THE FOLLOWING NOTICE DESCRIBES HOW YOUR CHILDS' MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY!
Integrative Counseling Solutions, Inc., maintains full compliance with all local, state and federal laws and regulations pertaining to protected health information.
Generally, no protected health information will be disclosed to any third party or agency without your specific, written authorization. There are circumstances, however, where Integrative Counseling Solutions, Inc., may disclose some protected health information about a client without an express, written authorization.
These include disclosures made to secure payment for services rendered, as where your health insurer requests information from our files to process a payment for services, pursuant to their agreement with you.
If, however, you, or any one you authorize, pays the full fee for services of Integrative Counseling Solutions, Inc., without submitting a claim to an insurer or agency for payment, no such disclosure will be made.
Another example is a limited release for purposes of treatment. Integrative Counseling Solutions, Inc., may share certain protected health information with other staff persons, including professional staff, at Integrative Counseling Solutions, Inc., to enable that person to treat a client.
A third situation where a release of protected health information can occur is when necessary for health care operations. An example of this is when certain protected health care information is shared with support staff of Integrative Counseling Solutions, Inc.
All health care providers, including Integrative Counseling Solutions, Inc., are required, under state law, to report to the appropriate government agency, instances where it has a reasonable basis to believe a child or dependent adult has been or is likely to be abused or neglected.
Similarly, if a client threatens self-harm, we may be required to notify law enforcement or family members who can help provide protection.
In addition, if a client communicates a threat or intent to cause significant physical harm to an identifiable person or persons, Integrative Counseling Services, Inc., may be required to disclose protected health information concerning the threat to the affected person or to law enforcement personnel.
This is known as our “duty to warn.” In addition, Integrative Counseling Solutions, Inc., may be required to release certain information by court order or pursuant to a subpoena.
No protected health information will be disclosed for purposes of marketing or fundraising without your prior, written, approval.
Integrative Counseling Solutions, Inc., may contact a client or the guardian or custodial parent of a client to provide appointment reminders or to provide information about treatment alternatives.
You have the right to request certain restrictions on certain uses and disclosures of protected health information, but Integrative Counseling Solutions, Inc., is not required to agree to such restrictions.
The client or, in the case of an unemancipated minor, the guardian or custodial parent of a client, has the right to inspect and copy protected health information about the client, and to amend such information and to receive certain confidential communication from Integrative Counseling Solutions, Inc.
Integrative Counseling Solutions, Inc., is required by law to maintain the privacy of protected health information. It also has the right to change its privacy practices.
Any change in privacy practices will necessitate the client or, in the case of an unemancipated minor, the guardian or custodial parent of a client, to be given a revised Notice of Privacy Policies.
In the event a client, or in the case of an unemancipated minor, the guardian or custodial parent of a client, wishes to make a complaint about a violation of these privacy policies, a complaint may be made to Integrative Counseling Services, Inc., as set out in the Client Handbook, or to the Secretary of the Department of Health and Human Services by going to the website: HHs.gov/ocr/privacy and following the instructions for filing a complaint.
In the event of a breach of the confidentiality requirements set out in local, state or federal laws or regulations, Integrative Counseling Solutions, Inc., may have an obligation to notify the client or, in the case of an unemancipated minor, the guardian or custodial parent of a client of such breach.
It is your responsibility to keep Integrative Counseling Solutions, Inc., advised as to how you wish such a notification to be communicated to you. We ask that you keep your contact information current.
If you wish notification to be made by electronic needs, you should be aware that e-mail, cell phone, text messaging and fax transmissions may not be secure.