Notice of Privacy Practices
Sun and Stars Therapy
682-463-1316
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.
MY PLEDGE REGARDING YOU OR YOUR CHILD’S HEALTH INFORMATION
I am committed to protecting health information about you or your child. I create a record of the care and services you or your child receive from me. I need this record to provide you or your child with quality care and to comply with certain legal requirements. This notice applies to all the records of your or your child’s care generated by Sun and Stars Therapy. This notice will tell you about how I may use and disclose health information about you or your child. I also describe your rights to the health information I keep about you or your child and describe certain obligations I have regarding the use and disclosure of you or your child’s health information.
I AM REQUIRED BY LAW
To maintain the privacy and security of your or your child’s protected health information (PHI)
Let you know promptly if a breach occurs that may have compromised the privacy or security of your or your child’s information.
Give you this notice of my legal duties and privacy practices concerning health information.
Follow the terms of the notice that is currently in effect.
Provide you with a new Notice of Privacy Practices, should I choose to change the terms of this Notice, and such changes will apply to all the information I have about you or your child.
Not use or share your or your child’s information other than as described here unless you tell me I can in writing. If you authorize me to share information, you may change your mind at any time. Let me know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
YOUR RIGHTS
When it comes to you or your child’s health information, you have certain rights. This section explains your rights and some of my 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 or your child’s medical record and other health information we have about you or your child. I will provide you with an electronic or paper copy of your or your child’s record, ora summary of it, if you agree to receive a summary, within 15 days of receiving your written request, for $150 an hour depending on the amount of time it takes to write up the request.
ASK ME TO CORRECT YOUR MEDICAL RECORD
If you believe that there is a mistake in your or your child’s PHI, or that a piece of important information is missing from your or your child’s PHI, you have the right to request that I correct the existing information or add the missing information.
I may say “no” to your request, but I tell you why in writing within 60 days of receiving your request.
CHOOSE HOW I SEND PHI TO YOU
You can ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
I will say “yes” to all reasonable requests.
ASK ME TO LIMIT WHAT I USE OR SHARE
You can ask me not to use or share certain health information for treatment, payment, or our operations. I am not required to agree to your request, and I 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 me not to share that information for payment or our operations with your health insurer. I 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 I’ve shared your or your child’s health information for five years prior to the date you ask, who I shared it with, and why. The list I will give you will include disclosures made in the last six years unless you request a shorter time.
I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked me to make). I’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. I will provide you with a papercopy 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.
I 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 I have violated your rights by contacting me using the information on the last page.
You can file a complaint with the U.S. Department of Health and HumanServices Office for Civil Rights by sending a letter to 200 IndependenceAvenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting: www.hhs.gov/ocr/privacy/hipaa/complaints
I will not retaliate against you for filing a complaint.
YOUR CHOICES
For certain health information, you can tell me your choices about what I share. If you have a clear preference for how I share your or your child’s information in the situations described below, please let me know. Tell me what you want me to do, and I will follow your instructions.
In these cases, you have both the right and choice to tell me to:
Share information with your family, close friends, or others involved in your or your child’s care
Share information in a disaster relief situation
If you are not able to tell me your preference, for example, if you are unconscious, I may go ahead and share your or your child’s information if I believe it is in your or your child’s best interest. I may also share your or your child’s information when needed to lessen a serious and imminent threat to health or safety.
CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION
In these cases, I never share your or your child’s information unless you give me written permission or Authorization:
Marketing
Sale of PHI
Disclosure of most psychotherapy or session notes--unless the use of disclosure falls in one of the categories listed below in My Uses and Disclosures.
MY USES AND DISCLOSURES
This section explains some ways in which I may typically use or share your or your child’s health information, without requiring your authorization. Not every use or disclosure in a category will be listed. However, all the ways I am permitted to use and disclose information will fall within one of the categories.
In addition, I am allowed or required to share your or your child’s information in ways that contribute to the public good, such as public health and research. I must meet many conditions in the law before I can share your or your child’s information for these purposes.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
FOR TREATMENT
Federal privacy rules (regulations) allow healthcare providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization. I may disclose your or your child’s protected health information for the treatment activities of any healthcare provider to provide you with the best possible treatment and care.
For example, if a clinician were to consult with another licensed health care provider about your or your child’s condition, they would be permitted to use and disclose your or your child’s personal health information, which is otherwise confidential, to assist the clinician in the diagnosis and treatment of your or your child’s mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard.Therapists and other health care providers need access to the full record/complete information to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.
TO RUN MY PRACTICE/ORGANIZATION
I can use and share your or your child’s health information to run my practice, improve your care, and contact you when necessary. Example: I use health information about you or your child to manage your treatment and services, such as providing appointment reminders or providing information to you regarding treatment-related alternatives, benefits, or services that I offer.
I can use my session or psychotherapy notes for my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual therapy.
TO BILL FOR YOUR SERVICES
I can use and share your or your child’s health information to bill and get payment from you, a person who is paying for your treatment, health plans, or other entities. Example: Giving information about you or your child to your health insurance plan so it will pay for you or your child’s services.
HELP WITH PUBLIC HEALTH AND SAFETY ISSUES
I can share health information about you or your child for certain situations such as:
Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
DO RESEARCH
I can use or share your or your child’s information for health research, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
COMPLY WITH THE LAW
I will share information about you or your child if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I am complying with federal privacy law.
HEALTH OVERSIGHT
Federal law allows me to release your or your child’s protected health information to appropriate health oversight agencies or for health oversight activities.
WORK WITH A MEDICAL EXAMINER OR FUNERAL DIRECTOR
I can share health information with a coroner, medical examiner, or funeral director when an individual dies.
RESPOND TO LAWSUITS AND LEGAL ACTIONS
If you or your child is involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about you or your child in response to a subpoena, discovery request, or other lawful processes by someone else involved in the dispute. My preference is to obtain an Authorization from you before doing so.
My psychotherapy notes or session notes can be used in defending myself in legal proceedings instituted by you, without your Authorization.
For law enforcement purposes, including reporting crimes occurring on my premises. Texas state law may require greater limits on disclosure
Chapter 611 of the Texas Health & Safety Code may provide greater limits onsome disclosures of your health information.
You may review it Chapter 611 of the Texas Health & Safety Code at: http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.611.htm
OUR RESPONSIBILITIES:
Sun and Stars Therapy will not use or share your or your child’s information other than as described here unless you explicitly grant permission in writing. If you, explicitly grant permission in writing, 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
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 or your child. The new notice will be available upon request, in our office, and on our website.
ACKNOWLEDGMENT OF REVIEW OF NOTICE OF PRIVACY PRACTICES
I have reviewed Sun and Stars Therapy Notice of Privacy Practices, which explains how my or my child’s personal information will be used and disclosed. I understand thatI am entitled to receive a copy of this document.