waterfallNotice of Georgetown College Counseling Center’s Policies and Practices to Protect the Privacy of Your Health Information

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Uses and Disclosures for Treatment and Health Care Operations

The Georgetown College Counseling Center (hereafter referred to as the Counseling Center) may use or disclose your protected health information (PHI), for treatment and health care operations purposes. To help clarify these terms, here are some definitions:

· “PHI” refers to information in your health record that could identify you.

· “Treatment, and Health Care Operations”

Treatment is when the Counseling Center provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when consulting with another health care provider, such as your family physician or another psychologist.

- Health Care Operations are activities that relate to the performance and operation of the Counseling Center’s practice. Examples of health care operations are quality assessment and improvement activities, business-related matters, such as audits and administrative services, and case management and care coordination.

· “Use” applies only to activities within the Counseling Center such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

· “Disclosure” applies to activities outside of the Counseling Center, such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures Requiring Authorization

The Counseling Center may use or disclose PHI for purposes outside of treatment or health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when the Counseling Center is asked for information for purposes outside of treatment or health care operations, the Counseling Center will obtain an authorization from you before releasing this information. The Counseling Center will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes your therapist has made about your conversations during a private, group, joint, or family counseling session, which are kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) the Counseling Center has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

III. Uses and Disclosures with Neither Consent nor Authorization

The Counseling Center may use or disclose PHI without your consent or authorization in the following circumstances:

· Child Abuse: If the Counseling Center has reasonable cause to believe that a child is dependent, neglected or abused, the Counseling Center must report this belief to the appropriate authorities, which may include the Kentucky Cabinet for Families and Children or its designated representative; the commonwealth’s attorney or the county attorney; or local law enforcement agency or the Kentucky state police.

“Dependent child” means any child, other than an abused or neglected child, who is under improper care, custody, control, or guardianship that is not due to an intentional act of the parent, guardian, or person exercising custodial control or supervision of the child.

· Adult and Domestic Abuse: If the Counseling Center has reasonable cause to believe that an adult has suffered abuse, neglect, or exploitation, the Counseling Center must report this belief to the Kentucky Cabinet for Families and Children.

· Health Oversight Activities: The Kentucky Board of Examiners of Psychology may subpoena records from the Counseling Center relevant to its disciplinary proceedings and investigations.

· Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and records thereof, such information is privileged under state law, and the Counseling Center will not release information without the written authorization of you or your personal or legally-appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.

· Serious Threat to Health or Safety: If you communicate to the Counseling Center an actual threat of physical violence against a clearly identified or reasonably identifiable victim or an actual threat of some specific violent act, the Counseling Center has a duty to notify the victim and law enforcement authorities.

· Workers’ Compensation: If you file a claim for workers’ compensation, you waive the psychotherapist-patient privilege and consent to disclosure of your health information reasonably related to your injury or disease to your employer, workers’ compensation insurer, special fund, uninsured employers’ fund or the administrative law judge.

IV. Patient’s Rights and Psychologist’s Duties

Patient’s Rights:

· Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information. However, the Counseling Center is not required to agree to a restriction you request.

· Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are receiving therapy at the Counseling Center. On your request, the Counseling Center will send correspondence to another address.)

· Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in the Counseling Center mental health records used to make decisions about you for as long as the PHI is maintained in the record. The Counseling Center may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, the Counseling Center will discuss with you the details of the request and denial process.

· Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. The Counseling Center may deny your request. On your request, the Counseling Center will discuss with you the details of the amendment process.

· Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, the Counseling Center will discuss with you the details of the accounting process.

· Right to a Paper Copy – You have the right to obtain a paper copy of the notice from the Counseling Center upon request, even if you have agreed to receive the notice electronically.

Psychologist’s Duties:

· The Counseling Center is required by law to maintain the privacy of PHI and to provide you with a notice of the Counseling Center’s legal duties and privacy practices with respect to PHI.

· The Counseling Center reserves the right to change the privacy policies and practices described in this notice. Unless the Counseling Center notifies you of such changes, however, the Counseling Center is required to abide by the terms currently in effect.

· If the Counseling Center revises policies and procedures, notices will be posted at the Counseling Center and you will be given a revised notice at your next appointment.

V. Questions and Complaints

If you have questions about this notice, disagree with a decision the Counseling Center makes about access to your records, or have other concerns about your privacy rights, you may contact Dr. Edward Marshall, Director of the Counseling Center at (502) 863-7074.

If you believe that your privacy rights have been violated and wish to file a complaint with the Counseling Center, you may send your written complaint to Dr. Edward Marshall, Director of the Georgetown College Counseling Center, Georgetown College, 400 E. College Street, Georgetown, Kentucky 40324 or email at Edward_Marshall@georgetowncollege.edu.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed above can provide you with the appropriate address upon request.

You have specific rights under the Privacy Rule. The Counseling Center will not retaliate against you for exercising your right to file a complaint.

VI. Effective Date, Restrictions, and Changes to Privacy Policy

This notice will go into effect on December 1, 2003. The Counseling Center reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that the Counseling Center maintains.