HIPAA Notice of Privacy Practices

PER THE HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA) AND HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC & CLINICAL HEALTH (HITECH) ACT.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.
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If you have any questions about this notice, you may contact the Family Dynamics Resource Center main office via one of the following options:  Telephone: (530) 242-9007, Email: tforrister.fdrc2@gmail.com, Mailing Address: 3657 Ricardo Ave, Redding, CA 96002


Who Will Follow This Notice
This notice describes Family Dynamics Resource Center’s privacy practices and that of:

  • Any health care professional authorized to enter information into your chart.
  • All departments and units of Family Dynamics Resource Center.
  • Any member of a volunteer group we allow to help you while you are at Family Dynamics Resource Center.
  • All employees, staff, and other Family Dynamics Resource Center personnel.

Purpose of this Notice
‍This notice describes the privacy practices of Family Dynamics Resource Center, its departments and programs and the individuals who are involved in providing you with health care services. These individuals are health care professionals and other individuals authorized by the agency to have access to your health information as a part of providing you services or compliance with state and federal laws. Health care professionals and other individuals include:

  • Behavioral health care professionals (such as psychiatrists, psychologists, licensed clinical social workers, marriage and family therapists, psychiatric technicians, and registered nurses, interns);
  • Other individuals who are involved in taking care of you at this agency or who work with this agency to provide care for its beneficiaries, staff, and other personnel who perform services or functions that make your health care possible.

These people may share health information about you with each other and with other health care providers for purposes of treatment, payment, or health care operations, and with other persons for other reasons as described in this notice.
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Our Responsibility
‍Your health information is confidential and is protected by certain laws. It is our responsibility to protect this information as required by these laws and to provide you with this notice of our legal duties and privacy practices. It is also our responsibility to abide by the terms of this notice as currently in effect. This notice will:

  • Identify the types of uses and disclosures of your information that can occur without your advance written approval
  • Identify the situations where you will be given an opportunity to agree or disagree with the use or disclosure of your information.
  • Advise you that other disclosures of your information will occur only if you have provided us with a written authorization.
  • Advise you of your rights regarding your personal health information.

How We May Use and Disclose Health Information about You
‍The types of uses and disclosures of health information can be divided into categories. Described below are these categories with explanations and some examples. Not every type of use and disclosure can be listed, but all uses and disclosures will fall within one of the categories.

  • Treatment. We may use or share your health information to provide you with health services. The term “behavioral health care services” (mental health services and alcohol or other drug treatment services) that you might receive. For example, a licensed clinician may arrange for a psychiatrist to see you about possible medication and might discuss with the psychiatrist his or her insight about your treatment. If you obtain mental health care from another provider, we may also disclose your health information to your new provider for treatment purposes.
  • Payment. We may use or share your health information to enable us to bill you or an insurance company or third party for payment for the treatment and services that we had provided to you. For example, we may need to give your health plan information about treatment or counseling you received here so that they will pay us or reimburse you for the services. We may also tell them about treatment or services we plan to provide in order to obtain prior approval or to determine whether your plan will cover the treatment. If you obtain health care from another provider, we may also disclose your health information to your new provider for payment purposes.
  • Health Care Operations. We may use and disclose health information about you for our own operations. These uses and disclosures are necessary to the successful operation of FDRC and to make sure that all of our beneficiaries receive quality care. For example, we may use your health information:
    • To review our treatment and services and to evaluate the performance of the staff in caring for you.
    • To help decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.
    • For the review or learning activities of clinicians, other health care staff, clients, interns and other agency staff.
    • To help us with our fiscal management and compliance with laws.
    • If you obtain health care from another provider, we may also disclose your health information to your new provider for certain of its health care operations. In addition, we may remove information that identifies you from this set of health information so that others may use it to study health care and health care delivery without learning the identity of specific patients.
    • We may also share medical information about you with the other health care providers, health care clearinghouses and health plans that participate with us in “organized health care arrangements” (OHCAs) for any of the OHCAs’ health care operations. OHCAs include hospitals, physician organizations, health plans, and other entities which collectively provide health care services. A listing of the OHCAs we participate in is available from the ACCESS.
  • Sign-in. We may call out your name when we are ready to see you.

Disclosures For Which We are Not Required to Give You an Opportunity to Agree or Object.
In addition to the above situations, the law permits us to share your health information without first obtaining your permission. These situations are described next.

  • As Required by Law. We will disclose health information about you when required to do so by federal, state, or local law. For example, information may need to be disclosed to the Department of Health and Human Services to make sure that your rights have not been violated.
  • Suspicion of Abuse or Neglect. We will disclose your health information to appropriate agencies if relevant to a suspicion of child abuse or neglect, or elder or dependent adult abuse and neglect, or if you are not a minor, if you are a victim of abuse, neglect or domestic violence and either you agree to the disclosure or we are authorized by law to disclose this and it is believed that disclosure is necessary to prevent serious harm to you or others.
  • Public Health Risks. We may disclose health information about you for public health activities. These activities generally include the following:
    • To prevent or control disease, injury or disability;
    • To report reactions to medications or problems with products;
    • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.  
  • Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  • Judicial and Administrative Proceedings. We may, and are sometimes required by law, to disclose your personal health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order.  We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative.
  • Law Enforcement. We may release health information if asked to do so by a law enforcement official:
    • In response to a court order or similar directive.
    • To report criminal activity or threats concerning our facilities, staff, or others, in accordance with our duty to protect under the Tarasoff ruling, when a client poses a serious threat of physical harm to an identifiable person or specific location, such as a named individual or known workplace, and disclosure is necessary to prevent that harm.
  • To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety, or to the health and safety of the public or another person. Any disclosures, however, would only be to someone who we believe would be able to prevent the threat or harm from happening.
  • Psychotherapy Notes. Psychotherapy notes means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date. We may use or disclose your psychotherapy notes, as required by law, or:
    • For use by the originator of the notes,
    • In supervised mental health training programs for trainees, or practitioners,
    • To prevent or lessen a serious & imminent threat to the health or safety of a person or the public,
    • For the health oversight of the originator of the psychotherapy notes,
  • Change of Ownership. In the event that this practice/program is sold or merged with another organization, your personal health information/record will become the property of the new owner, although you will maintain the right to request that copies of your personal health information be transferred to another practice/program.

Disclosure Only After You Have Been Given Opportunity to Agree or To Object. There are situations where we will not share your health information unless we have discussed it with you (if possible) and you have not objected to this sharing. These situations are:

  • Persons Involved in Your Care or Payment for Your Care. We may disclose to a family member, a close personal friend, or another person that you have signed a Release of Information as being involved with your mental health care (or the payment for your mental health care) your health information that is related to the person’s involvement.
  • Disclosures in Communications with You. We may have contact with you during which we will share your health information. For example, we may use and disclose health information to contact you as a reminder that you have an appointment for treatment here, or to tell you about or recommend possible treatment options or alternatives that might be of interest to you. We may use and disclose health information about you to tell you about health-related benefits or services that might be of interest to you. We might contact you about our fundraising activities.
  • Other Uses of Health Information. Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

Your Rights Regarding Health Information About You
You have the following rights regarding health information we maintain about you:

  • Breach Notification. In the case of a breach of unsecured protected personal health information, we will notify you as required by law. If you have provided us with a current email address, we may use email to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate.
  • Right to Inspect and Copy. You have the right to inspect and copy this health information. Usually this includes medical and billing records, but it may not include some mental health information. Certain restrictions apply:
    • You must submit your request in writing. We can provide you a form for this and instructions about how to submit it.
    • If you request a photocopy, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.
    • We may deny your request in certain circumstances. If you are denied access to health information, you may request that the denial be reviewed as provided by law.
    • If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
  • Right to Amend. If you feel the health information that we have about you is incorrect or incomplete, you may ask us to amend the information. We are not required to make the amendment if we determine that the existing information is accurate and complete. We are not required to remove information from your records. If there is an error, it will be corrected by adding clarifying or supplementing information. You have the right to request an amendment for as long as the information is kept by or for the facility. Certain restrictions apply:
    • You must submit your request for the amendment in writing. We can provide you a form for this and instructions about how to submit it.
    • You must provide a reason that supports your request.
    • We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
    • was not created by us, unless the creator of the information is no longer available to make the amendment;
    • is not part of the health information kept by or for our facility;
    • is not part of the information which you would be permitted to inspect or copy.
    • Even if we deny your request for an amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your health record, we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.
  • Right to Request Special Privacy Protections.  You have the right to request restrictions on certain uses and disclosures of your personal health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed.  If you tell us not to disclose information to your health plan concerning mental health care items or services for which you paid for in full, out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request and will notify you of our decision.
  • Right to Request Confidential Communications.  You have the right to request that you receive your personal health information in a specific way or at a specific location.  For example, you may ask that we send information to a particular email account or to your work address.  We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
  • Right to a Paper Copy of the Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice from your provider office. That office is generally open from Monday to Friday from 9:00 a.m. to 5:00 p.m. (except holidays).
  • Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of health information about you in the six (6) years prior to the date you request the accounting. The accounting will not include:
    • Disclosures needed for treatment, payment or health care operations.
    • Disclosures that we made to you.
    • Disclosures that were merely incidental to an otherwise permitted or required disclosure.
    • Disclosures that were made with your written authorization.
    • Certain other disclosures that we made as allowed or required by law.
    • To request this list or accounting of disclosures, you must submit your request in writing. We can provide you a form for this and instructions about how to submit it. Your request must state a time period, which may not be longer than six (6) years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

      In addition, we are required to notify you as required by law if your health information is unlawfully accessed or disclosed.

Changes to this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facilities and on our provider website. The notice will contain the effective date on the first page.  In addition, each time you register at a new service site, they will provide you with a copy of the current notice in effect.
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Complaints
‍If you feel your privacy rights have been violated, you may file a complaint with any or all of the entities below:

Family Dynamics Resource Center
3657 Ricardo Ave, Redding, CA 96002
Phone: (530) 242-9007
Email: tforrister.fdrc2@gmail.com

Secretary of the U.S. Department of Health & Human Services, Office for Civil Rights:
200 Independence Ave SW, Washington, DC 20201
Phone: 877-696-6775
Web: www.hhs.gov/ocr/privacy/hipaa/complaints/

Notice to Clients Regarding Psychotherapy Complaints:
‍The Administrative Office at Family Dynamics Resource Center receives and responds to complaints regarding the practice of psychotherapy by any unlicensed or unregistered counselor providing services at FDRC. To file a complaint, contact us at: 3657 Ricardo Ave, Redding, CA 96002. Phone: (530) 242-9007. Email: tforrister.fdrc2@gmail.com

Additionally, The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.


Board of Behavioral Sciences
State Department of California
1625 North Market Blvd., Suite S-200
Sacramento, CA 95834

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YOU WILL NOT BE PENALIZED IN ANY WAY FOR FILING A COMPLAINT

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Family Dynamics Resource Center. All rights reserved.