HIPAA Privacy Statement
NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION (PHI)
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.
This notice gives you information required by law about the duties and privacy practices of Acacia, and how we may use and disclose your protected health information.
“Protected Health Information” is health information created or received by your health care provider that contains information that may be used to identify you, such as demographic data, and that may relate to your past, present or future physical or mental health condition. This notice goes into effect immediately, and shall remain in effect until modified or amended.
Uses and Disclosures of Protected Health Information
Acacia Counseling will take all necessary steps to protect your health information and limit its disclosure as described in this notice. Acacia may use and disclose protected health information as permitted by the rules and regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and also with your consent or specific authorization.
Following are categories that describe the different ways that Acacia Counseling may use and disclose your protected health information. Acacia will not participate in research activities requiring release of consumer confidential information without obtaining For Payment Purposes:prior written informed consent for release of information from the consumer.
For Treatment Purposes:
Treatment purposes are defined as the provision, coordination or management of your care. An example of this would be consultations between agency staff.
For Payment Purposes
Payment purposes means activities that Acacia undertakes to obtain reimbursement for the mental health treatment provided to you, such as determination of insurance eligibility and coverage, obtaining authorization for services, filing of claims and other utilization review activities.
Health Care Operations:
Health care operations are defined as functions which facilitate the operation of this agency. For example, we may use your protected health information to review and improve the quality of care we provide, or for program compliance audits.
With Your Authorization:
Acacia may disclose your private health information for purposes not described in this Notice or otherwise permitted by law only with your written authorization. You may revoke an authorization at any time, but only as to future uses or disclosures, and only where we have not already acted in reliance on your authorization.
We may use and disclose your protected health information to remind you about appointments. We may phone your home. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.
Acacia may use and disclose protected health information to third party “business associates” that perform various activities on behalf of Acacia. These business associates may include the insurers, state auditors or other persons associated with providing services to the agency or you.
Acacia will have in place a written document, signed by a representative of the business associate, that contains terms and conditions that will protect the privacy of your protected health information.
As Required by Law:
Acacia may use and disclose protected health information for purposes required by law, but only to the extent and under the circumstances provided in that law.
Special Circumstances for Use and Disclosure
Abuse or Neglect:
Acacia may use or disclose protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.
Acacia may disclose protected health information to a court of law upon the receipt of duly executed court order signed by a judge.
Reporting of a Crime or Threats Against Agency Personnel:
Acacia may disclose protected health information to a law enforcement official in the reporting of a crime on the premises or against the agency or the reporting of threats against agency personnel.
Your Protected Health Information Rights
You have the right:
To request restrictions on certain uses and disclosures of your protected health information. This request must be made to us in writing and specify what information you want to limit and what limitations on our disclosure of the information you wish to impose. We reserve the right to accept or reject your request and will notify you of our decision.
To request that you receive protected health information in a specific way or at a specific location. For example, you may request that Acacia send all correspondence to you at your work address rather than your home address.
To review and obtain a copy of your protected health information that is contained in a designated record as long as Acacia maintains the protected health information, with limited exceptions defined by law. A reasonable fee may be charged for making copies. The request to review and/or obtain a copy of your protected health information must be made in writing to the agency Privacy Officer.
To request that we amend your protected health information that you believe is incorrect or incomplete. The request to amend protected health information must be made in writing to the agency. We are not required to change your protected health information and will provide you with an explanation if we deny your request for amendment or change.
To receive an accounting of disclosures made of your protected health information by Acacia, unless the disclosures were pursuant to your written authorization or for the purposes of treatment, payment, or healthcare operations as described in this Notice of Privacy Practices .
If you believe your privacy rights have been violated, you may file a complaint with Acacia, or with the State Board of Behavioral Health, or with the Secretary of the Department of Health and Human Services. You can not be penalized for filing a complaint.
Acacia Counseling reserves the right to change or amend this Notice of Privacy Practices at any time in the future. After an amendment is made, the revised Notice of Privacy Practices will apply to all protected health information created after the amendment or change. A copy of any revised Notice of Privacy Practices will be made available to you at your next appointment following the revision.
If you would like to have a more detailed explanation of these rights, or if you would like to exercise one or more of these rights, contact the Privacy Officer.