**Health Information Privacy**

Uses and Disclosures of Protected Health Information (PHI)

I may use or disclose your PHI for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, the following are some definitions:

· PHI – information in your health record that could identify you

· Treatment – when I provide, coordinate and manage your health care and other services related to your health care

· Payment – when I obtain reimbursement for your health care.

· Health care operations – activities that relate to the performance and operation of Thomason Counseling Services, LLC.

· Use – activities within my practice such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. I share an office with other providers and may at times, employ support staff. In those cases when I may employ a support staff, I may need to share information for purposes such as billing, scheduling, and quality assurance. All professionals and staff are bound by the same rules of confidentiality and have training in privacy rules and have agreed not to release any information outside of the practice without permission of a professional staff member.

· Disclosure – activities outside of my offices, such as releasing, transferring or providing access to information about you to other parties. I may find it helpful to share information with your primary care physician or other health and mental health professionals who are currently treating you. Your signature on this agreement is written, advance consent for me to release information to these professionals. A record of these disclosures will be kept in your clinical record.

I may occasionally find it helpful to consult other health and mental health providers in order to better serve clients’ needs. I make every effort to avoid revealing the identity of clients. Other professionals are also legally bound to keep the information confidential. I will note all consultations in your clinical record. Please let me know if you would prefer that I do not consult with other mental health professionals about your case.

Uses and Disclosures Requiring Authorization

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when authorization is obtained. An authorization is written permission above and beyond the general consent that permits only specific disclosures. In those instances when I am asked for information for purposes outside of treatment, payment and health care operations, I will obtain an authorization from you before releasing this information. I will also need to obtain a separate authorization before I can release your therapeutic notes. Therapeutic notes are notes I’ve made about our conversations during private, group, joint or family counseling sessions, which I’ve kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You make revoke all authorizations (of PHI or psychotherapy notes) at any time, provided that you are aware that the cancellation does not include any disclosures occurring prior to the date of revocation. Thomason Counseling Services, LLC reserves the right to change the terms of this notice and to make new provisions effective for all PHI that is maintained. I will provide you with a revised notice by posting the revisions in the waiting room for your inspection. You may not revoke an authorization to the extent that (1) I have relied on that authorization or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under policy.

Uses and Disclosures with Neither Consent or Authorization

I may use or disclose PHI without your consent or authorization in the following situations:

1. Child Abuse. If I know or suspect that a child under 18 or a cognitively impaired, developmentally disabled or physically impaired person under 21 has suffered or faces threat of suffering any physical or mental harm or condition of a nature that reasonably indicates abuse or neglect. Under these circumstances, I’m required by law to report that knowledge or suspicion to the Idaho Department of Health and Welfare or local police.

2. Elder Abuse. If I have reasonable cause to believe than elder is being abused, neglected or exploited, or is in a condition which is the result of aforementioned, I am required by law to immediately report such belief to the Idaho Department of Health and Welfare Adult Protection Agency.

3. Judicial or Administrative Proceedings. If you are involved in a court proceeding and a request is made for information concerning evaluation, diagnosis or treatment, such information is protected by counselor – client privilege. I cannot provide any information without you or your legal representative’s written consent. However, if I am court-ordered to disclose information, I’m required to provide it. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would likely order me to disclose information.

4. Serious Threat to Health/Safety. If I believe you pose a clear and substantial risk of imminent serious harm to yourself or someone else, I may disclose relevant confidential information to public authorities, the potential victim, other professions, and/or your family to protect against such harm. If you communicate an explicit threat of serious harm to yourself or others, and I believe you have the intent and ability, then I am required by law to: 1) take steps to hospitalize you on an emergency basis, 2) establish and undertake a treatment plan to eliminate the possibility that you will carry out the threat and initiate consultation for a second opinion risk assessment with another mental health professional, 3) communicate to a law enforcement agency and, if feasible, to the potential victim(s) or victim’s parent or guardian if a minor, all of the following information: a) nature of the threat, b)your identity, and c) the identity of the potential victim(s).

5. Worker’s Compensation. If you file a worker’s compensation claim, I may be required to give your mental health information to relevant parties and officials.

6. If the Client Is a Minor. Both parents have access to the minor client’s complete clinical record, including counseling notes, unless there is a court order prohibiting one of the parents from access.

7. Government Agency Request (i.e. Medicaid). At times, I may be required to provide information for health oversight activities in order to fulfill the requirements of Medicaid.

8. If a Client Files a Complaint or Lawsuit. Thomason Counseling Services may disclose relevant information regarding that patient in order to defend itself.

9. Presenting Disguised Material in Seminars, Classes, Scientific Writings. In this situation all identifying information and PHI is removed and client anonymity is maintained. In this situation all identifying information and PHI is removed and client anonymity is maintained.

10. Your Health Insurance Plan. Your carrier has the right to review your clinical records for any services you’ve asked them to pay for. Unless treatment is being paid for by a Workers Compensation plan, a health insurance company is not entitled to see counseling notes, which are detailed notes I may make concerning what has been discussed in therapy. However, they are entitled to see PHI in your clinical record, including information about session dates, symptoms, diagnosis, overall progress toward goals, past treatment records from other providers, billing records and any reports that have been sent or received on your behalf.

Client’s Rights

1. Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of PHI about you. However, I am not required to agree to a restriction you request.

2. Right to Receive Confidential Communication by Alternative Means and Locations. You have the right to request and receive confidential communication of PHI by alternate means and locations (i.e. if you don’t want family to know you are seeing a counselor, you can have bills sent to an alternate address).

3. Right to Inspect and Copy. You have the right to inspect and/or obtain a copy of you or your minor child’s PHI and counseling notes in your counselor’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. There will be a charge for records returned from offsite locations and copies made.

4. Right to Amend. You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Your counselor may deny your request.

5. Right to an Accounting. You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization.

6. Right to a Paper Copy. You have the right to obtain a paper copy of the Privacy Notice from your counselor upon request, even if you agreed to receive the Notice electronically.

Counselor’s Duties

1. I am required by law to maintain the privacy of PHI and to provide you notice of my legal duties and privacy practices with respect to PHI.

2. I reserve the right to change privacy policies and practices described here. It is my duty to notify you of such changes.

3. If I revise my policies and procedures, I will post them in the waiting room for your inspection.

Complaints

Complaints should first be addressed with me. However, if you are concerned that I have violated your privacy rights or you disagree with a decision I’ve made about access to your records, you may contact the Idaho Department of Occupational Licenses.