THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

INTRODUCTION

At Woodview Psychology Group, LLC (hereafter referred to as WPG), we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective 4/14/2003, and applies to all protected health information as defined by federal regulations.

UNDERSTANDING YOUR HEALTH INFORMATION/RECORD

When therapy/counseling services are provided to you or your legal dependents at WPG, a record is made of the service. Typically, this record contains your concerns, updated pertinent information, clinical impressions, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

  • Basis for planning your care and treatment,
  • Means of communication among the mental health/ health professionals who contribute to your care,
  • Legal document describing the care you received,
  • Means by which you or a third-party payer can verify that services billed were actually provided,
  • A source of data for limited research on the population we serve,
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of WPG, the information belongs to you. You have the right to:

  • Obtain a paper copy of this notice of information practices upon request,
  • Inspect and copy your health record as provided for in 45 CFR 164.524,
  • Amend your health record as provided in 45 CFR 164.528,
  • Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528,
  • Request communications of your health information by alternative means or at alternative locations,
  • Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522, and
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
OUR RESPONSIBILITIES
WPG is required to:

  • Maintain the privacy of your health information,
  • Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
  • Abide by the terms of this notice,
  • Allow access to your information within the office on a “need to know” basis,
  • Notify you if we are unable to agree to a requested restriction, and
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue using or disclosing your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If have questions and would like additional information, you may contact the WPG’s Privacy Officer at 317/573-0149.

If you believe your privacy rights have been violated, you can file a complaint with WPG’s Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201

Examples of Disclosures for Treatment, Payment and Health Operations:

We will use your health information for treatment.
For example: Information obtained by a counselor will be recorded in your record and used to determine the course of treatment that should work best for you. The recommended course of treatment will be documented, as will the means by which this information was relayed to you. This information will be updated at each visit. At your request, it will be sent to other providers who are involved in your care or whom you see subsequent to discontinuing care at WPG.

We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis and procedures (services) provided.

We will use your health information for regular health operations.
For example: Members of our staff may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the care and service we provide.

Business associates: There are some services provided in our organization through contracts with business associates. Examples include professional services, transcription services, and accounting services. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care in the event of an emergency.

Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may utilize information for our own research or disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. However, no identifiable information will leave our offices for research purposes.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.