Notice of Privacy Practices
HIPAA Notice of Privacy Practices for Protected Health Information
KNOWN COUNSELING, PLLC
(214) 810-5921
PO Box 190867, Dallas, TX 75219
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.
If you have any questions about this Notice of Privacy Practices, please contact our Privacy Officer at (214) 810-5921, or the specified contact information listed at the end of this document.
I. INTRODUCTION
We understand that medical information about you and your health care is personal. Known Counseling, PLLC is required by law to maintain the privacy of Protected Health Information (“PHI”), to provide individuals with notice of our legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and relates to the provision of health care or payment for the provision of health care for your past, present or future physical or mental health or condition and related healthcare services. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, obtain payment or perform our health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you.
Known Counseling, PLLC is required to follow the terms of this Notice currently in effect. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you.
II. OUR PLEDGE
The privacy of your personal health information (PHI) is important to us. Your PHI includes, but is not limited to, medical, dental, pharmacy, and mental health information. This Notice describes our privacy practices. Our privacy practices must be followed by all of our employees and staff. This Notice tells you about the ways in which we may use and disclose your PHI. Also described are your rights and certain obligations we have regarding the use and disclosure of your PHI. We use and disclose your PHI in compliance with all applicable state and federal laws. I am required by law to:
Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.
I am also required by law to provide you with adequate notice of your rights and my legal duties if I create or maintain records protected by 42 C.F.R. Part 2.
I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.
III. PROTECTED HEALTH INFORMATION IN CONNECTION WITH ALCOHOL OR DRUG SERVICES
Please note that 42 C.F.R. Part 2 protects your health information if you are applying for or receiving services (including diagnosis or treatment, or referral) for drug or alcohol abuse. Generally, if you are applying for or receiving services for drug or alcohol abuse, we may not acknowledge to a person outside the program that you attend the program or disclose any information identifying you as an alcohol or drug abuser except under certain circumstances that are listed in this notice.
IV. HOW PHI ABOUT YOU MAY BE USED AND DISCLOSED
The following categories describe different ways that we use and disclose PHI. For each category of use or disclosure, an explanation of what is meant, and some examples are provided. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose PHI will fall within one of the categories.
For Treatment, Payment, or Health Care Operations:
Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations.
For Treatment. We may use or disclose your health information to provide and coordinate the mental health treatment and services you receive. For example, if your mental health care needs to be coordinated with the medical care provided to you by another physician, we may disclose your health information to a physician or other healthcare provider. Also, counselors may disclose your health information to each other to coordinate individual and group therapy sessions for your treatment or information about treatment alternatives or other health-related benefits and services that are necessary or may be of interest to you. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order 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.
For Payment. We may use and disclose your health information for various payment-related functions, so that we can bill for and obtain payment for the treatment and services we provide for you. For example, your PHI may be provided to an insurance company so that they will pay claims for your care.
For Healthcare Operations. We may use and disclose your health information for certain operational, administrative, and quality assurance activities, in connection with our operations. These uses and disclosures are necessary to run the practice and to make sure that our patients receive quality treatment and services. For example, healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
If your records are protected under 42 C.F.R. Part 2, certain uses and disclosures permitted by HIPAA for treatment, payment, and health care operations are materially limited by the stricter standards of those regulations. Furthermore, information disclosed pursuant to these rules may be subject to redisclosure by the recipient and may no longer be protected by federal privacy standards.
For Special Purposes (Certain Uses and Disclosures Do Not Require Your Authorization):
We are permitted under federal and applicable state law to use or disclose your PHI without your permission only when certain circumstances may arise. Subject to certain limitations in the law, we can use or disclose your PHI without your permission or Authorization for the following purposes:
Individuals Involved in Your Care or Payment for Your Care (Opportunity to Object). When appropriate, we may disclose PHI to a close personal friend or family member who is involved in your medical care or payment for your care. Unless you object in whole or in part, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. The opportunity to consent may be obtained retroactively in emergency situations.
Disclosures to Parents or Legal Guardians. If you are a minor, we may release your PHI to your parents or legal guardians when we are permitted or required under federal and applicable state law.
Worker’s Compensation. We may disclose your PHI to the extent authorized by and necessary to comply with laws relating to worker’s compensation or other similar programs established by law. Although our preference is to obtain an Authorization from you, we may provide your PHI in order to comply with workers' compensation laws.
Public Health. We may disclose your PHI to federal, state, or local authorities, or other entities charged with preventing or controlling disease, injury, or disability for public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
Health Oversight Activities: We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for government monitoring of the health care system, government programs, and compliance with federal and applicable state law.
Law Enforcement. We may disclose your PHI for law enforcement purposes as required by law or in response to a court order, subpoena, warrant, summons, or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about a death resulting from criminal conduct; about crimes on the premises or against a member of our workforce (including reporting crimes occurring on our premises); and in emergency circumstances, to report a crime, the location, victims, or the identity, description, or location of the perpetrator of a crime.
Judicial and Administrative Proceedings / Lawsuits and Disputes. If you are involved in a lawsuit or a legal dispute, we may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, that meets the requirements of federal regulations 42 C.F.R. Part 2 concerning Confidentiality of Alcohol and Drug Abuse Patient Records. Our preference is to obtain an Authorization from you before doing so. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Please note also that if your records are not actually "patient records" within the meaning of 42 C.F.R. Part 2 (e.g., if your records are created as a result of your participation in the program at another non-treatment setting), your records may not be subject to the protections of 42 C.F.R. Part 2. For records protected by 42 C.F.R. Part 2, such records or testimony relaying their content shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide specific written consent or a court order is issued in accordance with 42 C.F.R. Part 2.
United States Department of Health and Human Services. Under federal law, we are required to disclose your PHI to the U.S. Department of Health and Human Services to determine if we are in compliance with federal laws and regulations regarding the privacy of health information.
Research. Under certain circumstances, we may use or disclose your PHI for research purposes, 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. However, before disclosing your PHI, the research project must be approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Coroners, Medical Examiners, and Funeral Directors. We may release your PHI to assist in identifying a deceased person or determine a cause of death when such individuals are performing duties authorized by law.
Organ or Tissue Procurement Organizations. Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Notification and Disaster Relief. We may use or disclose your PHI to assist in a disaster relief effort so that your family, personal representative, or friends may be notified about your condition, status, and location.
Correctional Institution and Specialized Government Functions. If you are or become an inmate of a correctional institution, we may disclose to the institution or its agents PHI necessary for your health and the health and safety of others. We may also disclose PHI for specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI to appropriate authorities when necessary to prevent a serious threat to your health and safety or the health and safety of another person or the public. We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.
Military and Veterans. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.
National Security, Intelligence Activities and Protective Services for the President and Others. We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, provision of protection to the President, other authorized persons or foreign heads of state, and other national security activities authorized by law.
As Required by Law. We must disclose your PHI when required to do so by applicable federal or state law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
Health-Related Benefits, Services, and Treatment Alternatives. We may use and disclose PHI to tell you about treatment alternatives, health-related benefits, or other health care services that we offer that may be of interest to you.
Appointment Reminders. We may use or disclose PHI to provide you with appointment reminders (such as contact calls, voicemail messages, postcards, or letters). You have a right, as explained below, to request restrictions or limitations on the PHI we disclose. You also have a right, as explained below, to request that information be communicated with you in a certain way or at a certain location.
V. OTHER USES AND DISCLOSURES OF PHI
Your Authorization
We will obtain your written authorization before using or disclosing your PHI for purposes other than those described above (or as otherwise permitted or required by law). If you give us an authorization, you may revoke it by submitting a written notice to Known Counseling, PLLC, at the contact information listed below. Your revocation will become effective upon our receipt of your written notice. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by the written authorization. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.
Psychotherapy Notes
I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
For my use in treating you.
For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
For my use in defending myself in legal proceedings instituted by you.
For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
Required by law and the use or disclosure is limited to the requirements of such law.
Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
Required by a coroner who is performing duties authorized by law.
Required to help avert a serious threat to the health and safety of others.
Substance Use Disorder (SUD) Counseling Notes
We may also maintain “SUD counseling notes,” which are notes recorded by a substance use disorder provider documenting the contents of a counseling session. Any use or disclosure of these notes requires your separate written authorization, which cannot be combined with a consent for other types of records. You can revoke your consent at any time except to the extent that we have already acted upon it to disclose these notes in accordance with your initial authorization.
Marketing Health-Related Services
We will not use or disclose your protected health information for marketing communications without your written authorization, and only as permitted by law. As a psychotherapist, we will not use or disclose your PHI for marketing purposes.
Sale of PHI
We will not sell your protected health information without your written authorization, and only as permitted by law. As a psychotherapist, we will not sell your PHI in the regular course of our business.
Fundraising
If we intend to use or disclose your records protected by 42 C.F.R. Part 2 for fundraising for our benefit, we will provide you with a clear and conspicuous opportunity to opt-out before any such use or disclosure occurs.
VI. CHANGES TO THIS NOTICE
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changed Notice effective for all health information that we maintain, including health information we created or received before we made the changes. When we make a change in our privacy practices, we will change this Notice and the new Notice will be made available to you upon request, in our office, and on our website.
VII. YOUR HEALTH INFORMATION PRIVACY RIGHTS
You have privacy rights under federal and state laws that protect your health information. These rights are important for you to know. You can exercise these rights, ask questions about them, and file a complaint if you think that your rights are being denied or your health information is not being protected. Providers and health insurers who are required to follow federal and state privacy laws must comply with the following rights:
To Request Restrictions/Limits on Certain Uses and Disclosures of PHI. You have the right to request restrictions or limits on our use or disclosure of your PHI for treatment, payment, or health care operations purposes by sending a written request to Known Counseling, PLLC, at the contact information listed below. We are not required to agree to those restrictions, and we may say “no” if we believe it would affect your health care. We cannot agree to restrictions on uses or disclosures that are legally required, or which are necessary to administer our business.
To Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full, and is not otherwise required by law. We must agree to this specific restriction request.
To Request Confidential Communications / Choose How We Send PHI. You have the right to request that PHI be communicated to you by alternative means or at alternative locations. For example, you can ask that you only be contacted at work, on an office phone, or by mail sent to a different address. We will accommodate all reasonable requests.
To Access PHI / See and Get Copies of Your PHI. Other than “psychotherapy notes” and “SUD counseling notes,” you have the right of access to inspect and obtain an electronic or paper copy of your medical record and other health information that we have about you. You may not be able to obtain all of your information in a few special cases—for example, if your treatment provider determines that the information may endanger you or someone else. Your paper or electronic copy of the records, or a summary of it if you agree to receive a summary, will be provided to you within thirty (30) days of receiving your written request (or within fifteen [15] calendar days of receipt in accordance with Texas law for standard requests). We may charge you a reasonable, cost-based fee for the costs of copying, mailing, supplies, and labor necessary to fulfill your request. In accordance with Texas law, you have the right to obtain a copy of your PHI in electronic form for records that we maintain using an Electronic Health Records (EHR) system capable of fulfilling the request. Where applicable, we must provide those records to you or your legally authorized representative in electronic form within fifteen (15) days of receipt of your written request and a valid authorization for electronic disclosure of PHI. You may request a copy of an authorization from Known Counseling, PLLC, at the contact information listed below.
To Obtain a Paper or Electronic Copy of the Notice Upon Request. You have the right to request a copy of our current Notice at any time, including by email. Even if you have agreed to receive the Notice electronically or via email, you are still entitled to a paper copy. You may obtain a copy from Known Counseling, PLLC, at the contact information listed below. A reasonable fee may be charged for the costs of copying, mailing or other supplies associated with your request.
To Request an Amendment / Correct or Update Your PHI. If you feel or believe that there is a mistake in your PHI, or that a piece of important information is incorrect or missing from the PHI we have about you, you have the right to request that we correct the existing information or add the missing information. Requests must identify: (i) which information you seek to amend, (ii) what corrections you would like to make, and (iii) why the information needs to be amended. We will respond to your request in writing within 60 days of receiving your request (with a possible 30-day extension). In our response, we will either: (i) agree to make the amendment, or (ii) inform you of our denial and explain our reason in writing. If denied, you have the right to file a statement of disagreement with the decision. We will provide a rebuttal to your statement and maintain appropriate records of your disagreement and our rebuttal.
To Receive an Accounting of Disclosures. You have the right to request an accounting or list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or healthcare operations, or for which you provided us with an Authorization. Your request must state a time period. The time period for the accounting of disclosures must be limited to less than 6 years from the date of the request. We will respond in writing within 60 days of receipt of your request (with a possible 30-day extension). We will provide an accounting per 12-month period free of charge, but you may be charged a reasonable cost-based fee for any subsequent accountings in the same year. We will notify you in advance of the cost involved, and you may choose to withdraw or modify your request at that time. You also have the right to request an accounting of disclosures specifically for your substance use disorder records protected under 42 C.F.R. Part 2.
To Notification in the Event of a Breach. You have a right to be notified of an impermissible use or disclosure that compromises the security or privacy of your PHI. We will provide notice to you as soon as is reasonably possible and no later than sixty (60) calendar days after discovery of the breach and in accordance with federal and state law.
To File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our privacy official, listed below. You may also file a complaint directly with any or all of the following federal and state agencies: the Secretary of the Department of Health and Human Services, the Office of the Attorney General of Texas, or the Texas Behavioral Health Executive Council. We will provide you with the addresses to file your complaint with the Secretary, the Office of the Attorney General of Texas and the Texas Behavioral Health Executive Council, upon request. You will not be penalized in any way for filing a complaint. Violation of federal law and regulations on Confidentiality of Alcohol and Drug Abuse Patient Records is a crime and suspected violations of 42 CFR Part 2 may be reported to the United States Attorney in the district where the violation occurs.
If you want more information about our privacy practices or have questions or concerns, please contact us.
ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By signing below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.
Privacy Official: Allison Williams
(214) 810-5921
PO Box 190867, Dallas, TX 75219
admin@knowncounseling.com