Effective Date of This Notice: July 16th, 2021
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Given the nature of Colorado Wildflower Couseling’s work, it is imperative that it maintains the confidence of client information that it receives in the course of its work. Colorado Wildflower Counseling is a mental health practice that provides mental health services. The practice works solely to provide the best counseling treatment options to its clients. It is prohibited from releasing any client information to anyone outside immediate staff, employees, interns, and/or volunteers except in limited circumstances in accordance with this Notice of Privacy Policies and Practices.
Discussions or disclosures of protected health information (“PHI”) within the practice are limited to the minimum necessary that is needed for the recipient of the information to perform his/her job.
Please review this Notice of Privacy Policies and Practices (“Notice of Privacy Policies”). It is my policy to:
Fully comply with the requirements of the HIPAA General Administrative Requirements, the Privacy and Security Rules.
Provide every client who receives services with a copy of this Notice of Privacy Policies.
Ask the client to acknowledge receipt when given a copy of this Notice of Privacy Policies.
Ensure the confidentiality of all client records transmitted by facsimile.
Obtain from each client an informed Authorization for Release of Protected Health Information form when required.
Colorado Wildflower Counseling is required to follow all state and federal statutes and regulations including:
Federal Regulation 42 C.F.R. Part 2
Title 25, Article 4, Part 14 and Title 25, Article 1, Part 1, CRS
Health Insurance Portability and Accountability Act (HIPAA), 45 C.F.R. Parts 142, 160, 162 and 164
These laws govern testing for and reporting of TB, HIV AIDS, Hepatitis, and other infectious diseases, and maintaining the confidentiality of PHI.
PHI refers to any information that I create or receive, and relates to an individual’s past, present, or future physical or mental health or conditions and related care services or the past, present, or future payment for the provision of health care to an individual; and identifies the individual or there is a reasonable basis to believe the information can be used to identify the individual.
PHI includes any such information described above that I transmit or maintain in any form, including Psychotherapy Notes.
HIPAA and federal law regulate the use and disclosure of PHI when transmitted electronically.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You can ask to see or get an electronic or paper copy of your mental health record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee to fulfill your request.
If we deny your request, in whole or in part, we will let you know why in writing and whether you have the option of having the decision reviewed by an independent third-party.
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
Please review the Consent For Communication Of Protected Health Information By Non-Secure Transmissions.
You are required to “opt-in” to receive communications electronically as set-forth in the Consent for Communication of Protected Health Information by Non-Secure Transmissions. If you choose not to “opt-in,” we will not communicate with you via electronic means.
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
You have the right to request additional restrictions on the use or disclosure of your mental health information. However, we do not have to agree to that request, and there are certain limits to any restriction. Ask us if you would like to make a request for any restriction(s).
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You may revoke all such authorizations to release information (PHI, Psychotherapy Notes, HIV information, and/or Alcohol and Drug Use Information) at any time, provided each revocation is in writing, signed by you, and signed by a witness. You may not revoke an authorization to the extent that:
Colorado Wildflower Counseling has relied on that authorization; or
If the authorization was obtained as a condition of obtaining insurance coverage, the law provides the insurer the right to contest the claim under the policy.
You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
If you believe that there is a mistake in your PHI, or that a piece of important information is missing, you have the right to request that I correct or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
You can complain if you feel we have violated your rights.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Avenue, S.W., Washington, D.C. 20201
Call: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not retaliate against you for filing a complaint.
You may also file a complaint with the Colorado Department of Regulatory Agencies, Division of Professions and Occupations, Mental Health Section:
Address: 1560 Broadway, Suite 1350, Denver, Colorado, 80202
Phone: 303-894-2291
Email: DORA_Mentalhealthboard@state.co.us
Please note that the Department of Regulatory Agencies may direct you to file your complaint with the U.S. Department of Health and Human Services Office for Civil Rights listed above and may not be able to take any action on your behalf.
A use of PHI occurs within a covered entity (e.g., discussions among staff regarding treatment). A disclosure of PHI occurs when Colorado Wildflower Counseling reveals PHI to an outside party (e.g., another treatment provider or third party) pursuant to a valid written authorization.
I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information.
Colorado Wildflower Counseling may use and disclose PHI, without an individual’s written authorization, for the following purposes:
Treatment – disclosing and using your PHI by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members and for coverage arrangements during your therapist’s absence, and for sending appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Payment – disclosing and using your PHI so that Colorado Wildflower Counseling can receive payment for the treatment services provided to you, such as: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization of review activities.
Health Care Operations – disclosing and using your PHI to support Colorado Wildflower Counseling’s business operations which may include but not be limited to: quality assessment activities, licensing, audits, and other business activities.
Follow the terms of the notice that is currently in effect.
I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.
The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.
Uses and disclosures for payment and health care operations purposes are subject to the minimum necessary requirement. This means that Colorado Wildflower Counseling may only use or disclose the minimum amount of Protected Health Information (PHI) necessary for the purpose of the use or disclosure.
For example, for billing purposes, we would not need to disclose a client’s entire medical record in order to receive reimbursement. We would likely only need to include a service code and/or diagnosis.
In contrast, uses and disclosures for treatment purposes are not subject to the minimum necessary requirement.
Federal privacy rules allow health care providers who have a direct treatment relationship with a patient/client to use or disclose the patient’s personal health information without the patient’s written authorization, for the following purposes:
Treatment
Payment
Health care operations
I may also disclose your protected health information for the treatment activities of any health care provider, again without your written authorization.
Example: If a clinician consults with another licensed health care provider about your condition, we are permitted to use and disclose your personal health information to assist in the diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard, because:
Therapists and health care providers require access to full and complete records in order to deliver quality care.
The term “treatment” includes:
Coordination and management of care with third parties
Consultations between health care providers
Referrals from one provider to another
Colorado Wildflower Counseling is required to promptly notify you of any breach that may have occurred and/or that may have compromised the privacy or security of your PHI.
Confidentiality of client records and substance abuse client records maintained are protected by federal law and regulations. It is Colorado Wildflower Counseling’s policy that a client must complete an Authorization for Release of Protected Health Information it provides prior to disclosing health information to another individual and/or entity for any purpose, except for treatment, payment, or health care operations in accordance with this Notice of Privacy Policies.
Absent the above referenced form, other than for treatment, payment, or health care operations purposes, Colorado Wildflower Counseling is prohibited from disclosing or using any PHI outside of or within the organization, including disclosing that the client is in treatment without written authorization.
Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:
The above exceptions are subject to several requirements under the Privacy Rule, including the minimum necessary requirement and applicable federal and state laws and regulations. See 45 C.F.R. § 164.512. Before using or disclosing PHI for one of the above exceptions, Colorado Wildflower Counseling must ensure compliance with the Privacy Rule. Violation of these federal and state guidelines is a crime carrying both criminal and monetary penalties. Suspected violations may be reported to appropriate authorities, as listed above in the “Client Rights” section, in accordance with federal and state regulations. Know that Colorado Wildflower Counseling will never market or sell your personal information without your permission.
Certain categories of information have extra protections by law, and thus require special written authorizations for disclosures.
Psychotherapy Notes: Your therapist may keep and maintain “Psychotherapy Notes”, as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
HIV/AIDS Information: Special legal protections apply to HIV/AIDS related information. Your therapist will obtain a special written authorization from you before releasing information related to HIV/AIDS.
Alcohol & Drug Use Information: Special legal protections apply to information related to alcohol and drug use and treatment. Your therapist will obtain a special written authorization from you before releasing information related to alcohol and/or drug use/treatment.
As a covered entity under the Privacy and Security Rules, Colorado Wildflower Counseling is required to reasonably safeguard PHI from impermissible uses and disclosures. Safeguards may include, but are not limited to the following:
For certain health information, you can tell your therapist (verbal authorization) your choices about what it shares. If you have a clear preference for how I share your information in the situations described below, talk to your therapist and state what you want to do. Your therapist may request you sign a separate document if you authorize it to share certain PHI. You may revoke that authorization at any time for future disclosure.
In these cases, you have both the right and choice to tell your therapist to:
Share information with your family, close friends, or others involved in your care • Share information in a disaster relief situation
Include your information in a hospital directory
If you are not able to state your preference, for example if you are unconscious, your therapist may go ahead and share your information if your therapist believes it is in your best interest and for your care/treatment and may also share your information when needed to lessen a serious and imminent threat to public health or safety.
In these cases we never share your information unless you give us written permission:
Marketing purposes
Sale of your PHI in the regular course of my business.
Most sharing of psychotherapy note
Colorado Wildflower Counseling can change the terms of this notice, and the changes will apply to all the information it has about you. The new notice will be available upon request.
For more information see:
www.hhs.gov/ocr/privacy/hipaa/
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.
