HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Kentucky Counseling Center, LLC is committed to maintaining client confidentiality in accordance with federal and state laws and ethics of the counseling profession. This notice describes our policies related to the use and disclose of your healthcare information.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
Your health information may be used for the purposes of providing treatment services, collecting payment, and conducting healthcare operations as necessary to support our operations and to promote quality care. We will use and disclosure your information for these purposes as state and federal laws allow. Examples include:
Treatment We may need to use or disclose health information about you to provide, manage, or coordinate your care or related services, including with third parties such as consultants and potential referral sources.
Payment We may use and disclose your information needed to verify insurance coverage and/or benefits with your insurance carrier, to process your claims, as well as for billing and collection purposes. We may bill the person in your family who pays for your insurance.
Healthcare Operations We may need to use information about you to review our treatment procedures and business activity. For example, information may be used for certification, compliance, and licensing activities. We may also contact you with information about treatment alternatives or other services that may be of interest to you. We may send you appointment reminders by text or by phone and/or leave a voicemail.
OTHER USES AND DISCLOSURES
Opportunity to Object to Certain Uses and Disclosures
You have the right to tell us whether you want us to use or disclose your information for the following purposes:
To Individuals Involved in Your Care or Payment for Your Care. We may share medical information about you with your family members, friends, or any others involved in your medical care or who helps pay for it. We may also share you information as necessary to identify, locate, and notify family members, guardians, or others involved in your care about your location, and general condition.
For Disaster Relief. In some cases, we may share limited information about you to a disaster relief agency assisting in disaster relief efforts.
If you are not present or unable to tell us your preference, we may go ahead and share your information if your health care provider thinks that it may be best for you.
Other Permitted Uses and Disclosures
We may share your information when needed to lessen a serious and imminent threat to health or safety. When permitted by law, we may also share information in certain situations to help with public health and safety issues. For example, in preventing disease, reporting adverse medication reactions, or helping with product recalls. We may share information with a medical examiner or coroner when an individual dies. We may share information with health oversight agencies for activities authorized by law, and for certain specialized government functions such a national security and presidential protective services.
Required Uses and Disclosures
There are some instances where we may be required by law to use and disclose information. For example, when you and/or your child or children report information about physical or sexual abuse, when required by the Secretary of the Department of Health and Human Services to audit or evaluate our compliance with the requirements of federal privacy law, or if you provide information that informs us that you are in danger of harming yourself or others. We may share information with law enforcement consistent with applicable laws, such as if a crime is committed on our premises or against our staff, or if required in response to a valid court order.
Use and Disclosure Requiring Your Authorization
Certain uses and sharing of your health information are only permitted with your written authorization. These include most uses and disclosures of psychotherapy notes, uses and disclosures of your health information for marketing communications, and disclosures that constitute a sale of your health information.
Uses and disclosures of your health information other than those described in this notice will be made only with your written authorization.
You may revoke an authorization, at any time, in writing, except to the extent that your provider or we have taken an action in reliance on the use or disclosure indicated in the authorization. To revoke an authorization, you must write to Kentucky Counseling Center at the address listed below.
The following is a statement of your rights with respect to your protected health information. If you have questions about how to exercise these rights, contact our Privacy Officer using the information below.
Right to request how we contact you
It is our normal practice to communicate with you at your home address and daytime phone number you gave us when you scheduled your appointment, about health matters, such as appointment reminders. Sometimes we may send a text appointment reminder or leave messages on your voicemail. You have the right to request that our office communicate with you by alternative means or at an alternative location. You must submit your request in writing to us at the address below. We will agree to reasonable requests.
Right to release your medical records
You may consent in writing to release your records to others. You have the right to revoke your consent, in writing, at any time. However, a revocation is not valid to the extent that we acted in reliance on such consent.
Right to inspect and copy your medical and billing records.
You have the right to inspect and obtain a copy of your information contained in our medical records. To request access to your billing or health information, contact the Privacy Officer. Under limited circumstance we may deny your request to inspect and copy. When permitted by law, may charge a reasonable fee for the costs of copying, mailing, and supplies to provide a copy of your information.
Right to add information or amend your medical records.
If you feel that information contained in your medical record is incorrect or incomplete, you may ask us to amend the record. We will make a decision on your request with 60 days, or some cases within 90 days. Under certain circumstance, we may deny your request to add or amend information. If we deny your request, you have a right to file a statement that you disagree. Your statement and our response will be added to your record. To request an amendment, you must contact the Privacy Officer. We will require you to submit your request in writing and to provide an explanation concerning the reason for your request.
Right to an accounting of disclosures.
You may request an accounting of any disclosures, if any, we have made related to your medical information, except for information we used for treatment, payment, or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. To receive information regarding disclosure made for a specific time period no longer than six years and after April 14, 2003, please submit your request in writing to the Privacy Officer. We will notify you of any cost involved in preparing this list.
Right to request restrictions on uses and disclosures of your health information.
You have the right to ask for restrictions on certain uses and disclosures of your health information. This request must be in writing and submitted to our Privacy Officer. You must tell us the type of restriction you want and to whom it applies. We are generally not required to agree to such a request, with one exception. You have a right to restrict any disclosure of personal health information for payment purposes or for our health care operations if you have paid for services out-of-pocket and in full.
You have a right to receive notification of a breach of your unsecured personal health information.
Right to complain.
If you believe your privacy rights have been violated, please contact us personally, and discuss your concerns. You may also file a written complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing such a complaint.
OTHER INFORMATION ABOUT THIS NOTICE
Compliance with Laws
We are required by law to provide you with this notice of our legal duties and privacy practices with respect to your protected health information, and to notify you in writing if the privacy or security of your health information is breached. We are required to abide by the terms of our Notice of Privacy Practices currently in effect.
Right to Request a Paper Copy
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
Revisions to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for your health information we already have, as well as any we get in the future. Any changes in this notice will be posted on our website at kentuckycounselingcenter.com. The revised notice also will be available upon request at our offices.
Questions and Contact
If you have any questions about this notice or about how your health information is used or shared by us, please contact us at:
Kentucky Counseling Center, LLC
Attn: Privacy Officer
4835 Poplar Level Road Suite 110
Louisville, KY 40213
Publication and Revisions Dates
Originally Published August, 2014
Revised, Effective February 11, 2019