THIS NOTICE DESCRIBES HOW MEDICAL, MENTAL HEALTH, AND DRUG AND ALCOHOL RELATED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date of this Notice: 4/13/03
Hummingbird Coaching Services(HCS) is required by law to maintain the privacy of all health related information and to provide notice of its legal duties and privacy practices with respect to this information. This Notice of Privacy Practices describes your rights to access and control your confidential and protected health information. It also describes the conditions and limitations we must follow in using and disclosing your confidential and protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all confidential and protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. You can obtain a revised copy by calling HCS and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment. If you have questions about any part of this notice or if you want more information about the privacy practices at Hummingbird Coaching Services, please contact us.
I. How Hummingbird Coaching Services may Use or Disclose your Health Information
Information about you including your name, contact information and the content of your conversations is kept secure at HCS. HCS’s staff or business associates will use this information to carry out treatment, payment and operations. The law permits HCS to use or disclose your information within HCS to ensure quality of services, ongoing counselor training and development, case management and care coordination, and technical support. We may share your protected health information with third party “business associates” that perform various activities (e.g., consulting and business support activities such as auditing, legal, or network provider management) for HCS. Whenever an arrangement between our office and a business associate involves the use or disclosure of protected health information, we will have a written contract that contains terms that will protect the privacy of your health information. Only that information which is necessary to fulfill that business associate function is accessible.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Except as described in this Notice of Privacy Practices, HCS will not use or disclose your health information without your written authorization. For situations where you request us to release confidential information, HCS requires written and notarized authorization from you in order for you to receive copies of your case records, to have us send a 3rd party copies of your records, or to have HCS discuss your case with anyone other than HCS staff and its contracted consultants.
If you do authorize HCS to use or disclose your health information, you may revoke your authorization in writing at any time.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
Required By Law: As required by law, we may use and disclose your health information.
Health Oversight Activities: We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
Abuse or Neglect: In accordance with mandatory reporting laws, HCS is required to report abuse and neglect of children and abuse, neglect or exploitation of an elderly person or person with disabilities. In the course of reporting, HCS may release limited protected health information necessary for reporting purposes.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal and in certain permissible conditions in response to a subpoena, discovery request or other lawful process.
Averting a Serious Threat to Health or Safety: Consistent with applicable law and standards of ethical conduct, HCS may use or disclose protected health information if HCS in good faith believes it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or persons. For example, HCS may notify law enforcement, medical authorities and/or potential victims of threats of harm. Notification could include your employer if you make a threat to the safety and health of individuals within your place of employment.
Marketing: HCS will not give your private health information to any outside marketers. We may contact you to conduct a follow-up survey on the helpfulness of our services or to give you information about other services or health-related benefits that may be of interest to you.
II. Your Rights
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and receive a copy of your protected health information. You have the right to inspect and have a copy of your own health information maintained by HCS except for information HCS compiled or originated for use in a civil, criminal or administrative proceeding or in other limited circumstances.
HCS may deny access to any portion of the record if we determine that release of that portion would be harmful to your physical, mental, or emotional health. You have a right to have this decision reviewed. Please contact us if you have questions about access to your records.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. HCS is not required to agree to any restrictions you request, but if HCS does agree, we may not use or disclose any information which you have restricted except as necessary in a medical emergency, as lawfully required or if necessary (as determined by HCS) in the event of a potential threat of harm to you or others. With this in mind, please discuss with your counselor any restriction you wish to request.
You have the right to request that we communicate with you by alternative means or at an alternative location. HCS will accommodate such requests that are reasonable and will not request an explanation from you except where it specifically relates to your counseling and provision of care.
You may have the right to have your counselor amend your protected health information. You may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact us to determine if you have questions about amending your records.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. You have the right to receive specific information regarding these disclosures that occurred after April 13, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request.
III. Complaints
You may complain to HCS and to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated by HCS. You may file a complaint with us by notifying our privacy officer of your complaint. We can be contacted by calling HCS at 1-877-240-4588. We will not retaliate against you for filing a complaint.
If you are not satisfied with the manner in which HCS handles a privacy complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
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