The privacy regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require ethical and legal commitment to the confidentiality of your Personal Health Information.
Under the laws of the United States and the state of Missouri your Personal Health Information (PHI) must be kept private. It is also required by law to give you this notice and to follow the terms of this notice while it is in effect.
Changes in these privacy practices are allowed at any time as long as those changes are permitted or required by law. Any changes in these privacy practices will affect how the privacy of your PHI is protected, including any PHI received about you or created in the course of your therapy. These changes could also affect the protection of the privacy of any of your PHI received before the changes. If changes are made, a new notice will be posted on www.norconfc.com or you can request a paper copy at the front desk at any time.
PLANNED USES OR DISCLOSURES TO WHICH YOU MAY REQUEST RESTRICTION:
Your PHI will be used for the purposes described in this section. You have the right to request in writing restrictions on uses and disclosures of Private Healthcare Information. Your request must indicate (1) what information you want restricted; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the restrictions to apply. Norcon Family Counseling is not required to agree to any restrictions that you may request and has the right to refuse treatment if permission to use or disclose your medical information is not granted, but if they do agree to your request, it will be in writing and the agreement is binding.
Treatment- PHI may be used and disclosed to a supervising therapist or to your physician or other healthcare provider who is also treating you to provide, coordinate or manage your health care and related services.
Payment - Your PHI may be used and disclosed to your health plan or other third party for payment of services provided for you. If your contract with your insurance company requires that information relevant to the services provided be given before payment, providing them with a clinical diagnosis, as well as clinical information such as treatment plans or summaries and/or copies of any records maintained about your therapy sessions may be required. You may also be contacted by phone, email and/or mail regarding account balances. If contact is by phone, a recorded message may be left on your answering machine/voicemail.
Health Care Operations - Your PHI may be used and disclosed to staff members for operations that are necessary to run our practice and make sure clients receive quality care. This includes but is not limited to for the purpose of obtaining insurance eligibility, billing health insurance and inquiring about claim status.
Appointment Reminders - You may be contacted by phone or email for an appointment reminder or that you have missed such an appointment. If contact is by phone, a recorded message may be left on your answering machine.
Therapist Cancellation – If for some reason an appointment must be cancelled, you will be contacted by phone or email. If contact is by phone, a recorded message may be left on your answering machine/voicemail.
Treatment Alternatives - Your PHI may be used to provide you with information about or recommendations of possible treatment options or alternatives that may interest you.
Treatment Services - Your PHI may be used or disclosed to inform you about health benefits or services that may interest you.
Event of an Emergency - Your PHI may be disclosed to the person you have listed as your “Emergency Contact” in the event of an emergency. We may also contact the person you have listed as your “Emergency Contact” in the event that we are unable to contact you and it has been clinically determined that we need to reach you to ensure appropriate treatment. In so doing, only the aspects of your PHI that are necessary for response to the emergency will be used or disclosed.
USES AND DISCLOSURES OF MEDICAL INFORMATION THAT DO NOT REQUIRE YOUR CONSENT OR AUTHORIZATION:
We may use or disclose your protected health information in the following situations without your authorization and are not required by law to tell you that we have done so.
These situations include:
As Law Requires - Your PHI may be used and disclosed to any person required by federal, state, or local laws to have lawful access to your treatment program.
Court Orders, Judicial and Administrative Proceedings, and Law Enforcement - Your PHI may be disclosed as part of a court proceeding, in response to a subpoena, or in other situations as required by law.
Victims of Abuse, Neglect, or Domestic Violence - Your PHI may be used or disclosed to authorized persons from state agencies in cases of disclosures required by applicable state laws governing abuse, neglect, criminal activities, threats to the health/safety of the client and others, domestic violence, etc. In the case of minor children, the law requires such information to be disclosed.
Legal Representative- Upon their request, your PHI may be disclosed to the parent of an unemancipated minor, to the legal custodian or the legal guardian or otherwise legal apointee to make decsions for medical care unless the therapist feels this will be harmful to the client's care. Because confidentiality is crucial in the treatment of teenagers, therapists generally only provide general information such as diagnosis and how therapy is going to parents of clients between the ages of 13-18 and treat the details as confidential.
Military - If you are a member of the armed forces, we may disclose your protected health information to military command authorities (or if foreign military personnel, to appropriate foreign military authorities).
Public Health- Your PHI may be used for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability.
Disaster Relief - We can disclose health information about you to a public or private entity that is authorized by law or its charter to assist in disaster relief efforts, i.e., the American Red Cross, for the purpose of notification of family
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN AUTHORIZATION:
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described above. Any specific written authorization you provide may be revoked at any time by your written request.
If you revoke your authorization, we will no longer use or disclose the information. However, we will not be able to
take back any disclosures that we have made pursuant to your previous authorization.
REPORTS RECORDS AND FORMS
Your medical record is the property of Norcon Family Counseling and Norcon is the custodian and guardian of all client records performed at 20 Westwoods Dr. after November 1, 2019. For records before this date or performed at a different location, you will need to contact your individual therapist to request records.
Any requests for medical records, reports/letters requests must be submitted to Norcon in writing through completing our Release/Request of Information Form. If you request copies of information, there will be a fee for costs associated with your request which will stated on the request form. Therapist will not start the request until we have received the completed Request Form and payment has been received. If there is a deadline, it is your responsibility to request item(s) 14 days prior to the deadline to guarantee delivery. If you notify Norcon of a deadline that is sooner than 14 days, Norcon will try to meet the deadline but it cannot be guaranteed.
When more than one client is involved in treatment, such as in the case of couples and family therapy, the therapist can only release records with signed authorizations from all of the adults involved in treatment.
As a client, you have the right to review or receive a summary of your records at any time, except in limited legal or emergency circumstances or when the therapist feels that releasing such information might be harmful in any way. Upon your request, the therapist will release information to any agency/person you specify unless he/she feels that releasing such information might be harmful in any way. If Norcon denies access to any or all parts of your protected information, and depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed.
AMENDMENT TO RECORDS
You have the right to request that your health information be changed if you believe that it is incorrect or incomplete. You have a right to request changes for as long as the information is kept by Norcon Family Counseling. To request a change in your information, you must submit it in writing to our agency’s privacy officer. In addition, you must give the reason that you want the information changed, including why you think the information is incorrect or incomplete. We may deny your request for an amendment. We can deny your request if it is not in writing and if it does not include a reason why the information should be changed. We can also deny your request for the following reasons:
(1) the information was not created by us, unless the person or entity that did create the information is no longer available; (2) the information is not a part of the medical record kept by or for us; (3) the information is not part of the information that you would be permitted to inspect and copy; or (4) we believe the information is accurate and complete. If an amendment is granted, it will be maintained with your protected health information; however, the original information will be maintained as well.
REQUEST PHI DISCLOSURES
You have the right to receive an accounting of disclosures of medical information that we have made, with some
exceptions and limitations. You must submit your request in writing to the Privacy Officer Your request must state
the time period that may not be longer than six (6) years. You
should include how you want the information reported to you, i.e., by paper, electronically, etc. You have the right to receive a free accounting every twelve (12) months. If you request more than one (1) accounting in a twelve (12) month period, we may charge you a reasonable fee for the costs of providing that list. We will notify you of the charge for such a request and you can then choose to withdraw or change your request before any costs are incurred.
FOR QUESTIONS, CONCERNS OR COMPLAINTS
As a mental health professional licensed by the State of Missouri, the therapists are committed to practice according to the ethics of the counseling profession. You may see and copy the information described on this form upon your request. You may contact the appropriate licensing board of your therapist or the secretary of the United States Department of Health and Human Services with questions or to register complaints about any licensed mental health professional or you may send a letter in writing to Melinda Haney, Privacy Officer, Norcon Family Counseling, 20 Westwoods Dr., Liberty, MO 64068. There will be no retaliation for filing a complaint.