Notice of Privacy Practices/HIPAA 07/2020

Summit Counseling
127 W. Illinois St
Spearfish, SD 57783
Notice of Privacy Practices/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 this notice carefully.
Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI.

We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request or providing one to you at your next appointment.

Your Rights
You have the right to:

• Get a copy of your paper or electronic medical records
• Correct your paper or electronic medical records
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
  
  Your Choices
  You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Provide mental health care
• Market our services and sell your information
• Raise funds
  
  Our Uses and Disclosures
  We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government
  requests
• Respond to lawsuits and legal actions
  
  YOUR RIGHTS
  You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to Summit Counseling, 127 W. Illinois St, Spearfish, SD 57783.
  
  Get an electronic or paper copy of your medical records
• You can ask to see or get an electronic or paper copy of your medical records and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request.
• You may request your medical records in the electronic platform you prefer, Summit Counseling will say “yes” to your request so long as it is feasible, safe and secure.
• If you choose to get your medical records electronically, Summit Counseling may charge you $6.50. If you choose to have a paper copy of your medical records made, you will be charged a fee equal to the cost of time and materials.
  
  Ask us to correct your medical records
• You can ask us to correct health information about you that you think is incorrect or incomplete.
  Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
  
  Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
  
  Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
  
  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 per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
• 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.
  
  Choose someone to act for you
• If you have given someone healthcare 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.
  
  File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us at Summit Counseling, 127 W. Illinois St., Spearfish, SD 57783.
• You can 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/.
• We will not retaliate against you for filing a complaint.
  
  YOUR CHOICES
  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 friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory
  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
• 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.
  
  OTHER USES AND DISCLOSURES
  For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services among health care providers or by a health care provider with a third-party, consultation between health care providers regarding you, as a patient, Or, if you are referred from one health care provider to another.
  For Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes
  necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.
  For Health Care Operations. We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a business associate agreement with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes, PHI will be disclosed only with
  your authorization.
  Required by Law. Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of
  investigating or determining our compliance with the requirements of the Privacy Rule.
  Verbal Permission. We may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
  Without Authorization. Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations. The following are example:
• Public Health. If required, we may use or disclose your PHI for mandatory public health
  activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.
• Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is
  authorized by law to receive reports of child abuse or neglect.
• Vulnerable Adult Abuse. If information is revealed about vulnerable adult or elder abuse, we are required by law to report this to the appropriate authority.
• Health Oversight. If required, we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors based on your prior consent) and peer review organizations performing utilization and quality control.
• Court Orders & Legally Issued Subpoenas. If we receive a subpoena for your records, we
  will contact you so you may take whatever steps you deem necessary to prevent the release of your confidential information. We will contact you twice by phone. If we cannot get in touch with you by phone, we will send you written correspondence. If a court of law issues a legitimate court order, we are required by law to provide the information specifically described in the order. Despite any attempts to contact you and keep your records confidential, we are required to comply with a court order.
• Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
• Deceased Patients. We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate or the person identified as next-of-kin. PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA.
• Self-Harm/Suicidality. Threats, plans or attempts to harm oneself. We are permitted to take steps to protect the client’s safety, which may include disclosure of confidential information.
• Harm to Others. We may disclose your PHI, if necessary, to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
• Medical Emergencies. We may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
• Specialized Government Functions. We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.
• Court-Ordered Therapy. If therapy is court ordered, the court may request records or
  documentation of participation in services. We will discuss the information and/or
  documentation with you in session prior to sending it to the court.
• Couples Counseling & “No Secret” Policy. When working with couples, all laws of
  confidentiality exist. We request that neither partner attempt to triangulate the therapist into keeping a “secret” that is detrimental to couple’s therapy goal. If one partner requests that a “secret” be kept in confidence, we may choose to end the therapeutic relationship and give referrals for other therapists as our work and your goals then become counter-productive.
  
  With Authorization. Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization: (i) most uses and disclosures of psychotherapy notes, which are separated from the rest of your medical record; (ii) most uses and disclosures of PHI for marketing purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and disclosures not described in this Notice of Privacy Practices.
  
  Psychotherapy Notes. You will be required to authorize the release of psychotherapy notes related to your treatment in a separate Authorization for Use and Disclosure of Psychotherapy Notes form. Even with your explicit authorization, your therapist may choose not to release psychotherapy notes if the therapist believes it will cause psychological harm.
  
  Social Media. If you choose to comment on our professional social media pages or posts, you do so at your own risk and you may breach your own confidentiality and we cannot be held liable if someone not associated with Brighter Sky Counseling identifies you as a client.
  
  Dual Relationships & Public. Our relationship is strictly professional. In order to preserve this relationship, it is imperative that there is no relationship outside of the counseling relationship (ie: social, business, or friendship). If we run into each other in a public setting, we will not acknowledge you as this would jeopardize confidentiality. If you were to acknowledge us, your confidentiality could be at risk.
  
  Telehealth. Due to illness or other circumstances, clients may want to meet in a telehealth appointment via technology assisted media. You understand there are risks, benefits and consequences associated with telehealth therapy, including, but not limited to, breaches of confidentiality by unauthorized persons. If you choose to have telehealth sessions additional documentation and consent will be required.
  
  COMPLAINTS
  If you believe we have violated your privacy rights, you have the right to file a complaint in writing with Summit Counseling 127 W Illinois St, Spearfish, SD 57783 or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202)619-0257. We will not retaliate against you for filing a complaint.

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