Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. YOU MAY HAVE ADDITIONAL RIGHTS UNDER STATE AND LOCAL LAW. PLEASE SEEK LEGAL COUNSEL FROM AN ATTORNEY LICENSED IN YOUR STATE IF YOU HAVE QUESTIONS REGARDING YOUR RIGHTS TO HEALTH CARE INFORMATION.
EFFECTIVE DATE OF THIS NOTICE
This Notice of Privacy Practices (“Notice”) went into effect on August 24, 2023.
ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE
Under the Health Insurance Portability and Accountability Act of 1996 (hereafter, “HIPAA”), you have certain rights regarding the use and disclosure of your protected health information (hereafter, “PHI”) by Sunflower Radiance Counseling LLC (“Practice”, “we”, “our”).
I. OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from the Practice. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by this Practice. This Notice will tell you about the ways in which we may use and disclose health information about you. This Notice also describes your rights to the health information we keep about you, and describes certain obligations we have regarding the use and disclosure of your health information.
We are required by law to:
Make sure that PHI that identifies you is kept private.
Give you this Notice of our legal duties and privacy practices with respect to health information.
Follow the terms of the Notice that is currently in effect.
We can change the terms of this Notice, and such changes will apply to all the information we have about you. The new Notice will be available upon request, in the Practice’s office, and on the Practice’s website.
We understand that medical information about you and your health is personal and we are committed to protecting your medical information. Furthermore, we will notify you following the discovery of any breach of your unsecured protected health information as required by law.
II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s PHI without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your PHI for the treatment activities of another health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
We may also use your PHI for operations purposes, including sending you appointment reminders, billing invoices and other documentation.
Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about you or your minor child(ren) in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes. We do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your authorization unless the use or disclosure is:
For our use in treating you.
For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
For our use in defending the Practice or therapists in legal proceedings instituted by you.
For use by the Secretary of the Department of Health and Human Services (HHS) to investigate my compliance with HIPAA.
Required by law and the use or disclosure is limited to the requirements of such law.
Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
Required by a coroner who is performing duties authorized by law.
Required to help avert a serious threat to the health and safety of others.
Marketing Purposes. We will not use or disclose your PHI for marketing purposes without your prior written consent. For example, if we request a review from you and plan to share the review publically online or elsewhere to advertise the Practice’s services or your therapist, we will provide you with a release form and HIPAA authorization. The HIPAA authorization is required in the instance that your review contains PHI (i.e., your name, the date of the service you received, the kind of treatment you are seeking or other personal health details). Because you may not realize which information you provide is considered “PHI,” we will send you a HIPAA authorization and request your signature regardless of the content of your review. Once you complete the HIPAA authorization, we will have the legal right to use your review for advertising and marketing purposes, even if it contains PHI. You may withdraw this consent at any time by submitting a written request to the Practice via the Practice’s email address set or via certified mail to the Practice’s address, both set forth at the top of this Notice. Once we have received your written withdrawal of consent, we will remove your review from our website and from any other places where we have posted it. We cannot guarantee that others who may have copied your review from our website or from other locations will also remove the review. This is a risk that we want you to be aware of, should you give the Practice permission to post your review.
Sale of PHI. The Practice will not sell your PHI.
IV. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION.
Subject to certain limitations and conditions in the law, we can use and disclose your PHI without your authorization for the following reasons:
Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with the Practice. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that the Practice offers.
When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order or subpoena.
For law enforcement purposes, including reporting crimes occurring on our premises.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
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.
For workers’ compensation purposes.
For organ and tissue donation requests.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others: You have the right and choice to tell the Practice that we may provide your PHI to a family member, friend, or other person whom you indicate is involved in your care or the payment for your health care, or to share your information in a disaster relief situation. The opportunity to consent may be obtained retroactively in emergency situations to mitigate a serious and immediate threat to health or safety or if you are unconscious.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on the disclosure of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than in limited circumstances, you have the right to get an electronic or paper copy of your medical record and other information that we have about you. Please make your request in writing by email, fax, or mailing address listed above. We will provide you with a copy of your record, or if you agree, a summary of it, within 30 days of receiving your written request. We may charge a reasonable cost based fee for doing so.
The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, and other disclosures (such as any you ask me to make). Please make your request in writing by email, fax, or mailing address listed above. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, a copy of this Notice by email, or both.
The Right to Choose Someone to Act For You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can make choices about your health information.
The Right to Revoke an Authorization. You have the right to rescind any authorization allowing us to disclose your PHI for purposes of treatment, payment, or health care operations, and other disclosures. Please make your request in writing by email, fax, or mailing address listed above.
The Right to Opt out of Communications. You have the right to opt out of any or all forms of communication styles communication (email, text, phone call, etc.) we use to notify you of upcoming appointments, document requests, billing documents, services offered, etc. Please make your request in writing by email, fax, or mailing address listed above
The Right to File a Complaint. You can file a complaint if you feel we have violated your rights by contacting us using the information on page one of this Notice or by filing a complaint with the HHS Office for Civil Rights located at 200 Independence Avenue, S.W., Washington D.C. 20201, calling HHS at (877) 696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.
VII. CHANGES TO THIS NOTICE
We can change the terms of this Notice, and such changes will apply to all the information we have about you. The new Notice will be available upon request, and on our website.
VIII. CONTACT INFORMATION
All correspondence relating to the contents of this Notice should be directed as follows:
Sunflower Radiance Counseling LLC
112 West Oak Lane
Glenolden, PA 19036
Attn: Shannon Kilroy
267-854-7715