NOTICE OF PRIVACY PRACTICES
This noticed is for the purpose of informing you of how your personal information may be used and disclosed and how this information is accessed. Pleaser review it carefully.
Federal and Illinois law and regulations protect the confidentiality of records. The principle purpose of maintaining information about you is to document your assessment and treatment. The Highest professional standards will be adhered to in maintaining your records.
The two federal laws that Protect Health Information are the Health Insurance Portability and Accountability Act of 1996(HIPPA) and the Confidentiality Law 42 C.F.R part 2. Under these laws, Epoch Counseling and Therapeutic Services may not inform others that you attend counseling or disclose any other protected information except as permitted by feral law as follows.
Disclosures of Information
Epoch Counseling and Therapeutic Services may disclose Protected Health Information (PHI) for the following reasons. For some of these uses of disclosures, prior authorization is required; for others, it is not.
PHI can be used without consent:
To Obtain payment for treatment. Epoch Counseling and Therapeutic Services can use disclosed PHI to bill and collect payment for the treatment and services provided from billing companies, claims, processing companies, and others that process health claims.
Under federal and state regulations, certain disclosures of information may be made:
- When the client consents in writing. (Any such written consent may be revoked in writing)
- When the disclosure is allowed by a valid court order
- In case of an emergency, and if you are not able to five or refuse permission, we will share only the information that is directly necessary for obtaining emergency care for you, according to our professional judgement.
- If there is a situation of danger to self or others. Epoch Counseling and Therapeutic Services may be required to notify the intended victim and/or law enforcement officials and the IL FOID Mental Health Reporting System
- When there is Suspected child or elder abuse and/or neglect
- When a crime is committed by a client at Epoch Counseling and Therapeutic Services, or against any person who works for Epoch Counseling and Therapeutic Services, or when there is a threat to commit such a crime
- No more Protected Health Information (PHI) maybe used than s necessary to accomplish the purpose for which the use or disclosure is made.
Under HIPPAA you have the right to request restrictions on certain uses and disclosures of your information. Epoch Counseling and Therapeutic Services is not required to agree to any restrictions you request, but if we do agree we are bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.
You have the right to request the we communicate with you by alternative means or at an alternative location. Epoch Counseling and Therapeutic Services will accommodate such request that are reasonable.
Under HIPPAA you also have the right to inspect and copy your own health information maintained by Epoch Counseling and Therapeutic Services except to the extent that the information contains psychotherapy notes or information compiled for the use in a civil, criminal, or administrative proceeding or in other limited circumstances. Such requests are to be made in writing. A reasonable fee for copying may be imposed.
Under HIPPAA you also have the right, with some exceptions, to amend health care information maintained in your records. Your request must be in writing, and it must explain why the information should be amended. We may deny your request, but if we do, we will provide a written explanation. If we accept your request to amend the information, we will make reasonable efforts to include the changes in any future disclosures of that information.
You have the right to request and receive an accounting of disclosures of your health related information made by Epoch Counseling and Therapeutic Services during the six years prior to your request but beginning no earlier than the date of the implementation of this document as stated at the end of this document (3/28/2018). You also have a right to receive a paper copy of this notice.
Violation of the federal and state law and regulations by Epoch Counseling and Therapeutic Services is a crime. Suspected violations maybe reported to appropriate authorities. You may complain to your counselor and the Secretary of the US Dept. of Heath and Human Services at 200 Independence Ave. SW, Washington D.C. 20201 or call 1-977-696-6775 if you believe that your privacy rights have been violated under HIPPAA. You will not be retaliated against for filing such a complaint.
Epoch Counseling and Therapeutic Services reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains and will provide you with a copy of the changed terms if they occur.
My signature below means I have a read this document, understand it, have been given the opportunity to ask questions for clarification and have received a copy of this notice