Efective Date 9/2/16
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. We care about your privacy and strive to protect the confidentiality of your health information at Psychological and Counseling Services. You have the right to confidentiality of your health information, and PACS is required by law to maintain the privacy of that information and to provide you with a description of our privacy practices with respect to your health information.
Who Will Follow This Notice
All staff and personnel at PACS must abide by this Notice, including any health care professional authorized to enter information into your health records, all employees, staff, and other personnel who may need access to your information. All subsidiaries, personnel, including business associates (e.g., independent contractor care providers), of this practice may share health information with each other for treatment or health care operations described in this Notice. Except where treatment is involved, only the minimum necessary information needed to accomplish the task will be shared. This Notice of Privacy Practices applies only to the operations and care provided by PACS, and does not apply to services provided by other University of New Hampshire departments.
Changes To This Notice
We will comply with the terms of the current effective Notice of Privacy Practices. We reserve the right to change this Notice. The changed Notice may be effective for health information we already have about you as well as any information we receive in the future. We have posted a copy of the current Notice in our waiting area with the effective date on the posted copy. You may receive a copy of the current Notice at any time at our website, or you may request a printed copy at PACS.
How We May Use and Disclose Health Information About You
The following categories describe different ways that we may use and disclose health information without your specific consent or authorization. Examples are provided for each category of uses or disclosures. Not all possible uses or disclosures are listed.
For Treatment. We will use health information about you to provide you with treatment or services.
For Health Care Operations. We may use and disclose health information about you for health care operations of PACS, to assure that you receive quality care. Example: We may use health information to review our treatment and services and evaluate the performance of our staff in caring for you.
Other Uses or Disclosure That Can Be Made Without Your Consent or Authorization. (Limits to Confidentiality)
Under New Hampshire law, communication between a client and a licensed Psychologist or his/her supervisees is confidential and, in general, may not be disclosed to any party outside PACS without your prior written consent. There are, however, some exceptions to confidentiality. Even without your consent, your therapist is legally obligated to report certain disclosures you may make. Your therapist may be required to disclose certain information if: (a) there is reason to suspect that a minor child (under age 18) or an incapacitated adult is being or has been subjected to abuse or neglect; (b) there is a serious threat of physical violence to yourself or a third party or a serious threat of substantial damage to real property; (c) you report any information about any incident of student hazing involving yourself or others; or (d) PACS receives a valid subpoena or court order requiring the disclosure of all or some part of your counseling record. In those rare instances where it is necessary for PACS to disclose information relating to your counseling without your permission, we will make every effort to fully discuss it with you.
Uses and Disclosures of Protected Health Information Requiring Your Written Authorization
Other uses and disclosures of health information not specifically covered by this Notice or required by the laws that apply to PACS will be made only with your written authorization. If you give us authorization to use or disclose health information about you, you may revoke that authorization in writing, at any time. If you revoke your authorization, we will thereafter no longer use or disclose health information about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your authorization, and we are required to retain your records of the care we have provided.
YOUR INDIVIDUAL RIGHTS REGARDING DISCLOSURES AND CHANGES TO YOUR HEALTH INFORMATION
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations or to someone who is involved in your care or the payment of your care. We are not required to agree to your request, particularly if it is in regards to uses and disclosures that can be made without your consent, and we will not agree to do so unless we feel we can live up to our promise to do so. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions, you must submit your request in writing to the Privacy Officer at PACS. In your request, you must tell us what information you want to limit.
We will agree, upon your written request, to a request to restrict disclosure of health information about you to a health plan if: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and (2) the health information pertains solely to a service for which you have paid in full.
Right to an Accounting of Disclosures.
You have the right to request a list of the disclosures we made of health information about you. To request this list, you must submit your request to the Privacy Officer at PACS. Your request must state the time period for which you want to receive a list of disclosures that is no longer than six years, and may not include dates before January 1, 2002 or dates after the date of the request. Your request should indicate in what form you want the list (example: on paper or electronically). The first list you request within a 12-month period will be free. For additional lists we reserve the right to charge you for the cost of providing the list.
Right to Amend
If you feel that health information we have about you 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. To request an amendment, your request must be made in writing and submitted to the Privacy Officer at PACS. In addition, 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 the information was not created by us, is not part of the health information kept at this practice, is not part of the information which you would be permitted to inspect and copy, or which we deem to be accurate and complete. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Statements of disagreement and any corresponding rebuttals will be kept on file and sent out with any future authorized requests for information pertaining to the appropriate portion of your record.
Your Access to Health Information.
Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. We may deny your request to inspect portions of your records in very limited circumstances (e.g., psychotherapist’s notes). To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer at PACS. Since 8/27/12 the PACS keeps electronic health records that are protected with encryption. You can request a copy of your records, within electronic format (you will need to provide us with a flash drive); however, we advise against this as once transferred the information is vulnerable to security breaches. If you request a copy of the information, we reserve the right to charge a fee for the costs of copying, mailing, or other supplies associated with your request. If you wish to receive a copy of your records, we strongly encourage you to review them with your therapist so that you can fully understand their contents.
Right to a Paper Copy of this Notice. You have the right to a paper copy of PACS current Notice of Privacy Practices at any time. We will offer you a copy at your initial appointment.
Right to Request Confidential Communications. You have the right to request how we should send communications to you about health matters, and where you would like those communications sent. To request confidential communication of your health information, you must make your request in writing to the Privacy Officer at PACS Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Complaints. If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer at PACS, at the address on the previous page. You also may file a complaint with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. PACS will not penalize or discriminate against you for filing a complaint.