THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AS WELL AS HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

Understanding Your Client Health and Wellness/Information

 

Each time you receive counseling services from Haven Point, LLC (“HP”), a record of your services is made. This record may include your presenting problems, background information, assessments, treatment, and plans for future counseling or other services. This information -your client record- is used to plan your counseling services. Although your client record belongs to HP, you do have certain rights with regard to your counseling information.

Our current Notice is posted online at thehavenpoint.com You also have the right to receive a paper copy on this Notice and may ask us to give you a copy of this Notice at any time. If you received this Notice electronically, you are entitled to a paper copy of this Notice. We must follow the privacy practice that is described in this Notice while it is in effect. If you have any questions about the Notice, please contact our Founder at 402-674-0774

 

Your Rights

• You have a right to receive a paper copy of this privacy notice at your request.

• You have a (limited) right to know who has seen your counseling information, and for what purpose. If you make additional requests for such an accounting during any 12-month period, we may charge you a reasonable, cost-based fee.

• You have a right to see, and to keep a copy of, your counseling records (except psychotherapy notes). Your request for a copy of your record must be in writing. We may charge you a reasonable, cost-based, copying fee. You may not inspect or copy psychotherapy notes, information compiled in anticipation of litigation, or information subject to a law that prohibits access. The decision to deny access may be reviewable in certain case.

• You have a right to ask for correction –or inclusion of a statement of disagreement – for anything in your records that you feel is in error. Your request must be in writing and include supporting documentation. We may, under certain circumstances, deny your request.

• You have a right to request, in writing, that we not use or disclose your information for treatment, payment, or administrative purpose, or to persons involved in your care except when specifically authorized by you, when required by law, or in emergency situations. To request a restriction on who may have access to your protected health information, you must submit a written request to HP. Your request must state the specific restriction requested and to whom you want the restriction to apply.  We are not required to agree to a restriction that you may request unless you are asking us to restrict the use and disclosure of your protected health information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we do agree to the requested restriction, we may not use or disclose your protected health information in violation of the restriction unless it is needed to provide emergency treatment.

• You have a right to request extra protections for counseling information you consider especially sensitive, and to request that we communicate with you by alternative means.

 

Our Responsibilities

 

We reserve the right to change this Notice of Privacy Practices and to make the new provisions effective for all health information we maintain. Should our privacy practices change, we will provide a revised Notice of Privacy Practices at your next appointment.

HIPAA generally permits use and disclosure of your health information without your permission for purposes of health care treatment, payment activities and health care operations. These uses and disclosures are more fully described below. The following categories describe the different ways that we may use and disclose your protected health information. These examples are not meant to be exhaustive, but to illustrate the types of uses and disclosures that may be made by us. However, we may never have a reason to make some of these disclosures:

 

We will use and disclose your information for treatment purposes.

 

For example: Information obtained by your clinician will be recorded in your record and used to determine the course of your professional services. Your clinician and other qualified mental health team members may communicate with one another personally and through the client record to coordinate your professional services and assess your treatment and outcomes. This information is used in our ongoing efforts to ensure the quality and effectiveness of our professional services we provide.

 

We will use and disclose your health information for payment purposes.

 

For example, a bill may be sent to you or a third party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis and/or procedures. If you do not wish for us to disclose information to a third-party payer, you understand that you will be required to pay for the full amount of your services at the time such services are rendered.

 

We will use and disclose your health information for healthcare operations.

 

We may use or disclose your health information to carry out our daily activities as they relate to the provision of healthcare. Healthcare operations include but are not limited to quality assessment activities and licensing activities. For example, we may disclose your information with third parties that perform various business activities (e.g., billing or computer software services) provided we have a written contract with the business that requires it to safeguard the privacy of your protected health information.

 

Other Disclosures That May be Made Without Your Authorization

Unless we are otherwise restricted from doing so, we may also use or disclose your information for the following purposes without your authorization:

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Notification: In an emergency situation, we may use or disclose your health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location, and general condition.

 

Public Health: When required or permitted by law, we may disclose your therapeutic information to public health or legal authorities responsible for preventing or controlling disease, injury, or disability or performing other public health functions. In addition, we may disclose your therapeutic information in order to avert a serious threat to health or life.

 

Abuse or Neglect: If we believe you have been a victim of abuse or neglect or engaging in behavior that is abusive toward children or other “vulnerable” persons as defined by applicable federal and/or states laws, we may disclose your health information to an authorized governmental entity or agency. This disclosure will be made pursuant to the requirements of federal or state laws. We may also disclose your information to a public health entity that is authorized to receive reports of child abuse or neglect.

 

Healthcare Oversight Activities: we may disclose your health information to appropriate authorities for activities including but not limited to monitoring, investigating, inspecting, and disciplining or licensing those who work in the healthcare system or for government benefit programs.

 

Judicial and Administrative Proceedings: We may disclose your health information that is expressly authorized by an administrative proceeding, in response to an order of a court or administrative tribunal, and under certain conditions in response to a subpoena, discovery request or other lawful process.

Specialized governmental functions: we may disclose your therapeutic information for military and veteran activities, national security and intelligence activities, and similar special governmental functions as required or permitted by law.

 

Law Enforcement: We may disclose your therapeutic information for law enforcement purposes as required or permitted by law or in response to a valid subpoena, court order or other binding authority.

 

Disclosure About Decedents: We may disclose health information about decedents to coroners and medical examiners for the purpose of identifying a deceased individual, determining a cause of death, or carrying out other duties permitted by law. Additionally, we may disclose the decedent’s information to funeral directors as authorized by law.

 

Avoid Threat to Health or Safety: We may disclose information to specified authorities if we believe in good faith that a disclosure of your health information is necessary to prevent or minimize a serious threat to you or the public’s health or safety.

 

Disclosure required by law: We may use or disclose your counseling information as required by law provided such use or disclosure complies with and is limited to the relevant requirements of such law.

 

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws related to workers’ compensation or other similar programs established by the law.

 

Charges Against Provider: In the event, you should file a suit against us, we may disclose health information necessary to defend such action. Also, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate and determine our compliance with the law.

 

Uses and Disclosures of Protected Health Information Requiring an Authorization: In situations other than those listed above, we will request your written authorization before using or disclosing protected health information about you. If you chose to sign such authorization to disclose information, you may, in writing, revoke that authorization to stop any future uses and disclosures except to the extent that action has been taken in reliance on the uses and disclose, or if the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim.

 

Additionally, if a use or disclosure of protected health information described above in this Notice is prohibited or materially limited by other laws that apply to use, it is our intent to meet the requirements of more stringent law.

 

BREACH NOTIFICATION

 

This Notice also reflects federal breach notification requirements in the event that your “unsecured protected health information” is acquired by an unauthorized party. We will notify you following the discovery of any “breach” of your unsecured protected health information as defined in the HITECH Act (the “Notice of Breach”). Your Notice of Breach will be in writing and provided via first-class mail, or alternatively, by email if you have previously agreed to receive such notes electronically. If the breach involves:

• 10 or more individuals for whom we have insufficient or out-of-date contact information, then we will provide substitute individual Notice of Breach by either posting the notice on our website or by providing the notice in a major print or broadcast media where the affected individuals likely reside.

• Less than 10 individuals for whom we have insufficient or out-of-date contact information, then we will provide substitute Notice of Breach by an alternative form.

 

Your Notice of Breach will be provided without unreasonable delay and in no case later than 60 days following the discovery of a breach and shall include, to the extent possible:

• A description of the breach

• A description of the types of information that were involved in the breach.

• The steps you should take to protect yourself from potential harm.

• A brief description of what we are doing to investigate the breach, mitigate the harm, and prevent further breaches

• Our relevant contact information.

 

Additionally, for any substitute Notice of Breach provided via web posting or major print or broadcast media, the Notice of Breach shall include a toll-free number for you to contact us to determine if your protected information was involved in the breach.

 

For More Information or to Report a Problem

 

If you have questions or would like additional information, you may contact Haven Point, LLC via telephone at (402) 674-0774 or in writing at the address below. If you believe your privacy rights have been violated, you have the right to file a complaint with Haven Point or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.