Your Information. Your Rights. Our Responsibilities.
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.
Your Rights
You have the right to:
- Get a copy of your paper or
electronic medical record
- Correct your paper or
electronic medical record
- 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
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
When it comes to your health information, you have certain
rights. This section explains your rights and some of our
responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get
an electronic or paper copy of your medical record 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.
- If you ask to see or
receive a copy of your record for purposes of reviewing current
medical care, we may not charge you a fee.
- If you request copies of
your patient records of past medical care, or for certain
appeals, we may charge you specified fees.
Ask us to correct your medical record
- 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. Minnesota Law requires
consent for disclosure of treatment, payment, or operations
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 a year for free
but will charge a reasonable, cost-based fee if you ask for
another one within 12 months.
Get a copy of this privacy notice
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
medical 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 using the
information on page 1.
- 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
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:
- Most sharing of
psychotherapy notes
Our Uses and Disclosures How do we typically use or share your
health information?
We typically use or share your health information in the
following ways. We need your consent before we disclose protected
health information for treatment, payment, and operations
purposes, unless the disclosure is to a related entity, or the
disclosure is for a medical emergency and we are unable to obtain
your consent due to your condition or the nature of the medical
emergency.
Treat you
We can use your health information and share it with other
professionals who are treating you only if we have your consent.
We can only release your health records to health care facilities
and providers outside our network without your consent if it is
an emergency and you are unable to provide consent due to the
nature of the emergency. We may also share your health
information with a provider in our network.
Example: A doctor treating you for an injury asks
another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice,
improve your care, and contact you when necessary.We are required
to obtain your consent before we release your health records to
other providers for their own health care operations.
Example: We use health information about you to manage your
treatment and services.
Bill for your services
We can use and share your health information to bill and get
payment from health plans or other entities only if we obtain
your consent.
Example: We give information about you to your health
insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other
ways - usually in ways that contribute to the public good, such
as public health and research. We have to meet many conditions in
the law before we can share your information for these purposes.
For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations
such as:
- Reporting suspected abuse,
neglect, or domestic violence
- Preventing or reducing a
serious threat to anyone's health or safety
- Reporting adverse reactions
to medications
Do research
We can use or share your information for health research if you
do not object.
Comply with the law
We will share information about you if state or federal laws
require it, including with the Department of Health and Human
Services if it wants to see that we're complying with federal
privacy law.
Work with a medical examiner or funeral director
- We can share health
information with a coroner, medical examiner, or funeral director
when an individual dies. We need consent to share information
with a funeral director.
Address workers' compensation, law enforcement, and other
government requests
We can use or share health information about you:
- For workers' compensation
claims
- For law enforcement
purposes or with a law enforcement official with your consent,
unless required by law.
- With health oversight
agencies for activities authorized by law
- For special government
functions such as military, national security, and presidential
protective services with your consent, unless required by law.
Respond to lawsuits and legal actions
We can share health information about you in response to a court
or administrative order, or in response to a subpoena.
Other State Laws
In Minnesota, we need your consent before we disclose protected
health information for treatment, payment, and operations
purposes, unless the disclosure is to a related entity, or the
disclosure is for a medical emergency and we are unable to obtain
your consent.
Our Responsibilities
- We are required by law to
maintain the privacy and security of your protected health
information.
- We will let you know
promptly if a breach occurs that may have compromised the privacy
or security of your information.
- We must follow the duties
and privacy practices described in this notice and give you a
copy of it.
- We will not use or share
your information other than as described here unless you tell us
we can in writing. If you tell us we can, you may change your
mind at any time. Let us know in writing if you change your mind.
For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
- We do not share your
information for fund raising or marketing purposes.
- We do not release substance
abuse records without your written permission.
Changes to the Terms of this Notice We can change the terms of
this notice, and the changes will apply to all information we have
about you. The new notice will be available upon request, in our
office, and on our web site. Other Instructions for Notice
- Privacy officer: Annie
Schwain, MA, LADC, LMFT, 612-325-2919, annie@vodacounseling.com
- Effective date: October 5,
2018
- This notice applies to Voda
Counseling 7831 East Bush Lake Road, Suite 200G, Bloomington, MN
55439, 612-325-2919, www.vodacounseling.com