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.
Our Commitment To Your Privacy
Banyan Counseling Center, Inc. (BCCI) is dedicated to maintaining the privacy of your personal health information as part of providing professional care. BCCI is also required by law to keep your information private. These laws are complicated, but you must have this important information. This document is a shorter version of the full, legally required Notice of Privacy Practices (NPP) which you can get from your therapist, Martha L. Harris, LCSW. However, it is not possible to cover all possible situations so please talk to your therapist about any questions or problems.
BCCI will use the information about your health which we get from you or from others mainly to provide you with treatment, to arrange payment for our services, and for some other business activities which are called, in the law, health care operations. After you have read this NPP, you may be asked to sign a Consent Form to let BCCI use and share your information if that is necessary in providing your care. If you do not consent and sign this form, BCCI cannot treat you.
If your therapist or you want to use or disclose (send, share, release) your information for any other purposes, your therapist will discuss this with you and ask you to sign an Authorization Form to allow this.
Of course, BCCI will keep your health information private, but there are some times when the laws require us to use or share it. For example:
When there is a serious threat to your health and safety or the health and safety of another individual or the public. We will only share information with a person or organization who is able to help prevent or reduce the threat.
Some lawsuits and legal or court proceedings.
If a law enforcement official requires to do so.
For Workers Compensation and similar benefit programs.
There are some other situation like these but which do not happen very often. They are described in the longer version of the NPP.
Your Rights Regarding Your Health Information
You can ask us to communicate with you about your health and related issues in a particular way or at a certain place which is more private for you. For example, you can ask your therapist to call you at home, and not at work, to schedule or cancel an appointment. Your therapist will try her best to do as you ask.
You have the right to ask your therapist to limit what she tells people involved in your care or the payment for your care, such as family members and friends. While your therapist does not have to agree to your request, if she does agree, she will keep her agreement with you except if it is against the law, or in an emergency, or when the information is necessary to treat you.
You have the right to look at the health information BCCI has about you such as your medical and billing records. Your therapist is under no legal obligation to provide you with copies of her psychotherapy notes. Psychotherapy notes are defined as the notes she takes while in session with you. You can get a copy of your client records but BCCI will charge a fee of $1.00 per page for such records, plus the cost of mailing if applicable.
If you believe the information in your records is incorrect or missing important information, you can ask your therapist to make some kinds of changes (called Amendments) to your health information. You have to make this request in writing and send your written request to your therapist. You must tell your therapist the reasons you want to make the changes.
You have the right to a copy of this notice. If BCCI changes this NPP, the new version will be posted on BCCI's website from which you can print a copy.
You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with your therapist and with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care BCCI provides to you in any way.
If you have any questions regarding this Notice or BCCI's health information privacy policies, please contact Martha L. Harris, LCSW. She can be reached by phone at 703-717-0999 or by email at BanyanCounseling@aol.com.
The effective date of this notice is April 14, 2003.
