Notice of Midwest Center for Human Services (MCHS) psyhotherapy policies and practices to protect the privacy of your health information.
THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
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I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
MCHS may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your written authorization. To help clarify these terms, here are some definitions:
- “PHI” refers to information in your health record that could identify you (protected health information).
- “Treatment, Payment and Health Care Operations”
Treatment is when MCHS provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when your psychotherapist consults with another health care provider, such as your family physician or a psychologist.
Payment is when MCHS obtains reimbursement for your healthcare. Examples of payment are when MCHS discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
Health Care Operations are activities that relate to the performance and operation of therapy practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
- “Use” applies only to activities within the [office, clinic, practice group, etc.] such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
- “Disclosure” applies to activities outside of the [office, clinic, practice group, etc.], such as releasing, transferring, or providing access to information about you to other parties.
- “Authorization” is your written permission to disclose confidential mental health information. All authorizations to disclose must be on a specific legally required form.
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II. Other Uses and Disclosures Requiring Authorization
MCHS may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when your therapist is asked for information for purposes outside of treatment, payment, or health care operations, MCHS will obtain an authorization from you before releasing this information. MCHS will also need to obtain an authorization before releasing your Psychotherapy Notes.
- “Psychotherapy Notes” are notes your therapist has made about your conversation during a private, group, joint, or family counseling session, which your therapist has kept separate from the rest of your record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.
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III. Uses and Disclosures without Authorization
MCHS may use or disclose PHI without your consent or authorization in the following circumstances:
- Child Abuse – If your MCHS therapist knows or has reasonable cause to suspect that a child known to your therapist in his/her professional capacity has been or is in immediate danger of being a mentally or physically abused or neglected child, your therapist must immediately report such knowledge or suspicion to the appropriate authority.
- Adult and Domestic Abuse – If your therapist believes that an adult is in need of protective services because of abuse or neglect by another person, your therapist must immediately report this belief to the appropriate authorities.
- Health OversightActivities – If the Wisconsin Psychology Examining Board is investigating your therapist or MCHS, your therapist may be required to disclose PHI to the Board.
- Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made for information about the professional services provided you and/or the records thereof, such information is privileged under law, and MCHS will not release information without the written authorization of you or your legally appointed representative or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
- Serious Threat to Health or Safety – If MCHS believes disclosure of PHI is necessary to protect you or another individual from a substantial risk of imminent and serious physical injury, MCHS may disclose the PHI to the appropriate individuals.
- Worker’s Compensation – If you are being treated for Worker’s Compensation purposes, MCHS must provide periodic progress reports, treatment records, and bills upon request to you, your employer, or your insurer, or their representatives.
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IV. Patient’s Rights and MCHS's Duties
- Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information. However, MCHS is not required to agree to a restriction you request.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations –You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing a therapist. On your request, MCHS will send your bills to another address.)
- Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in MCHS's mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. MCHS may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. You may be denied access to Psychotherapy Notes if your therapist believes that a limitation of access is necessary to protect you from a substantial risk of imminent psychological impairment or to protect you or another individual from a substantial risk of imminent and serious physical injury. MCHS shall notify you or your representative if your are not granted complete access. On your request, MCHS will discuss with you the details of the request and denial process.
- Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. MCHS may deny your request. On your request, MCHS will discuss with you the details of the amendment process.
- Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, MCHS will discuss with you the details of the accounting process.
- Right to a Paper Copy – You have the right to obtain a paper copy of the notice from MCHS upon request, even if you have agreed to receive the notice electronically.
- MCHS is required by law to maintain the privacy of PHI and to provide you with a notice of MCHS legal duties and privacy practices with respect to PHI.
- MCHS reserves the right to change the privacy policies and practices described in this notice. Unless you are notified of such changes, however, MCHS is required to abide by the terms currently in effect.
- If MCHS intends to revise PHI-related policies and procedures, MCHS must describe in the notice to patients how the patient will be provided with a revised notice of privacy policies and procedures (e.g., by mail, e-mail).
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V. Questions and Complaints
If you have questions about this notice, disagree with a decision MCHS makes about access to your records, or have other concerns about your privacy rights, please contact us.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. MCHS can provide you with the appropriate address upon request.
You have specific rights under the Privacy Rule. MCHS will not retaliate against you for exercising your right to file a complaint.
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This notice is effective as of April 14, 2003.
MCHS reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that are maintained. MCHS will provide a revised notice by leter, email, or by changing this part of the Site.
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