This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Atlantic Counseling & Consultation, Inc., is covered by the medical information privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (generally called “HIPAA) and it’s Regulations. As a result, we are required to comply with HIPAA and the Regulations in the use and disclosure of health information by which our patients can be individually identified. This health information is referred to as “Protected Health Information” or “PHI” for short. We are also required under Section 164.520 to give our patients this notice (in paper or electronically as the patient wishes) of our legal duties and privacy practices concerning their Protected Health Information, and also to tell our patients about their rights under HIPAA and the Regulations. Uses and Disclosures Treatment: Providing, coordinating or managing health care and related services, consultation between health care providers relating to a patient or referral of a patient for health care from one provider to another. Payment: Billing and collecting for services provided, determining plan eligibility and coverage, recertification and medical necessity review. Health Care Operations: General agency administrative and business functions, quality assurance/improvement activities; medical review; auditing functions; licensing, survey, certification and credentialing actives. We are permitted to use or disclose information about you without consent or authorization in the following circumstances: 1.) Certain law enforcement purposes such as helping to identify or locate a suspect, fugitive, material witness or missing person, or to comply with a court order or subpoena and other law enforcement purposes; 2.) To coroners, medical examiners and funeral directors, in certain circumstances, for example, to identify a deceased person, determine the cause of death or to assist in carrying out their duties. Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
You have certain rights under the federal privacy standards. These include: • the right to request restrictions on the use and disclosure of your protected health information • the right to receive confidential communications concerning your medical condition and treatment • the right to inspect and copy your protected health information which is maintained in a designated record set, EXCEPT FOR PSYCHOTHERAPY NOTES, information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding, or protected health information that is subject to the Clinical Laboratory Improvements Amendments of 1988 [42 USC 263a and 45 CFR 493 (2)]. • The right to amend or submit corrections to your protected health information • The right to receive an accounting of how and to whom your protected health information has been disclosed • The right to receive a printed copy of this notice
Atlantic Counseling and Consultation, Inc. Duties
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We are also required to abide by the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.
Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting: The Clinical Director Atlantic Counseling and Consultation, Inc. 49 Pleasant Street South Weymouth, MA 02190
Atlantic Counseling and Consultation, Inc. is providing all patients with a notice that describes how medical information about you may be used and disclosed and how you can get access to this information. This notice meets the requirements as stipulated in the Health Insurance Portability and Accountability Act (45CFR 165.520). Please sign below acknowledging receipt of the Notice of Privacy Practices for Protected Health Information.