aviso de prácticas de privacidad

CONFIDENTIALITY
‍THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. IT DESCRIBES YOUR RIGHTS TO THE HEALTH INFORMATION WE KEEP ABOUT YOU AND HOW YOU MAY EXERCISE THESE RIGHTS. IT ALSO DESCRIBES OUR LEGAL DUTIES REGARDING THE USE AND DISCLOSURE OF YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
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We understand that information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by this mental health care practice.  

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
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For Treatment, Payment, or Health Care Operations
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Federal privacy rules and regulations allow health care providers that have direct treatment relationship with the client to use or disclose the client’s personal health information WITHOUT THE CLIENT’S WRITTEN AUTHORIZATION, to carry out the health care provider’s own treatment, payment or health care operations. We may disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization.

For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between healthcare providers, and referrals of a patient for health care from one health care provider to another.
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Lawsuits and Disputes
If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

Psychotherapy Notes
We may keep “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:
1. For our use in treating you.
2. For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
3. For our use in defending ourselves in legal proceedings instituted by you.
4. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
5. Required by law and the use or disclosure is limited to the requirements of such law.
6. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
7. Required by a coroner who is performing duties authorized by law.
8. Required to help avert a serious threat to the health and safety of others.

Marketing Purposes
We will not use or disclose your PHI for marketing purposes.

Sale of PHI
We will not sell your PHI in the regular course of our business.

Your Written Authorization
We will not use or disclose your protected health information for any purpose not specified in this Notice without your written authorization. Such written authorization will include a meaningful description of the information being used or disclosed, identify the person(s) receiving the information, describe the purpose of the use or disclosure, and the time frame that the authorization is valid. You may revoke the authorization at any time, in which case we will no longer use or disclose your protected health information for this purpose, except to the extent we have already relied on your authorization. You are not required to sign an authorization form and we will not deny you treatment if you refuse to do so.

CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

Subject to certain limitations in the law, we can use and disclose your PHI without your authorization for the following reasons:
1. When disclosure is required by state or federal law, the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order,  although our preference is to obtain an Authorization from you before doing so.
5. For law enforcement purposes, including reporting crimes occurring on our premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although our preference is to obtain an authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
10. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that We offer.

CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

Disclosures to family, friends, or others  
We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. We will say “yes” unless a law requires us to share that information.
3. The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and We will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that We have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and We may charge a reasonable, cost-based fee for doing so.
5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which We have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list We will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost-based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that We correct the existing information or add the missing information. We may say “no” to your request, but We will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
8. The Right to File a Complaint. You have the right to complain if you feel we have violated your rights. Our administrative staff can be reached at 541-904-5216 or via email at contactus@brightwayscounseling.com. They will direct you to our Privacy Officer to discuss your complaint.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.  
We will not retaliate against you for filing a complaint.

OUR LEGAL DUTIES
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• We will give you this notice of our legal duties and privacy practices with respect to health information.
• As required by law, we will ensure that Protected Health Information (“PHI”) that identifies you is kept private.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We will follow the terms of the notice that is currently in effect. We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office and on our website.
• We will not use or share your information other than as described here
unless you tell us we can in writing. If you tell us we can, you may change
your mind at any time by writing us at: Brightways Counseling Group, Attn: Privacy Officer, 7515 Falcon Crest Drive #200, Redmond, OR 97756, or by email at: contactus@brightwayscounseling.com.

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

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. By signing this document, you are acknowledging that you have received a copy of HIPPA Notice of Privacy Practices, as well as a personal disclosure statement of the primary clinician and their credentials.


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Client’s name (printed)
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Client’s date of birth



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Signature of client or legal representative

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Name of representative (printed) if applicable

__________________________
Date
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Relationship to client



Client’s Bill of Rights

While in professional counseling, your respect and dignity will never be intentionally compromised. It is important to note that the counselor may question or challenge your past or present behaviors for the purpose of assessing if these behaviors have contributed to your emotional pain and suffering. Yet, therapy is very hard work for both the client and the counselor. If you feel, at any time, that you have a concern or complaint in counseling, please share this concern or complaint with your counselor. In most cases, this brings about a solution which is acceptable to all.
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As a client of an Oregon licensee, you have the following rights:  
∗ To expect that a licensee has met the qualifications of training and experience required by state law;  
∗ To examine public records maintained by the Board and to have the Board confirm credentials of a licensee;  
∗ To obtain a copy of the Code of Ethics (Oregon Administrative Rules 833-100);  
∗ To report complaints to the Board;  
∗ To be informed of the cost of professional services before receiving the services;  
∗ To be assured of privacy and confidentiality while receiving services as defined by rule or law, with the following exceptions:
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1) Reporting suspected child abuse
2) Reporting imminent danger to you or others
3) Reporting information required in court proceedings or by your insurance company, or other relevant agencies
4) Providing information concerning licensee case consultation or supervision
5) Defending claims brought by you against me
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∗ To be free from discrimination because of age, color, culture, disability, ethnicity, national origin, gender, race, religion, sexual orientation, marital status, or socioeconomic status.
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You have the right to contact:
The State Board of Licensed Social Workers, 3218 Pringle Road, #240, Salem, OR 97302-6310, (503) 378-5735, http://www.oregon.gov/blsw/Pages/index.aspx, or The Board of Licensed Professional Counselors and Therapists at: 3218 Pringle Rd Ste. #120, Salem, OR 97302-6312, Telephone: (503) 378-5499, Email: lpct.board@oregon.gov, Website: www.oregon.gov/OBLPCT
 
For additional information about your counselor or therapist, consult the board’s website.