Humboldt Counseling Connection Privacy Practices
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION:
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. We understand that information about you and your health care is personal. HCC is committed to protecting your Protected Health Information (“PHI”). We create a record of the care and services you receive from our providers to provide quality care and to comply with legal requirements. This notice applies to all records generated by Humboldt Counseling Connection.
By law, Humboldt Counseling Connection is required to:
Ensure that PHI that identifies you is kept private in accordance with HIPAA and the California Confidentiality of Medical Information Act (CMIA).
Give you this notice of our legal duties and privacy practices with respect to your PHI.
Follow the terms of the notice that is currently in effect.
We reserve the right to change the terms of this notice. Revised notices will apply to all PHI we maintain and will be available upon request, our offices and on our website.
II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
Federal and California laws permit HCC to use and idsclose your PHI without your written authorization for the following purposes:
For Treatment: We may use PHI to provide, coordinate or manage your mental health care. For example, our providers may consult with other licensed health care providers regarding your treatment.
For Payment: We may use and disclose PHI to bill and collect payment from you, insurance companies, or third parties.
For Health Care Operations: We may use and disclose PHI for operational purposes, such as quality assessment, business planning and compliance reviews.
Appointment Reminders & Health-Related Benefits: We may contact you via phone, email, or text (with your consent) to remind you of appointments or share treatment alternatives.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes: Notes taken during sessions that are kept separate from the rest of your medical record require your explicit written authorization to release, except for use in treating you, during training/supervision, defending myself in legal proceedings or as required by law.
Marketing & Sale of PHI: We will never sell your PHI for marketing purposes without your express written authorization.
Other uses: Any other uses and disclosures not described in this notice will be made ONLY with your written authorization, which you may revoke at any time in writing.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.
Subject to state and federal limits, We may disclose your PHI without authorization for:
Mandated Reporting: Suspected child abuse, elder abuse, or dependent adult abuse.
Threat to Health or Safety: To prevent or lessen a serious and imminent threat to your health or safety or the safety of another person.
Health Oversight & Judicial Proceedings: Persuant to a lawful court order signed by a judge (Note: Under California law, an attorney-generated subpoena alone is generally insufficient without your authorization or a judge’s order).
Public Health & Law Enforcement: As required by state or federal law, workers’ compensation laws, or specialized government functions.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
We may share PHI with family member, friend or relative directly involved in your care or payment for care if you agree or fail to object when given the opportunity.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
Right to Request Restrictions: You can ask our providers not to use/share certain PHI for treatment, payment or operations. We are not required to agree, except if you pay out-of-pocket in full for a service and ask us not to disclose that service to your health plan, in which case we must agree.
Right to Confidential Communications: You have the right to request that we communicate with you in a specific way (e.g. specific email or phone number).
Right to Inspect and Copy: You have the right to inspect and obtain paper or electronic copies of your record (excluding psychotherapy notes). Under California law, records must be provided within 15 days of a written request (or 10 days for a summary). Reasonable cost-based fees may apply.
Right to Amend: If you feel your PHI is incorrect or incomplete, you may request an amendment in writing.
Right to an Accounting of Disclosures: You can request a list of certain non-routine disclosures made in the past 6 years.
Right to a paper or electronic copy: You may request a copy of this notice at any time.
VII. COMPLAINTS AND QUESTIONS
If you believe your privacy rights have been violated, or if you have questions about this notice:
Contact Practice Privacy Officer: Joselyn Legacy, 310 F Street, Eureka, CA 95501, 707-390-0393, info@humcounseling.com
File a complaint with the Federal Government: Contact the Secretary of the U.S. Department of Health and Human Services (HHS) Office for Civil Rights at 200 Independence Avenue, S.W., Washington, D.C. 20201, calling (870) 696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa,complaints.
File a complaint with the State Licensing Board: Board of Behavioral Services (BBS) 1625 North Market Blvd., Suite S-200, Sacramento, CA 95834. Phone: (916) 574-7830. Website: www.bbs.ca.gov
You will NOT be penalized or retaliated against for filing a complaint.