HIPAA Notice of Privacy Practices
In order to protect the privacy of your health information and your child’s health information, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protections apply to individually identifiable “protected health information” that is created or received by us and that relates to the past, present, or future physical or mental health or conditions of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to and individual; and that identifies the individual, or for which there is a reasonable basis to believe the information can be used to identify the individual (hereinafter referred to as “protected health information”). This notice of our privacy practice is intended to inform you of the ways we may use your information and the occasions on which we may disclose this information to others.
- Uses and disclosures for treatment, payment, and health care operations
SI/CBALD may use or disclose your protected health information (PHI) for treatment, payment, and health care operation, purposes with your written authorization. To help clarify these terms, the following definitions apply:
- PHI: Information in your health record that could identify you.
- Treatment: Actions we take to provide, coordinate, or manage your health care and other services related to your health care. An example of treatment is when we consult with another health care provider, such as your family physician or another psychologist.
- Payment: Actions to obtain reimbursement for your health care.
- Health care operations: Activities that relate to the performance and operation of SI/CBALD, such as quality assessment, business relater matters, audits and administrative services, case management, and care coordination.
- Use: Activities within SI/CBALD such as sharing, employing, using, and analyzing information that identifies you or your child.
- Disclosure: Activities outside of SI/CBALD, such as sharing, employing, using, and analyzing information that identifies you or your child.
- Authorizations: Your written permission to disclose confidential mental-health information. This requires your signature on a specific legally required form.
- Other uses and disclosures requiring authorization
SI/CBALD may use or disclose PHI for purpose outside of treatment, payment, or healthcare operations, when your appropriate authorization is obtained. In such cases, we will obtain an authorization form you before releasing this information. We will also need your authorization before releasing your child’s program information. This also includes assessment data and the associated written report.
You may revoke all such authorizations (PHI and/or Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that we have relied on that authorization for treatment and/or assessment 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.