HIPAA Notice of Privacy Practices
If you have any questions about this notice, please contact Pennie Berry with LinnBerry Creative Counseling at Pennie@linnberry.com
EFFECTIVE DATE: January 1, 2021
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.
Purpose of this notice
I am required by applicable federal and state law to maintain the privacy of your protected health information. Protected Health Information (PHI) 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. I am required to give you this notice about my privacy practices, legal duties, and your rights concerning your PHI. I must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect January 1, 2021 and will remain in effect until it is replaced. I reserve the right to change my privacy practice and the terms of this notice at any time, provided such changes are permitted by applicable law. I reserve the right to make the changes in my privacy practices and the new terms of my notice effective for all PHI that I maintain, including PHI I created or received before I made the changes. Before significant changes in my privacy practices are made, I will make the new notice available upon request.
Complaints
If you are concerned that your privacy rights have been violated, you may contact LinnBerry Creative Counseling at the contact information below. You may also send a written complaint to the United States Department of Health and Human Services. I will not retaliate against you for filing a complaint with the government on me.
The contact information for the United States Department of Health and Human Services is:
U.S. Department of Health and Human Services
HIPAA Complaint
7500 Security Blvd., C5-24-04
Baltimore, MD 21244
Who Will Follow This Notice
This notice describes LinnBerry Creative Counseling practices and that of: All employees, staff, student interns, and faculty involved with the operation of LinnBerry Creative Counseling practice
Any health care professional authorized to enter information into your medical record
Uses and Disclosures of Protected Health Information
1. Treatment
I may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. Example: If a psychiatrist is treating you, I may disclose your PHI to her/him in order to coordinate your care. I will consult you and ask for you to sign a written agreement authorizing this communication, so that you are aware of these times.
2. Payment
I am permitted to use and disclose your PHI to bill and collect payment for the services provided to you. For example, I may complete a claim form to obtain payment from your insurer or HMO. The form will contain PHI, such as a description of the medical service provided to you that your insurer or HMO needs to approve payment to me.
3. Health Care Operations
I am permitted to use or disclose your PHI for the purposes of health care operations, which are activities that support this practice and ensure that quality care is delivered. For example, I may engage the services of a professional to aid this practice in its compliance programs. This person will review billing and medical files to ensure I maintain my compliance with regulations and the law. I also may ask another professional such as a LPC, MD, LCSW to review this practice’s charts and medical records to evaluate performance so that I may ensure that the best quality of care is provided to you.
4. Pennie Berry may be required by law to disclose your PHI without written authorization for the following reasons:
To avoid harm, I may provide PHI to law enforcement personnel or persons able to prevent or mitigate a serious threat to the health or safety of a person or the public.
If disclosure is mandated by the Arkansas Elder/Dependent Adult Abuse Reporting law
If disclosure is compelled or permitted by the fact that you divulge a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims
When required by federal, state, and/or local law
Reporting victims of abuse, neglect, or domestic violence
Health oversight activities (audits, investigations, and inspections)
Judicial proceedings (valid Court Orders)
Appropriate law enforcement requests
Deceased person information (Coroners, Medical Examiners, Funeral Directors)
Organ and tissue donation
Assist in a disaster relief effort so that your family can be notified about your condition, status, and location
Medical research
Military activities/National Security/Aversion of Criminal Activities
Worker’s Compensation
Correctional institutions, parole or other law enforcement officials
As required by the Secretary of the Department of Health and Human Services
Public Health activities for reporting requirement (deaths, child abuse, domestic violence, gunshots, communicable disease, infectious disease control, Food and Drug Administration (FDA) compliance/reporting adverse events, product defects/recall, biological product defects, tracking FDA related products, etc.)
If an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel.
Authorizations
All other uses and disclosures of you PHI will be made by Pennie Berry only with your written authorization. You may revoke your authorization at any time in writing.
Your Rights Regarding Your PHI
The United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (HIPAA). Those regulations create several privileges that patients may exercise. I will not retaliate against a patient that exercises their HIPAA rights.
1. Requested Restriction
You have the right to request a restriction or limitation of the PHI I use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information I disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that I not use or disclose information about a diagnostic test you had.
I am not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you shall make your request in writing to Pennie Berry. In your request, you shall tell me:
The information to be restricted
What kind of restriction you are requesting (i.e. in the use of information, disclosure of information or both)
To whom the limits apply
Please send the request to the address listed at the end of this notice. You may also request that I limit disclosure to family members, other relatives, or close personal friends that may or may not be involved in your care.
2. Confidential Communications
You have the right to request that I communicate with you about health matters in a certain way or at a certain location. For example, you can ask that I only contact you at work or by mail.
To request confidential communications, you shall make your request in writing to Pennie Berry. I will not ask you the reason for your request. I will accommodate all reasonable requests. Your request shall specify how or where you wish to be contacted.
3. Inspections and Copies
You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical records and billing records, but does not include psychotherapy notes or information compiled for legal proceedings. You do have the right to request a summary of treatment provided from your therapist at any time.
To inspect and copy health information that may be used to make decisions about you or to request a summary of treatment, you shall submit your request in writing to Pennie Berry. If you request a copy of the information, pursuant to Arkansas Code 16-46-106, I may charge a fee for the costs of copying, labor charge, and mailing or other supplies associated with the request.
I may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by Pennie Berry will review your request and the denial. The person conducting the review will not be the person who denied your request. I will comply with the outcome of the review.
4. Amend
If you feel that health information I have about you is incorrect or incomplete, you may ask me to amend the information. You have the right to request an amendment for as long as the information is kept by or for Pennie Berry.
To request an amendment, your request shall be made in writing and submitted to Pennie Berry. In addition, you shall provide a reason that supports your request. I 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, I may deny your request if you ask me to amend a record that was not created by myself unless the person or entity that created the information is no longer available to make the amendment; is not part of the health information kept by or for Pennie Berry; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.
5. Accounting of Disclosures
You have the right to request an “accounting of disclosures.” This is a list of the disclosures I made with your PHI. To request this list or accounting of disclosures, you shall submit your request in writing to Pennie Berry. Your request shall state a time period which may not be longer than four years and may not include dates before January 1, 2021. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, I may charge you for the costs of providing the list. I will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
6. Right to a Paper Copy of this Notice
You have the right to a paper copy of this notice. You may ask me 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.
Other Uses of Health Information
Other uses and disclosures of your PHI not covered by this notice or the laws that apply to me will be made only with your written permission. If you provide me permission to use or disclose your PHI, you may revoke that permission in writing at any time. If you revoke your permission, I will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that I am unable to take back any disclosures I have already made with your permission and that I am required to retain our records of the care that I provided to you.
This document is LinnBerry Creative Counseling Notice of Privacy Practices. Pennie Berry will ask you to sign an acknowledgement that you have received a copy of the Privacy Practices at the first provision of services for each treatment episode. If you have any questions about LinnBerry Creative Counseling Privacy Practices, please feel free to contact Pennie Berry at Pennie@linnberry.com
The effective date of this Notice is January 1, 2021
Contact Information for Requests
LinnBerry Creative Counseling
Pennie@linnberry.com