773-850-9046 or email@example.com.
The effective date of this Notice is June 24, 2022.