THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. CONNECT PLUS THERAPY IS REQUIRED BY LAW TO MAINTAIN THE PRIVACY OF, AND PROVIDE INDIVIDUALS WITH THIS NOTICE OF OUR LEGAL DUTIES AND PRIVACY PRACTICES WITH RESPECT TO PROTECTED HEALTH INFORMATION (PHI). PLEASE REVIEW IT CAREFULLY. This Notice of Privacy Practices describes how we may use and disclose your PHI to carry out treatment, payment, or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information
Your PHI may be used and disclosed by your therapist, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing mental health services to you, to pay your mental health care bills, to support the operation of Connect Plus Therapy, and any other use required by law.
Treatment We will use and disclose your PHI to provide, coordinate, or manage your mental health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your PHI, as necessary, to a third party provider to whom you have been referred to (e.g. speech therapist, school counselor) to ensure that the provider has the necessary information to diagnose or treat you.
Payment Your PHI will be used, as needed, to obtain payment for your mental health care services. For example, obtaining authorization for services may require that your relevant PHI be disclosed to your insurance plan to obtain approval for treatment.
Healthcare Operations We may use or disclose, as needed, your PHI in order to support the business activities of Connect Plus Therapy. These activities may include, but are not limited to, quality assurance activities, licensing, and conducting or arranging for other business activities. For example, we may disclose your PHI, as necessary, to contact you to remind you of your appointment. We may use or disclose your PHI in the following situations without your authorization. These situations include: as Required By Law, Public Health issues (as required by law), Abuse or Neglect, Legal Proceedings, Law Enforcement, Danger to Self or Others.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES WILL BE MADE ONLY WITH YOUR CONSENT, AUTHORIZATION, OR OPPORTUNITY TO OBJECT UNLESS REQUIRED BY LAW.
- You have the right to inspect and copy your PHI. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.
- You have the right to request to receive confidential communications from us by alternative means or at an alternative location. 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 alternatively (i.e. electronically).
- You have the right to have your therapist amend your PHI. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such material.
- You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI.
- You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in the therapy or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
- Your therapist is not required to agree to a restriction that you may request. If the therapist believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. You then have the right to use another provider.
WE RESERVE THE RIGHT TO CHANGE THE TERMS OF THIS NOTICE AND WILL INFORM YOU OF THESE CHANGES. YOU THEN HAVE THE RIGHT TO OBJECT OR WITHDRAW AS PROVIDED IN THIS NOTICE.
You may submit a complaint to us if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.