7441 O St #300
Lincoln, NE 68510
This notice describes how your health-related information, known as Protected Health Information or PHI, will be protected, how it may be used and disclosed by our practice and how you may obtain access to it. As counseling professionals, we are committed to maintaining the privacy of the information you provide to us. In compliance with state laws and general mental health care practices, we will create records regarding you and the treatment services we provide to you. The physical security and the privacy of this information is mandated by the Health Information Portability and Accountability Act (HIPAA) (1996), and this notice describes how our practice will fulfill some of our key obligations as defined by this federal statute.
A. Treatment. We will use PHI to assess your mental health, your response to counseling and to plan for future care. With your written permission, we may disclose or receive PHI from other professionals, such as physicians and pastors, in order to coordinate efforts to provide assistance that addresses the full range of your medical, spiritual and psychological needs.
B. Supervision and quality assurance. Clinical supervisors on our counseling staff routinely use PHI as part of discharging their oversight duties. In addition, all LCEA mental health professionals meet regularly to review one another’s work and to evaluate the quality of care provided to counselees. Finally, PHI may be shared amongst members of the LCEA staff in order to coordinate on-call services during anticipated emergencies or in urgent situations.
C. Appointment reminders. Our practice may use and disclose your PHI to remind you of an appointment. Unless you inform us otherwise, this will include messages we may leave on your home or personal answering machine or your cell phone voice mail.
D. Release of information to family/friends. In the case of independent adults, PHI will only be released upon receipt of a signed release of information from the patient. In the case of children and dependent adults, PHI may be shared at the discretion of the LCEA counseling professional with parents holding legal custody, guardians or with those holding powers-of-attorney.
E. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you receive from us. For example, we may contact your health insurer or other third party payor (e.g.s. Medicare, Medicaid) to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details about your diagnosis and treatment if your insurer requires that we do so in order for you to receive coverage for services. We may use your PHI to bill you directly for services, or disclose your PHI to other entities in order to assist us in our billing and collection efforts.
F. Disclosures required by law. Our practice will use and disclose your PHI when we are required to do so by federal, state and local law.
The following paragraphs describe unique circumstances under which your PHI may be disclosed to personnel outside LCEA.
A. Protection of yourself or others. If you provide us with information that indicates that you may pose a physical danger to yourself or to others, or if another party poses a physical danger to you or to others, PHI may be disclosed.
B. Abuse and neglect. If you disclose that you or another person has physically or sexually abused a child, an incompetent or a disabled adult, or if a child, an incompetent or disabled adult has suffered from neglect, we are required to report such to an appropriate governmental agency.
C. Child custody disposition. If you are a party in a divorce or other legal proceeding involving contested child custody, a court order may mandate the release of PHI to the body holding jurisdiction over the proceeding. This will be more likely if there is an accusation of child abuse made against you. Should this occur, we will inform you of the legal action so that you may take steps to secure your PHI.
D. Lawsuits. If you are a plaintiff in a lawsuit, the defendant in the action may file a petition for the release of your PHI and a court order may be imposed upon us to comply. As in (C), you will be made aware of any attempts to force us to release your PHI before any disclosures are undertaken.
E. Worker’s Compensation. If you are receiving financial support from Worker’s Compensation for health care services, your PHI may be released to their representatives.
A. Confidential communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For example, you may request that we contact you at home, rather than at work.
B. Requesting restrictions. You have the right to request restrictions in our use or disclosure of your PHI to individuals who are involved in your treatment or in payment of your services. We are not required to agree to your request; however, if we do agree, we are bound by that agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of PHI, you must submit a request to us in writing.
C. Accounting of disclosures. You have the right to request an “accounting of disclosures,” a list of non-routine disclosures our practice has made of your PHI for non-payment or non-operational purposes. Use of your PHI as part of your routine care is not required when, for example, your counselor discusses your case with a supervisor or when billings are submitted to your insurance company. In order to obtain a copy of disclosures, submit a request to us in writing.
D. Inspection and copies. In most cases our patients have the right to inspect and obtain a copy of their PHI , including mental health and billing records. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Please submit your request to us in writing. This right to inspect and copy your records does not automatically extend, however, to patients with a history of violent, suicidal, or other behavior that could result in physical harm to themselves or to others, or to patients who are in the judgment of their counselor at significant risk of engaging in such behavior. If your request is denied under the conditions mentioned above, you may request a review of that determination in which case another mental health professional chosen by us will examine your records and provide a second opinion.
E. Amendment. You may ask us to amend your health information if you believe it is inaccurate or incomplete, and you may request an amendment as long as your PHI is kept by our practice. To request an amendment, submit your request to us in writing and provide us with the reason that supports your request for amendment. Our practice will deny your request if it is not presented to us in writing. In addition, we may deny your request if in our opinion a) your PHI is accurate and complete or b) the information you wish to include is not appropriate for a mental health record or for the evaluation and treatment you received while under our care.
F. Right to provide an authorization for uses and disclosures of PHI. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After revocation of your authorization, we will terminate the disclosures previously authorized although we will retain records of your care.
G. Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of Health and Human Services. All complaints to us must be submitted in writing and addressed to Privacy Officer, LCEA, 7441 “O” Street # 300, Lincoln, Nebraska 68510.
If you have any questions regarding this notice or our health information privacy practices, please contact: Privacy Officer, LCEA, 7441 “O” Street # 300, Lincoln, Nebraska 68510. For telephone inquires, contact us at (402) 488-7400.