Uses and Disclosures for Treatment, Payment, and Health Care Operations: 

A clinician may use or disclose your Protected Health Information (PHI) for the treatment, payment, and healthcare  operations purpose with your consent. To help clarify these terms, here are some definitions: 

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PHI- refers to information in your health record that could identify you. 

Treatment- is when a provider coordinates or manages your health care and other services that are related to your  health care, such as consulting with another health care provider or clinician. 

Payment- is when reimbursement is obtained for your health care. Examples of payment are when disclosing 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 the practice. Examples of  health care operations are quality assessment and improvements activities, business-related matters such as audits  and administrate services and case management and care coordination. 

Use- pertains only to activities within the practice group, such as sharing, employing, applying, utilizing,  examining and analyzing information that identifies you. 

Disclosure- applies to activities outside of the practice group, such as releasing, transferring or providing access to  information about you to other parties.

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Uses and Disclosures Requiring Authorization: 

A clinician may use or disclose PHI without your consent in the following circumstances:

 

Child Abuse; If, in the professional capacity, knowledge or suspicion is obtained that a child under 18 years of age, or a mentally, developmentally or physically impaired individual under the age of 21 has suffered or faces a threat  of suffering any physical or mental would, injury, disability or conditions of a nature that reasonably indicates  abuse or neglect, the clinician is required, by law, to immediately report that knowledge or suspicion to the Ohio  Public Children Services Agency, or a municipal or county peace officer. 

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Adult and Domestic Abuse; If there is reasonable cause to believe that an adult is being abused, neglected, or  exploited, or is in a condition which is the result of abuse, neglect or exploitation, the clinician is required, by law,  to immediately report such belief to the County Department of Jobs and Family Services. 

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Judicial or Administrative Proceedings; If you are involved in a court proceeding and a request is made for  information about your re-evaluation, diagnosis or treatment, and the records thereof, such information is  privileged under state law and will not be released without written authorization from you or your  personally/legally appointed representative or a court order. The privilege does not apply when you are being  evaluated by a third party or where the evaluation is court order. You will be notified in advance if this is the case.

 

Serious Threat to Health or Safety; If a clinician believes that you pose a clear and substantial risk of imminent  harm to yourself or others, disclosure of relevant confidential information to public authorities, the potential  victim, other professional and/or your family in order to protect against such harm may take place. If you  communicate an explicit threat of inflicting serious harm or causing the death of one or more clearly identifiable  victims, and if you have the intent and ability to carry out the threat, then the law requires one or more of the  following actions to be taken in a timely manner:

 

1. Take steps to hospitalize you on an emergency basis. 

2. Establish and undertake a treatment plan calculated to eliminate the possibility that you will carry  out the threat, and initiate arrangements for a second opinion risk assessment with another mental  health professional. 

3. Communicate to a law enforcement agency and, if feasible, to the potential victim(s) or victim’s  parent or guardian if a minor, all of the following: (a) nature of the threat (b) your identity  

(c) the identity of the potential victim. 

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Workers' Compensation; If you file a worker’s compensation claim, it may be required to give your mental health  information to relevant parties and officials. 

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Right to Request Restrictions; You have the right to request restrictions on certain uses and disclosures of  protected health information pertaining to you. However, the practitioner is not required to agree to a restriction  you request.

 

Right to Receive Confidential Communications by Alternative Means and 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 receiving services. Upon request, your bills  could be sent to another address. 

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Right to Inspect and Copy; You have the right to inspect and/or obtain a copy PHI regarding mental health and  billing records used to make decisions about you for as long as the PHI is maintained in the record. You may be  denied access to PHI under certain circumstances but, in some cases, you may have this decision reviewed. On  your request, the details of the request process will be discussed with you. 

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Right to Amend; You have the right to request an amendment of PHI for as long as the PHI is maintained in the  record. Your request may be denied. At your request, a discussion of the details of the amendment process will be  held. 

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Right to Accounting; You generally have the right to receive an accounting of disclosures of PHI for which you  have neither provided consent nor authorization (as described in section 3 of this notice). At your request, the  details of the accounting process will be discussed with you. 

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Right to a Paper Copy; You have the right to obtain a paper copy of this notice upon request, even if you have  agreed to receive the notice electronically. 

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Professional Duties 

Professional is required, by law, to maintain the privacy of PHI and to provide you with notice of the professional's legal duties and privacy practices with respect to PHI. 

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Complaints 

If you are concerned that a professional has violated your privacy rights, or you disagree with a decision the  professional has made about access to your records, you may contact the U.S. Departments of Health and Human  Services at www.HHS.gov . 

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Effective Date, Restrictions and Changes to Privacy Policy 

This policy goes into effect July 1, 2010. 

The professional reserves the right to change the privacy policies and practices described in this notice. Unless the  professional notifies you of such changes, the professional is required to abide by the terms currently in effect. If  the professional revises policies and procedures, you will be provided with a revised notice, either by hand, mail or electronically.