WHO WILL FOLLOW THIS NOTICE
This notice describes the information privacy practices followed by our employees. The practices described in this notice will also be followed by agency employees and/or volunteers you consult with by telephone.
YOUR CONFIDENTIAL INFORMATION
This notice applies to the information and records we have about your counseling, mental health status, and the care and services you receive at this office.
We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose information about you and describes your rights and our obligations regarding the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
We may use or disclose information about you without your permission for the following purposes, subject to all applicable legal requirements and limitations:
- To Avert a Serious Threat to Health or Safety
- We may use and disclose confidential information about you when necessary to prevent a serious threat to your health and safety or the health and safety of another person. We also may disclose information relative to the disclosure of past or present knowledge of child abuse, abuse of the elderly, or of persons with disabilities.
Required by law
We will disclose health information about you when required to do so by federal, state or local law.
Lawsuits and disputes
If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose information about you in response to a subpoena.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your confidential information for any purpose other than those identified in the previous sections without your specific, written Authorization. We must obtain your Authorization separate from any Consent we may have obtained from you. If you give us Authorization to use or disclose confidential information about you, you may revoke that Authorization, in writing, at any time.If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.
YOUR PRIVACY RIGHTS
You have the following rights regarding health information we maintain about you:
Right to inspect and copy
You have the right to inspect and copy your health information, such as progress notes and billing records. You must submit a written request to your therapist in order to inspect and/or copy your information. If you request a copy of the information, a fee of $50 will be charged for the costs of copying, mailing or other associated supplies. Your therapist may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your information, you may ask that the denial be reviewed. If such a review is required by law, the Custodian of Records of LWCC will review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.
Right to amend
If you believe information we have about you is incorrect or incomplete, you may ask your therapist to amend the information. You have the right to request an amendment as long as the information is kept by this office.
To request an amendment, complete and submit a Record Amendment/Correction form to your therapist. Your therapist 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, your therapist may deny your request if you ask him/her to amend information that:
- We did not create, unless the person or entity that created the information is no longer available to make the amendment
- Is not part of the information that we keep
- You would not be permitted to inspect and copy
- Is accurate and complete
Right to an accounting of disclosures
You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of confidential information about you. To obtain this list, you must submit your request in writing to your therapist. It must state a time period, which may not be longer than six years and may not include dates before May 1, 2010. Your request should indicate in what form you want the list (for example, on paper, electronically). A fee of $50 will be charged to you for the costs of providing the list. Your therapist will remind you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to request restrictions
You have the right to request a restriction or limitation on the confidential information we use or disclose about you for any of the purposes outlined above. You also have the right to request a limit on the information we disclose about you. We are not required to agree to such requests.
Right to request confidential communications
You have the right to request that we communicate with you about treatment matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate all reasonable requests. In the event that emails or text messages are exchanged between therapist and client with therapy related discussions, please note that confidentiality is not guaranteed because LWCC’s email and texts are unencrypted. So be advised of the risk that may be involved when asking for transmission of communication with these mediums.
Right to a paper copy of this notice
You have the right to a paper copy of this notice. You may ask your therapist or our office staff to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact our office staff. The fee for a copy of records is $50.
Changes to This Notice
We reserve the right to change this notice, and to make the revised or changed notice effective for confidential information we already have about you as well as any information we receive in the future. We will post a summary of the current notice in the office with its effective date in the top right-hand corner. You are entitled to a copy of the notice currently in effect.