THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

PLEDGE REGARDING HEALTH INFORMATION: All information describing your mental health treatment and related health care services (“mental health information”) is personal, and Living Story Mental Health & Healing is committed to protecting the privacy of the personal and mental health information you disclose to us. This notice applies to all of the records of your care generated by this mental health care practice. Throughout this document Living Story Mental Health & Healing shall be identified as “LSMHH” and shall include all counselors, psychotherapists, administrative staff and other professionals and employees working for or on behalf of Living Story Mental Health & Healing.

Protected Health Information (PHI):  “Protected health information“ (PHI) refers to past, present and future information that can be used to identify you including demographic information or information about your past, present, or future physical or mental health conditions, healthcare services or payment for services. LSMHH is required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• LSMHH can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office and will also be posted in a reasonable amount of time to the Living Story Mental Health & Healing website at www.livingstorymhh.com.

HOW YOUR PHI MAY BE USED AND DISCLOSED

The following categories describe different ways that we use and disclose PHI. For each category of use or disclosure, an explanation of what is meant and some examples are provided. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose PHI will fall within one of the categories.

LSMHH may use your information:

For TREATMENT. LSMHH can use your health information and share it with other professionals in the interest of best practice for your treatment. For example, if your health care needs to be coordinated with another medical provider treating you, we may disclose your health information to a physician or other healthcare provider. Another example would be if your provider gave information about your psychological condition or mental health needs to another health care provider for the purpose of treatment, referral or consultation. 

For PAYMENT. LSMHH may use and disclose your health information for various payment-related functions, to bill for and obtain payment for the treatment and services we provide for you. For example, LSMHH may contact your insurance providers to verify benefits, obtain prior authorization or submit claims for payment. Commercial and other insurance providers may request that LSMHH provide records without your consent for the purpose of compliance with provider contracts and for the purpose of rendering or disputing payment. By choosing to use your insurance benefits you are giving consent for records to be used in these ways should they be requested.

For HEALTHCARE OPERATIONS. LSMHH  may use and disclose your health information for certain operational, administrative, and quality assurance activities, in connection with our operations for the purpose of running our practice, improving care standards, and contacting you when necessary. For Example LSMHH would include use of your PHI for the purpose of training or supervision of a mental health professional to help them develop and improve their skills.

For APPOINTMENT REMINDERS. LSMHH may use or disclose PHI to provide you with appointment reminders (such as voicemail messages, emails and texts). You have a right, as explained below, to request restrictions or limitations on the PHI we disclose. You also have a right, as explained below, to request that information be communicated with you in a certain way or at a certain location.

For SPECIAL PURPOSES. Under federal and applicable state law LSMHH may use or disclose your PHI without your permission but only when certain circumstances arise. More information can be found at: https://www.hhs.gov/hipaa/for-individuals/index.html  

Some of the more common purposes that LSMHH may use or disclose your PHI without your permission when specific conditions are met include:

• As REQUIRED BY LAW when required or authorized by other laws, such as the reporting of child abuse, elder abuse or dependent adult abuse.

• INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT OF YOUR CARE. If it is determined you are do not have the capacity, unable or incapable to agree or object to such a disclosure, LSMHH may disclose such information as necessary for your care needs or the payment of your care to a family member, friend, or other representative that directly relates to that person’s involvement in your health care, if LSMHH determines that it is in your best interest based on our professional judgment. The opportunity to consent may be obtained retroactively in emergency situations. At times when you are actively involved in your care, you may object to or revoke this permission.  

• To PARENTS OR LEGAL GUARDIANS. If you are a minor, LSMHH may release your PHI to your parents or legal guardians when permitted or required under federal and applicable state law.

• WORKER’S COMPENSATION. While it is the preference to obtain written consent, LSMHH may disclose your PHI to the extent authorized by and necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

• In JUDICIAL PROCEEDINGS in response to court/administrative orders, subpoenas, discovery requests or other legal process. Please note it is LSMHH preference to obtain written consent when possible.

• For HEALTH OVERSIGHT ACTIVITIES to governmental, licensing, auditing, and accrediting agencies as authorized or required by law including audits; civil, administrative or criminal investigations; licensure or disciplinary actions; and monitoring of compliance with law. 

• For SPECIALIZED GOVERNMENT FUNCTIONS including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions

• To PUBLIC HEALTH AUTHORITIES to prevent or control communicable disease, injury or disability, or ensure the safety of drugs and medical devices.

• To LAW ENFORCEMENT for example, to assist in an involuntary hospitalization process. If you are or become an inmate of a correctional institution, LSMHH may disclose to the institution or its agents PHI necessary for your health and the health and safety of others.

• For RESEARCH PURPOSES subject to a special review process and the confidentiality requirements of state and federal law. 

• To PREVENT A SERIOUS THREAT TO HEALTH OR SAFETY of you as a client or another individual. LSMHH may notify the person, tell someone who could prevent the harm, or tell law enforcement officials.

With YOUR WRITTEN AUTHORIZATION LSMHH will obtain your written authorization before using or disclosing your PHI for purposes other than those described in this notice (or as otherwise permitted or required by law). If you give written authorization, you may revoke this authorization at any time as described in your rights below.

• Marketing Health-Related Services. LSMHH will not use or disclose your protected health information for marketing communications without your written authorization, and only as permitted by law.

• Sale of PHI. LSMHH will not sell your protected health information without your written authorization, and only as permitted by law.

Your Rights Regarding PHI  You have the right:

To OBTAIN A PAPER COPY OF THIS NOTICE by notifying LSMHH in writing. Upon receipt of your request a paper copy will be mailed to you. You may also download a copy from your Simple Practice Client Portal. 

To ACCESS YOUR PHI. You have the right to obtain and inspect a copy of your PHI. An electronic or paper copy or a summary (when applicable and acceptable) of your medical record will be provided within 45 days of your written request. Under very select circumstances you may not receive a full copy of your medical record. This is typically only if your treatment provider determines that information within the full record could endanger your or someone else.  If your request is altered in any way, you will be notified of the details in writing within 45 days of your written request.  LSMHH may charge you a reasonable fee in accordance with state law for the costs of processing your request. 

To REQUEST RESTRICTIONS. You have the right to ask LSMHH to limit what is disclosed or shared about you for treatment, payment or health care operations.  You must put your request in writing. LSMHH is dedicated to protect your privacy along with your self determination on what is important to you to share and not share. While we will do our best, it is not required to agree with your request. We cannot agree to restrictions on uses or disclosures that are legally required, or which are necessary to administer our business. If we do agree with the request, we will comply with your request except to the extent that disclosure has already occurred or if you are in need of emergency treatment and the information is needed to provide the emergency treatment. If you pay for a service or health care item out-of-pocket in full, you can ask LSMHH not to share that information for the purpose of payment with your health insurer. LSMHH will comply with this specific request for services paid in full unless otherwise stated in law.

To REQUEST AN AMENDMENT AND/OR ADDENDUM OF PHI TO YOUR MEDICAL RECORD. If you feel that PHI we have about you is incorrect or incomplete, you may ask that the information be amended or an addendum be added. Requests must be in writing and should not be more than 250 words per inaccuracy.  Requests must identify: (i) which information you seek to amend, (ii) what corrections you would like to make, and (iii) why the information needs to be amended. LSMHH will respond to your request in writing within 45 days (with a possible 30-day extension). In our response, LSMHH will either: (i) agree to make the amendment, or (ii) inform you of our denial, explain our reason, and outline appeal procedures. If denied, you have the right to file a statement of disagreement with the decision. We will provide a rebuttal to your statement and maintain appropriate records of your disagreement and our rebuttal. Even if we accept your request, we do not delete any information already in your records.

To REQUEST CONFIDENTIAL COMMUNICATIONS. You have the right to request how and what means we use to communicate with you. For example you may request that LSMHH use an alternate phone number, communicate through fax, or send written correspondence to an alternate address.  If you select a means of communication that is not HIPAA compliant- such as email or text- you recognize and accept the implications and limitations on protection of you PHI.  LSMHH will try to accommodate all reasonable requests. If you initiate communication with LSMHH through alternate means you are giving implicit permission for LSMHH to return communication and engage in future communication through those same means unless and until you clearly indicate otherwise.

To RECEIVE AN ACCOUNTING OF DISCLOSURES. You have the right to request a list (accounting) of the times LSMHH has shared your PHI outside of treatment, payment and health care operations. Your written request must state a time period for which you are requesting. This accounting of disclosures must be limited to less than 6 years from the date of the request. LSMHH will respond in writing within 45 days of receipt of your request. LSMHH will provide one accounting per 12-month period free of charge, but you may be charged a reasonable cost of any subsequent accountings. We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). 

To BE NOTIFIED IN THE CASE OF A BREACH. It is the responsibility of LSMHH to notify you promptly within accordance with the law if there has been a compromise in the privacy or security of your information.

To FILE A COMPLAINT. If you believe your privacy rights have been violated, do not hesitate to speak to us. Please notify us in writing of any concerns that you may have so that we may discuss and address them with you as quickly as possible.  You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html

Living Story Mental Health & Healing will not retaliate against you for filing a complaint.

For more information on your privacy rights and responsibilities please see: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html