HIPAA NOTICE OF PRIVACY PRACTICES
I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
II. IT IS PEARL VITALITY COUNSELING’S LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI).
By law, Pearl Vitality Counseling is required to ensure that your PHI is kept private. The PHI constitutes information created or noted by us that can be used to identify you. It contains data about your past, present, or future health or condition, the provision of health care services to you, or the payment for such health care. Pearl Vitality Counseling is required to provide you with this Notice about our privacy procedures. This Notice must explain when, why, and how Pearl Vitality Counseling would use and/or disclose your PHI. Use of PHI means when Pearl Vitality Counseling share, apply, utilize, examine, or analyze information within our practice; PHI is disclosed when Pearl Vitality Counseling release, transfer, give, or otherwise reveal it to a third party outside our practice. With some exceptions, Pearl Vitality Counseling may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, Pearl Vitality Counseling is always legally required to follow the privacy practices described in this Notice.
Please note that Pearl Vitality Counseling reserves the right to change the terms of this Notice and our privacy policies at any time as permitted by law. Any changes will apply to PHI already on file with us. Before Pearl Vitality Counseling makes any important changes to our policies, we will immediately change this Notice and post a new copy of it in our office and website. You may also request a copy of this Notice from us, or you can view a copy of it in our office or on www.pearlvitality.com.
III. HOW PEARL VITALITY COUNSELING WILL USE AND DISCLOSE YOUR PHI.
Pearl Vitality Counseling will use and disclose your PHI for many different reasons. Some of the uses or disclosures will require your prior written authorization; others, however, will not. Below you will find the different categories of our uses and disclosures, with some examples.
A. Uses and Disclosures Related to Treatment, Payment, or Health Care Operations
Do Not Require Your Prior Written Consent. Pearl Vitality Counseling may use and disclose your PHI without your consent for the following reasons:
1. For treatment. Pearl Vitality Counseling can use your PHI within our practice to provide you with mental health treatment, including discussing or sharing your PHI with our trainees and interns. Pearl Vitality Counseling may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. Example: If a psychiatrist is treating you, Pearl Vitality Counseling may disclose your PHI to her/himin order to coordinate your care.
2. For health care operations. Pearl Vitality Counseling may disclose your PHI to facilitate the efficient and correct operation of our practice. Examples: Quality control – Pearl Vitality Counseling might use your PHI in the evaluation of the quality of health care services that you have received or to evaluate the performance of the health care professionals who provided you with these services. Pearl Vitality Counseling may also provide your PHI to our attorneys, accountants, consultants, and others to make sure that Pearl Vitality Counseling is in compliance with applicable laws.
3. To obtain payment for treatment. Pearl Vitality Counseling may use and disclose your PHI to bill and collect payment for the treatment and services Pearl Vitality Counseling provided you. Example: Pearl Vitality Counseling might send your PHI to your insurance company or health plan to get payment for the health care services that Pearl Vitality Counseling has provided to you. Pearl Vitality Counseling could also provide your PHI to business associates, such as billing companies, claims processing companies, and others that process health care claims for our office.
4. Other disclosures. Examples: Your consent isn’t required if you need emergency
treatment provided that Pearl Vitality Counseling attempt to get your consent after treatment is rendered. If Pearl Vitality Counseling tries to get your consent but you are unable to communicate with us (for example, if you are unconscious or in severe pain) but Pearl Vitality Counseling think that you would consent to such treatment if you could, Pearl Vitality Counseling may disclose your PHI.
B. Certain Other Uses and Disclosures Do Not Require Your Consent. Pearl Vitality Counseling may use and/or disclose your PHI without your consent or authorization for the following reasons:
1. When disclosure is required by federal, state, or local law; judicial, board, or
administrative proceedings; or, law enforcement. Example: Pearl Vitality Counseling may make a disclosure to the appropriate officials when a law requires us to report information to government agencies, law enforcement personnel and/or in an administrative proceeding.
2. If disclosure is compelled by a party to a proceeding before a court of an
administrative agency pursuant to its lawful authority.
3. If disclosure is required by a search warrant lawfully issued to a governmental
law enforcement agency.
4. If disclosure is compelled by the patient or the patient’s representative pursuant
to California Health and Safety Codes or to corresponding federal statutes of
regulations, such as the Privacy Rule that requires this Notice.
5. To avoid harm. Pearl Vitality Counseling may provide PHI to law enforcement personnel or persons able to
prevent or mitigate a serious threat to the health or safety of a person or the public (i.e.,
adverse reaction to meds).
6. If disclosure is compelled or permitted by the fact that you are in such mental or
emotional condition as to be dangerous to yourself or the person or property of
others, and if Pearl Vitality Counseling determine that disclosure is necessary to prevent the threatened
7. If disclosure is mandated by the California Child Abuse and Neglect Reporting
law. For example, if Pearl Vitality Counseling has a reasonable suspicion of child abuse or neglect.
8. If disclosure is mandated by the California Elder/Dependent Adult Abuse
Reporting law. For example, if Pearl Vitality Counseling has a reasonable suspicion of elder abuse or dependent adult abuse.
9. If disclosure is compelled or permitted by the fact that you tell us of a
serious/imminent threat of physical violence by you against a reasonably
identifiable victim or victims.
10. For public health activities. Example: In the event of your death, if a disclosure is
permitted or compelled, Pearl Vitality Counseling may need to give the county coroner information about you.
11. For health oversight activities. Example: Pearl Vitality Counseling may be required to provide information to assist the government in the course of an investigation or inspection of a health care organization or provider.
12. For specific government functions. Examples: Pearl Vitality Counseling may disclose PHI of military personnel and veterans under certain circumstances. Also, Pearl Vitality Counseling may disclose PHI in the interests of national security, such as protecting the President of the United States or assisting with intelligence operations.
13. For research purposes. In certain circumstances, Pearl Vitality Counseling may provide PHI in order to conduct medical research.
14. For Workers’ Compensation purposes. Pearl Vitality Counseling may provide PHI in order to comply with Workers’ Compensation laws.
15. Appointment reminders and health related benefits or services. Examples: Pearl Vitality Counseling may use PHI to provide appointment reminders. Pearl Vitality Counseling may use PHI to give you information about alternative treatment options, or other health care services or benefits Pearl Vitality Counseling offer.
16. If an arbitrator or arbitration panel compels disclosure, when arbitration is
lawfully requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel.
17. If disclosure is required or permitted to a health oversight agency for oversight
activities authorized by law. Example: When compelled by U.S. Secretary of Health
and Human Services to investigate or assess our compliance with HIPAA regulations.
18. If disclosure is otherwise specifically required by law.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
1. Disclosures to family, friends, or others. Pearl Vitality Counseling may provide your PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.
D. Other Uses and Disclosures Require Your Prior Written Authorization. In any
other situation not described in Sections IIIA, IIIB, and IIIC above, Pearl Vitality Counseling will request your written authorization before using or disclosing any of your PHI. Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (assuming that Pearl Vitality Counseling hasn’t taken any action subsequent to the original authorization) of your PHI by us.
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
These are your rights with respect to your PHI:
A. The Right to See and Get Copies of Your PHI. In general, you have the right to see
your PHI that is in Pearl Vitality Counseling’s possession, or to get copies of it; however, you must request it in writing. If Pearl Vitality Counseling does not have your PHI, but Pearl Vitality Counseling know who does, Pearl Vitality Counseling will advise you how you can get it.
You will receive a response from us within 30 days of our receiving your written
request. Under certain circumstances, Pearl Vitality Counseling may feel we must deny your request, but if we do, Pearl Vitality Counseling will give you, in writing, the reasons for the denial. Pearl Vitality Counseling will also explain your right to have our denial reviewed. If you ask for copies of your PHI, Pearl Vitality Counseling will charge you not more than $.25 per page. Pearl Vitality Counseling may see fit to provide you with a summary or explanation of the PHI, but only if you agree to it, as well as to the cost, in advance.
B. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the
right to ask that Pearl Vitality Counseling limits how we use and disclose your PHI. While we will consider your request, we are not legally bound to agree. If we do agree to your request, we will put those limits in writing and abide by them except in emergency situations. You do not have the right to limit the uses and disclosures that Pearl Vitality Counseling is legally required or permitted to make.
C. The Right to Choose How Pearl Vitality Counseling Sends Your PHI to You. It is your right to ask that your PHI be sent to you at an alternate address (for example, sending information to your work address rather than your home address) or by an alternate method (for example, via e-mail instead of by regular mail). Pearl Vitality Counseling is obliged to agree to your request providing that Pearl Vitality Counseling can give you the PHI, in the format you requested, without undue inconvenience. Pearl Vitality Counseling may not require an explanation from you as to the basis of your request as a condition of providing communications on a confidential basis.
D. The Right to Get a List of the Disclosures Pearl Vitality Counseling Has Made. You are entitled to a list of disclosures of your PHI that Pearl Vitality Counseling has made. The list will not include uses or disclosures to which you have already consented, i.e., those for treatment, payment, or health care operations, sent directly to you, or to your family; neither will the list include disclosures made for national security purposes, to corrections or law enforcement personnel, or disclosures made before April 15, 2003. After April 15, 2003, disclosure records will be held for six years.
Pearl Vitality Counseling will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we give you will include disclosures made in the previous six years unless you indicate a shorter period. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure.
We will provide the list to you at no cost, unless you make more than one request in the same year, in which case Pearl Vitality Counseling will charge you a reasonable sum based on a set fee for each additional request.
E. The Right to Amend Your PHI.
If you believe that there is some error in your PHI or
that important information has been omitted, it is your right to request that Pearl Vitality Counseling corrects the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of our receipt of your request. Pearl Vitality Counseling may deny your request, in writing, if we find that: the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of our records, or (d) written by someone other than us. Our denial must be in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and our denial be attached to any future disclosures of your PHI. If Pearl Vitality Counseling approves your request, we will make the change(s) to your PHI. Additionally, We will tell you that the changes have been made, and will advise all others who need to know about the change(s) to your PHI.
F. The Right to Get This Notice by E-mail. You have the right to get this notice by email.
You have the right to request a paper copy of it, as well.
V. HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If, in your opinion, Pearl Vitality Counseling may have violated your privacy rights, or if you object to a decision we made about access to your PHI, you are entitled to file a complaint with the person listed in Section VI below. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W. Washington, D.C. 20201. If you file a complaint about our privacy practices, we will take no retaliatory action against you.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR
TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If you have any questions about this notice or any complaints about Pearl Vitality Counseling’s privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact us at: [Pearl Vitality Counseling, 4809 Eisenhower Ave, Suite B, Alexandria VA 22304,
(571) 402-2541, firstname.lastname@example.org).
VII. NOTIFICATIONS OF BREACHES
In the case of a breach, Pearl Vitality Counseling is required to notify each affected individual whose unsecured PHI has been compromised. Even if such a breach was caused by a business associate, we are ultimately responsible for providing the notification directly or via the business associate. If the breach involves more than 500 persons, OCR must be notified in accordance with instructions posted on its website. Pearl Vitality Counseling bears the ultimate burden of proof to demonstrate that all notifications were given or that the impermissible use or disclosure of PHI did not
constitute a breach and must maintain supporting documentation, including documentation pertaining to the risk assessment.
VIII. PHI AFTER DEATH
Generally, PHI excludes any health information of a person who has been deceased for
more than 50 years after the date of death. Pearl Vitality Counseling may disclose deceased individuals’ PHI to non-family members, as well as family members, who were involved in the care or payment for healthcare of the decedent prior to death; however, the disclosure must be limited to PHI relevant to such care or payment and cannot be inconsistent with any prior expressed preference of the deceased individual.
IX. INDIVIDUALS’ RIGHT TO RESTRICT DISCLOSURES; RIGHT OF ACCESS
To implement the 2013 HITECH Act, the Privacy Rule is amended. Pearl Vitality Counseling is required to restrict the disclosure of PHI about you, the patient, to a health plan, upon request, if the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law. The PHI must pertain solely to a healthcare item or service for which you have paid the covered entity in full. (OCR
clarifies that the adopted provisions do not require that covered healthcare providers create separate medical records or otherwise segregate PHI subject to a restrict healthcare item or service; rather, providers need to employ a method to flag or note restrictions of PHI to ensure that such PHI is not inadvertently sent or made accessible to a health plan.) The 2013 Amendments also adopt the proposal in the interim rule requiring Pearl Vitality Counseling, to provide you, the patient, a copy of PHI if you, the patient, requests it in electronic form. The electronic format must be provided to you if it is readily producible. OCR clarifies that Pearl Vitality Counseling must provide you only with an electronic copy of their PHI, not direct access to their electronic health record systems. The 2013 Amendments also give you the right to direct Pearl Vitality Counseling to transmit an electronic copy of PHI to an entity or person designated by you. Furthermore, the amendments restrict the fees that Pearl Vitality Counseling may charge you for handling and reproduction of PHI, which must be reasonable, cost-based and identify separately the labor for copying PHI (if any). Finally, the 2013 Amendments modify the timeliness requirement for right of access, from up to 90 days currently permitted to 30 days, with a one-time extension of 30 additional days.
Pearl Vitality Counseling NPP must contain a statement indicating that most uses and
disclosures of psychotherapy notes, marketing disclosures and sale of PHI do require prior
authorization by you, and you have the right to be notified in case of a breach of unsecured PHI.
XI. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on January 2013.