THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
We are Required by Law to:
Ensure that health information that identifies you is kept private and in accordance with federal and state laws
Provide you this notice as to our legal duties and privacy practices with respect to individually identifiable health information that we collect and maintain about you
Allow you to obtain a copy of your health information in paper and electronic form
Correct any information in your health information that you prove to be inaccurate
Train our personnel concerning privacy and confidentiality
Implement a sanction policy to discipline those who breach privacy/confidentiality or our policies with regard to Personal Health Information (PHI)
Mitigate (lessen the harm)any breach of privacy/confidentiality
Abide by terms of this notice
Who We May Disclose Health Information to and Reasons for Disclosure
To a specialist in which our health center is sharing in the treatment
We may disclose your health information to your insurance provider, Medicare, Medicaid and other health plan providers for billing of services
Public Health, abuse or neglect and health oversight. Example: To alert a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease
Workers Compensation relating to a work-related injury that you were treated for at our health center
Authorization required by law including legal proceedings where a subpoena has been issued
In the event of a death that may be the result of criminal conduct
To identify or locate a suspect, fugitive, material witness or missing person
Information may be released or disclosed to a coroner, medical examiner, or funeral director to assist in the performance of their duties in accordance with applicable law
To prevent a threat to National Security
To a business associate who provides services through a contract and who has signed a HIPAA Business Agreement
If you are an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
We may disclose your health information to the Department of Health and Human Services (HHS) as necessary to determine our compliance with those standards.
Disclosure for Which Authorization is Required:
Use for Psychotherapy
For marketing purposes including subsidized treatment communication
Disclosures that constitute a sale of Personal Health Information
Disclosure to health insurance providers where you paid the full amount of the services
Disclosure to any third party that is not listed in (Who We May Disclose Your Information to)
We will notify you in writing of all other disclosures that are not listed here and request your permission for such disclosure.
Note: The list above is not inclusive and there may be other instances in which your Authorization is required for release of your Personal Health Information
Notice of Intent:
We may contact you by mail or phone calls to remind you of your appointment
We may contact you to provide information regarding your treatment alternatives or other health-related benefits and services.
If we decide to contact you concerning fundraising, we will first ask for your approval.
Right to Restrict Disclosure: You have a right to request restrictions or limitations on certain uses and disclosures of your Personal Health Information. Each individual request will be reviewed to determine if the restriction is within your rights. You have a right to request and receive an accounting of all disclosures of your Personal Health Information.
Right to Inspect and Copy: You have a right to inspect and copy your Personal Health Information. You have a right to receive the information electronically once we have such authorization in writing. If you feel that this information is incorrect or incomplete, you may ask us to amend the information.
Instances Where Right to Copy or Inspect May be Refused:
Psychotherapy notes that are recorded in any medium by a health care provider who is a mental health professional documenting or analyzing a conversation during a private, group, joint, or family counseling session and that are separated from the rest of your medical record.
Information compiled in reasonable anticipation of or for use in civil, criminal, or administrative actions or proceedings
Protected Health Information that is subject to the Clinical Laboratory Improvement Amendments 1988 (CLIA), 42 USC §263a, to the extent that giving you access would be prohibited by law.
Information that was obtained from someone other than a health care provider under a promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information.
Information that is copyright protected, such as certain rad data obtained from testing
Note: In other situations, we may deny you access, but if we do, we must provide you a review of our decision denying access. These reviewable grounds for denial include the following.
A licensed health care professional, such as your attending physician, has determined in the exercise of professional judgment, that the access is reasonably likely to endanger the life or physical safety of you or another person.
Protected Health Information makes reference to another person (other than a health care provider) and a licensed health care provider has determined in the exercise of professional judgment, that the access is reasonably likely to cause substantial harm to such other person.
The request is made by your personal representative and a licensed health care professional has determined, in the exercise of professional judgment that giving access to such personal representative is reasonably likely to cause substantial harm to you or another person.
For these reviewable grounds, another licensed professional must review the decision of the provider denying access within 60 days. If we deny you access, we will explain why and what your rights are, including how to seek review. If we grant access, we will tell you what, if anything, you have to do to get access. We reserve the right to charge a reasonable cost-based fee for making copies.
If We Deny Your Request for Amendment/Correction: If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut) and how you can complain. If we grant the request, we will make the correction and distribute the correction to those who need it and those whom you identify to us that you want to receive the corrected information.
Changes to this Notice: We reserve the right to make changes to this notice. If changes are made, we will make the changes readily available to you upon request on or after the effective date of the revisions to existing patients who request a copy and we will post the revised copy in our centers. Copies may also be found on our website, www.lccc.us.com.
Breaches: If your Protected Health Information is breached, we will notify within sixty (60) days of the breach that your Protected Health Information has been breached. We will take every precaution and steps as required by federal and state law to circumvent any damages caused by the breach.
Complaints: If you believe that there has been a violation of your Privacy Rights, you may file a complaint with the Secretary of the Department of Health and Human Services at
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
Complaints may be filed with our Privacy Officer by mail, email, or fax:
Privacy Officer: Andrea Hope Howard
530 Atkins Boulevard
Marianna, AR 72360