Privacy Practices
Notice of Privacy Practices for Protected Health Information For the offices of:
Paul D. Dalton, MS, LPCC, CRC, CADC & Substance Abuse Professionals of KY, PLLC
501 Darby Creek Road, Suite #14, Lexington, KY 40509, 859.338.0466
Effective April 14, 2003
This notice describes how health related information about you may be used and disclosed and how you can access this information. This notice applies to all of the records of your care generated by our office whether created by our office or an associated facility. This notice describes our practices policies which extend to: All employees, staff and other personnel that work for or with our practice (billing clerk, etc.). All office areas (front desk, waiting area, etc.); Our business associates (billing service, clearinghouse, covering therapists, etc.)
We are required by law to:
Make sure that medical information that identifies you is kept private, except in certain situations where we are allowed to disclose information under the protection or direction of state or federal law. Give you this notice of our legal duties and privacy practices with respect to medical information about you. Follow the terms of this notice now in effect.
Responsibilities:
Maintain the privacy of your health information as required by law
Provide you with a notice of our duties and privacy practices as to the information we collect and maintain about you. Abide by the terms of this notice. Notify you if we cannot accommodate a requested restriction or request.
Accommodate your reasonable requests regarding methods to communicate health information with you.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. We will keep a posted copy of the most current notice in our office containing the effective date. In addition, each time you visit our office for treatment, you may obtain a copy of the current notice in effect upon request. We will not use or disclose your heath information without your authorization except as described in this notice or in situations that can be reasonably inferred from the intended uses listed in this notice. We will also discontinue using or disclosing your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.
Patient Health Information Rights:
The health record we maintain and billing records are the physical property of the practice. The information in it, however, belongs to you. You have the right to:
Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office. We are not required to grant the request but we will comply with any request granted;
Request that you be allowed to inspect and copy your health record and billing record– you may exercise this right by delivering the request in writing to our office;
File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;
Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office; and,
Revoke authorizations that you made previously to use or disclose information except to the extent of information or action has already been taken by a written revocation to our office.
With your consent, the practice is permitted by federal privacy laws to make use and disclosure of your health information for purposes of treatment, payment and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, assessment and test results, diagnoses, treatment and future care or treatment. You have a right to review this notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment and health care operations purposes.
How we use and disclose health information:
For Treatment: We may use your health related information to you to provide initial, ongoing or referral services for you. This may mean discussing your case or collecting records from a previous provider or disclosing your records to collaborate with a previous, current or future provider, such as psychiatrists, psychiatric hospitals and or doctors or other healthcare professionals. If you are a minor certain healthcare information may be disclosed to your parents or guardian during treatment.
For Payment: We may use and disclose health related information in billing and insurance operations needed to collect payment for the services you have received. This information may be shared with your insurance or managed care company and will be viewed by our billing department. You may receive a bill at your address for services rendered. Your healthcare plan may require ongoing and updated detailed information of your treatment in order to provide payment as permitted by KY and USA laws. Individuals involved in your care or in payment of your care may also be informed of your healthcare.
For Healthcare Operations: We may use or disclose information about you for practice operations. These uses and disclosures are necessary to run the operations efficiently and increase the quality of care we provide. For example, we may use your healthcare information to review our treatment and service and to evaluate our performance of our staff in providing your care. We may also use this information to determine the need for new services and to train students, billing personnel and other employees of the practice. We may remove data that identifies you personally before others view it or use it to study healthcare delivery without identifying patients.
Appointment Reminders: We may send reminders in the mail or leave phone messages both or which could be intercepted by others. If you do not wish for us to leave messages please indicate this with your therapist or counselor.
Emergency Situations: We may disclose medical information about you to an organization assisting with an emergency medical or mental health condition or crisis so that you may receive the proper health care and or so that your family can be notified about your condition.
Law Enforcement: We may release healthcare information if asked to do so by a law enforcement official in response to a court order, to protect and individual or yourself from imminent harm or danger, in emergency situations to report a crime or in the process of facilitating a transfer to a hospital of any kind.
Department of Community Based Services: We may disclose healthcare as required by KY law in order to report suspected child abuse or domestic violence of any kind.
Judicial/Administrative Proceedings, Probations Officers, Court designated Workers, Parole offices and Judges: Healthcare information may be disclosed to these individuals with a written consent to do so. We disclose detailed information including date and time of appointments, clinical progress and treatment compliance as well as other information requested and listed on the consent.
To Report a Problem please notify Paul Dalton at (859) 338-0466
If you believe your privacy rights have been violated, you can file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Ave, SW, Washington, D.C. 20201 or email to www.hhs.gov There will be no retaliation for filing a complaint. The address for OCR is listed as follows
Office for Civil Rights:
U.S. Department of Health and Human Services
200 Independence Ave., S.W.
Room 509F, HHH Building
Washington, D.C. 20201
We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment.