HIPAA Notice

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1966 (HIPAA):

This notice describes how health information about you (as a client of this organization) may be used and disclosed, and how you can get access to your individually identifiable health information.

Please review this notice carefully.

A. Our Commitment to Your Privacy

Our practice is dedicated to maintaining the privacy of your individually identifiable health information as protected by law, including the Health Information Portability and Accountability Act (HIPAA). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your Protected Health Information (PHI). By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

• How we may use and disclose your PHI.
• Your privacy rights in your PHI.
• Our obligations concerning the use and disclosure of your PHI.

The terms of this notice apply to all records containing your PHI that are created or retained by our organization. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our organization has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our organization will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. If You Have Questions About This Notice, Please Contact:

Privacy Officer: Rebecca Dwyer-Coop
74 Cleburne Park Road
Heber Springs, AR 72543
501-362-0943

We May Use and Disclose Your Protected Health Information (PHI) in the Following Ways

The following categories describe the different ways in which we may use and disclose your PHI:

1. Treatment. Our organization may use your PHI to treat you. For example, we may ask you to have tests (such as hearing, vision, psychological), and we may use the results to help us develop appropriate services. Many of the people who work for our organization – including, but not limited to, our Early Childhood Specialists, Service Coordinator, and Therapists may use or disclose your PHI to others who may assist in your care, such as your parent. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.
2. Billing. Our organization may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with the details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
3. Health Care Operations. Our organization may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our organization may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your PHI to other health care providers and entities to assist in their health care operations
4. Appointment Reminders. Our organization may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment Options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services. Our organization may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
7. Fundraising. We may contact you to raise funds for our organization.
8. Release of Information to Family/Friends. Our organization may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.
9. Disclosures Required by Law. Our organization will use and disclose your PHI when we are required to do so by Federal, State or Local Law.

D. Use and Disclosure of Your PHI in Certain Special Circumstances

The following categories describe unique scenarios in which we may use or disclose your identifiable health information: 

1. Public Health Risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

• • Maintaining vital records, such as births and deaths.
  • Reporting child abuse or neglect.
  • Preventing or controlling disease, injury or disability.
  • Notifying a person regarding potential exposure to a communicable disease.
  • Notifying a person regarding a potential risk for spreading or contracting a disease or condition.
  • Reporting reactions to drugs or problems with products or devices.
  • Notifying individuals if a product or device that they may be using has been recalled.
  • Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult client (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
  • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. Health Oversight Activities. Our organization may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
4. Law Enforcement. We may release PHI if asked to do so by a law enforcement official:

• • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.
  • Concerning a death we believe has resulted from criminal conduct.
  • Regarding criminal conduct at our offices.
  • In response to a warrant, summons, court order subpoena or similar legal process.
  • To identify/locate a suspect, material witness, fugitive or missing person.
  • In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identify or location of the perpetrator).

5. Deceased Patients. Our organization may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
6. Serious Threats to Health or Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
7. National Security. Our organization may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
8. Law Enforcement. Our organization may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosures for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety of the health and safety of other individuals.
9. Workers’ Compensation. Our organization may release your PHI for workers’ compensation and similar programs.

E. Your Rights Regarding Your PHI

You have the following rights regarding the PHI that we maintain about you:

1. Confidential Communications. You have the right to request a restriction in our use or disclosure of your PHI treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care of the payment for your care, such as family members and friends. We are not required to agree to your request: however, if we do not agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use of disclosure of your PHI, you must make your request in writing to the Privacy Officer, Rebecca Dwyer-Coop. Your request must describe in clear and concise fashion:
   1. 1. The information you wish restricted;
      2. Whether you are requesting to limit our organization’s use, disclosure or both: and
      3. To whom you want the limits to apply.
2. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decision about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to the Privacy Officer in order to inspect and/or obtain a copy of your PHI. Our organization may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
3. Amendments. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. You must provide us with a reason that supports your request for amendment. Our organization will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete: (b) not part of the PHI kept by or for the organization; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our organization, unless the individual or entity that created the information is not available to amend the information.
4. Accounting of Disclosures. All of our clients have the right to request an “accounting of disclosure.” An “accounting of disclosures” is a list of certain non-routine disclosures our organization has made of your PHI for non-treatment, non-payment or non-operations purposes. Use of your PHI as part of the routine client care in our organization is not required to be documented. Also, we are not required to document disclosures made pursuant to an authorization signed by you. In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but our organization may charge you for additional lists within the same 12-month period. Our organization will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
5. Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer.
6. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the Privacy Officer. We urge you to file your complaint with us first and give us the opportunity to address your concerns. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
7. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.

Again, if you have questions regarding this notice of our health information privacy policies, please contact the Privacy Officer, Rebecca Dwyer-Coop, 501-362-0943.