Notice of Privacy Practices
Notice of University Counseling Services Policies and Practices to Protect the Privacy of Your Health Information
THIS NOTICE DESCRIBES HOW BEHAVIORAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Uses and Disclosures for Treatment, Payment, and Health Care Operations
University Counseling Services may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your written authorization. To help clarify these terms, here are some definitions:
- "PHI" refers to information in your health record that could identify you.
- "Treatment, Payment, and Health Care Operations"
- Treatment is when University Counseling Services provide, coordinate, or manage your health care and other services related to your health care. An example of treatment would be when University Counseling Services consults with another health care provider, such as your family physician, psychologist, or another mental health professional.
- Payment is when University Counseling Services obtains reimbursement for your healthcare. Examples of payment are when University Counseling Services discloses 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 our practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
- "Use" applies only to activities within our office and clinic practice such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
- "Disclosure" applies to activities outside of our office and clinic practice, such as releasing, transferring, or providing access to information about you to other parties.
- "Authorization" is your written permission to disclose confidential mental health information. All authorizations to disclose must be on a specific legally required form.
Other Uses and Disclosures Requiring Authorization
University Counseling Services may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when we are asked for information for purposes outside of treatment, payment, or health care operations, University Counseling Services will obtain an authorization from you before releasing this information. University Counseling Services will also need to obtain an authorization before releasing our Psychotherapy Notes. "Psychotherapy Notes" are notes University Counseling Services have made about your conversations with us during a private, group, joint, or family counseling session, which University Counseling Services may chose to keep separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.
Uses and Disclosures without Authorization
University Counseling Services may release PHI to a third-party payer or peer review organization with the prior written consent of you or your legal representative.
University Counseling Services may use or disclose PHI without your consent or authorization in the following circumstances:
- Child Abuse – If University Counseling Services reasonably believes a child, whom we’re treating, has been abused, we must report this belief to the appropriate authorities as required by law.
- Adult and Domestic Abuse – If University Counseling Services suspect that a dependent adult has been abused, University Counseling Services must report this suspicion to the appropriate authorities as required by law.
- Health Oversight Activities – If University Counseling Services receives a subpoena from the Kansas Behavioral Science and Regulatory Board for protected health information regarding you, University Counseling Services must comply with that subpoena and disclose that information to the Board.
- Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made about the professional services University Counseling Services provided you or the records thereof, such information is privileged under state law, and University Counseling Services will not release information without your written consent or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
- Serious Threat to Health or Safety – If University Counseling Services believes you present a clear, imminent risk to another, University Counseling Services may disclose information necessary to seek hospitalization or otherwise protect that individual. If University Counseling Services believe there is a clear and imminent risk that you will harm yourself, University Counseling Services may disclose information necessary to seek hospitalization for you or to alert family members or others who have the ability to protect you.
Patient’s Rights and University Counseling Services Employees Duties
- Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information. However, University Counseling Services are not required to agree to a restriction you request.
- Right to Receive Confidential Communications by Alternative Means and at 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 seeing University Counseling Services. On your request, University Counseling Services will send your bills to another address.)
- Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. University Counseling Services may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, University Counseling Services will discuss with you the details of the request and denial process.
- Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. University Counseling Services may deny your request. On your request, University Counseling Services will discuss with you the details of the amendment process.
- Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, University Counseling Services will discuss with you the details of the accounting process.
- Right to a Paper Copy – You have the right to obtain a paper copy of the notice from University Counseling Services upon request, even if you have agreed to receive the notice electronically.
University Counseling Services Employees Duties:
- University Counseling Services is required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
- University Counseling Services reserves the right to change the privacy policies and practices described in this notice. Unless University Counseling Services notifies you of such changes, however, University Counseling Services is required to abide by the terms currently in effect.
- If University Counseling Services revises our policies and procedures, University Counseling Services will attempt to provide you with a revised notice by mail.
If you are concerned that University Counseling Services has violated your privacy rights, or you disagree with a decision University Counseling Services made about access to your records, you may contact Dr. Steven B. Mayhew, Director, 1701 S. Broadway, Pittsburg, KS 66762 to state your complaint in writing. Our office will attempt to work with you in resolving your complaint.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. University Counseling Services can provide you with the appropriate address upon request.
This notice will go into effect on August 2, 2004.
University Counseling Services reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that University Counseling Services maintain. University Counseling Services will maintain a written copy of any new notice available for your inspection during normal business hours. A copy can also be made available to you upon your written request. If you have questions, please contact our Privacy Officer, Jame Brooksher, 620-235-4136.