Client Information
DISCOUNTS AVAILABLE TO CLIENTS WITHOUT INSURANCE
Discounts are available to eliminate barriers of care and assure access to healthcare services for uninsured families and individuals at a cost based on the eligible patient's ability to pay. The Sliding Fee Discount Program assures that no patient will be denied healthcare services and is available to patients based on the patient's ability to pay. Ability to pay is determined by the patient's household size and annual income with respect to a discount schedule based on current Federal Poverty Guidelines.
Client Information Effective Date: September 23, 2013
NOTICE OF PRIVACY PRACTICE
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. THIS NOTICE PROVIDES YOU WITH INFORMATION TO PROTECT THE PRIVACY OF YOUR CONFIDENTIAL HEALTH CARE INFORMATION, HEREAFTER REFERRED TO AS PROTECTED HEALTH INFORMATION (PHI). THE NOTICE ALSO DESCRIBES THE PRIVACY RIGHTS YOU HAVE AND HOW YOU CAN EXERCISE THOSE RIGHTS. PLEASE REVIEW IT CAREFULLY.
We will work with you to address any questions you may have about this Notice or your PHI. Please contact Sabrina Rothhaar HIPAA Privacy Officer, 1310 Valley View Blvd., Altoona, PA 16602. Phone: 814-944-9970.
OUR COMMITMENT REGARDING YOUR PROTECTED HEALTH INFORMATION(PHI):
Our practice is dedicated to maintaining the privacy of your PHI. Federal and state laws mandate that Blair Family Solutions must protect the privacy of your treatment and your health record. We are required to provide you with this Notice about our policies, safeguards and practices. Your PHI may include your diagnosis, treatment plan, history, evaluations, progress notes or anything that is part of your clinical record. Psychotherapy notes are notes recorded by some counselors documenting or analyzing the contents of conversations during a counseling session. Psychotherapy notes are PHI, but they are not part of your health record and must be kept separate from the rest of your record as they are given greater protection than other types of PHI.This notice applies to any health care professional authorized to enter information into your medical record created and/or maintained at our organization, and all staff of our organization. The notice describes the ways in which we may use or disclose your PHI and also describes your rights and our obligations regarding any such uses or disclosures. We will abide by the terms of this notice, including any future revisions that we may make to the notice as required or authorized by law.We reserve the right to change this notice and to make the revised or changed notice effective for protected health information we already have about you as well as any information we receive in the future.
OUR OBLIGATIONS:
We are required by law to:
Maintain the privacy of protected health information
Give you this notice of our legal duties and privacy practices regarding health information about you
Follow the terms of our notice that is currently in effect.
The major laws that address treatment of your PHI in Pennsylvania are:
The Health Insurance Portability and Accountability Act of 1996 – HIPAA Privacy Regulations
The Pennsylvania Mental Health Procedures Act of 1966 – Pennsylvania laws may provide more protection for your PHI than the HIPAA regulations. In situations where your PHI is to be shared, the laws and regulations that apply will be the ones that are the most protective regarding the use and sharing of your PHI.
The Minor’s Consent Act as amended by Act 147 Pennsylvania Code, Title 55 – Public Welfare – Mental Health Manual
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:
Except as described in this Notice, it is our practice to obtain your authorization before we disclose your PHI to another person or party. We may use or disclose the information about your health mainly:
1. To provide you with treatment, to arrange payment for our services or for some other activities which are called, health care operations.
A. Treatment. We may use your PHI to provide you with health care treatment and services. We may disclose your PHI to those directly involved in your care. Appointment reminders - we may use or disclose your PHI for purposes of contacting you to remind you of a health care appointment. Members of our staff may need to talk with those involved in your care in order to coordinate services and to develop a plan of care.
B. Payment. We may use or disclose your PHI so that we may bill and collect payment from you, an insurance company, or another third party for the health care services you receive at our organization. For example, we may give your health plan information about you so that they will pay for your treatment.
C. Health care operations. Our practice may use and disclose your PHI to operate our business. For example, we may use and disclose information 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 care providers and entities to assist in their health care operations.
2. Pursuant to your written authorization (for purposes other than treatment, payment or health care operations)
3. As required or permitted by law. Certain state and federal laws and regulations either require or permit us to make certain uses or disclosures of your PHI without your permission. These uses and disclosures are generally made to meet public health reporting obligations or to ensure the health and safety of the public at large. The uses or disclosures which we may make pursuant to these laws and regulations include the following:
A. Duty to Warn. We may use or disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent or lessen the threat.
B. Military and Veterans. If you are a member of the armed forces, we may release PHI as required by military command authorities. We also may release PHI to the appropriate foreign military authority if you are a member of a foreign military.
C. Business Associates. We may disclose PHI to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
D. Suspected Child or Elder Abuse. Your clinician is required to report or disclose PHI related to child or elder abuse or neglect and commitment proceedings authorized by the Pennsylvania Mental Health Procedure Act.
E. Emergencies. We may use or disclose your PHI in an emergency treatment situation when use and disclosure of the PHI is necessary to prevent serious risk of bodily harm or death to you.
F. Law Enforcement Activities. We are not permitted by Pennsylvania laws to disclose PHI regarding mental health or drug and alcohol services to Law Enforcement agencies or officials except pursuant to a court order or in a special circumstances required by law. For example, we may disclose the minimum necessary PHI to report a death or criminal conduct on our premises.
4. In certain special circumstances. The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
A. Judicial or Administrative Proceedings. We may use or disclose your Protected Health Information if a court issues an appropriate order and follows required procedures. We will not release any information in response to a subpoena alone. We will make a good faith effort to notify you by certified mail at your last known address that we disclosed your PHI pursuant to a court order.
B. Health oversight activities. We may use or disclose your PHI to a health oversight agency that is authorized by law to conduct health oversight activities. These activities may include: audits, investigations, inspections, or licensure and certification surveys.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES:
The following uses and disclosures of your PHI will be made only with your written authorization:
1. Uses and disclosures of PHI for marketing purposes
2. Disclosures that constitute a sale of your PHIOther uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose PHI under the authorization. But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
YOUR RIGHTS:
You have the following rights regarding PHI we have about you:
1. Right to Inspect and Copy. You have a right to inspect and copy PHI that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this PHI, you must make your request, in writing, to the Program Director or Privacy Officer. We have up to 30 days to make your PHI information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state or federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
2. Right to an Electronic Copy of Electronic Medical Records. If your PHI is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your PHI in the form or format you request, if it is readily producible in such form or format. If the PHI is not readily producible in the form or format you request, your record will be provided in either our standard electronic format or, if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
3. Right to be notified of a Breach. You have the right to be notified upon a breach of any of your unsecured PHI.
4. Right to Amend. If you feel that PHI we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to the Medical Records Coordinator or Privacy Officer.
5. Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of PHI for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to the Medical Records Coordinator or Privacy Officer.
6. Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to the Medical Records Coordinator or Privacy Officer. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your PHI to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
7. Out-of-Pocket Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
8. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communications, you must make your request, in writing, to the Medical Records Coordinator or Privacy Officer. Your request must specify how and where you wish to be contacted. We will accommodate reasonable requests.
9. Right to a Paper Copy of This 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. A copy of this notice will be provided to you upon entry into services. This notice is available on our website: www.blairfamilysolutions.org
CHANGES TO THIS NOTICE:
We reserve the right to change this notice and make the new notice apply to PHI we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page, in the upper left-hand corner.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact the Program Director or Privacy Officer. All complaints must be made in writing. You will not be penalized for filing a complaint.
Admissions, the provisions of services and referrals of clients shall be made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age, or sex.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-723-6288 (TTY: 1-844-723-6288).
Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-844-723-6288 (TTY: 1-844-723-6288).