NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
EFFECTIVE DATE OF THIS NOTICE The effective date of this notice is March 1, 2000. Revisions of text (but not general content) were made to this notice on January, 21, 2016 and December 19, 2021
I only release health information in accordance with state and federal laws and the ethics of the counseling profession.
This notice describes my policies related to the use and disclosure of your healthcare information.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION FOR THE PURPOSES OF PROVIDING SERVICES. Providing treatment services, collecting payment and conducting healthcare operations are necessary activities for quality care. State and federal laws allow us to use and disclose your health information for these purposes.
I may use or disclose your PHI for treatment, payment, and healthcare operations (TPO).
TREATMENT is when I provide, coordinate, or manage your mental health care and related services. An example would be when I consult with another healthcare provider, such as your family physician or another counselor to discuss your symptoms or safety and to provide you with the best possible care.
PAYMENT is when I am reimbursed for services provided to you. Examples of payment related disclosures are when information is disclosed to your health insurer for the purposes of reimbursement such as filing claims to your insurance or to determine eligibility or coverage by an insurance plan. I can also share information with someone you have indicated is paying for your services in order to obtain payment, or give information to my bank or credit card processing company to process your payments. If a bill for fees incurred becomes neglected, the law also allows for use of a collection agency if necessary.
OPERATIONS are activities that relate to the operation of my office practices. Examples are quality assessment and improvement activities, business related matters such as audits and administrative services, and case management, scheduling and care coordination.
I am also allowed or required to use or disclose your PHI in other ways.
HEALTH & SAFETY: I can share PHI to prevent a serious health or safety threat. Examples: In an emergency, I can share information with emergency personnel and your emergency contact. I am required to report suspected child abuse or neglect and can also report abuse or neglect of older or dependent adults. If I have reasonable cause, or pursuant of the standards of my profession,
determine that you present a serious danger of violence to yourself or someone else, I must disclose information necessary to provide protection against such danger for you or the intended victim.
RESEARCH: I can use or share PHI for research purposes.
REVIEWS & AUDITS: State or federal agencies may review or audit my records.
JUDICIAL/ADMINISTRATIVE PROCEEDINGS: I must comply with a court or administrative order to release my records. I may also disclose PHI in response to a subpoena, discovery request or other legal process, but only if I have first attempted to tell you or obtain a protection order
LAW ENFORCEMENT: I can share PHI for certain law enforcement purposes, including to report a crime that occurs on my premises or if I am the victim of a crime.
MEDICAL EXAMINERS: I can share PHI with a coroner, medical examiner or funeral director performing duties authorized by law.
WORKERS’ COMPENSATION: I can share PHI to comply with workers’ compensation laws.
SPECIAL GOVERNMENT FUNCTIONS: I can share PHI to support certain government functions, including the execution of military missions, protecting the President, intelligence operations or ensuring the safety of those working or housed within correctional institutions.
LEGAL OBLIGATIONS: I can use or share PHI when disclosure is required by state or federal law and the use or disclosure complies with and is limited to the relevant requirements of such law.
COMPLAINT/LAWSUIT FILED AGAINST ME- If you file a complaint or lawsuit against All Things New Counseling Services, LLC or J. Kristin McIntyre, MS, LPC, NCC, your PHI may be disclosed for the purpose of defense.
HEALTH OVERSIGHT ACTIVITIES- I may disclose your PHI to a health oversight agency for oversight activities authorized by law, including licensure and disciplinary activities. Examples would be to the Missouri State Committee
of Licensed Professional Counselors.
YOUR RIGHTS: This section explains rights you have about how I use or disclose PHI.
RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATION- You have the right to request and receive confidential communications of PHI in a particular way or at a certain place which is more private for you. For example, you can request that no messages be left at specific phone numbers.
RIGHT TO RELEASE MEDICAL RECORDS: I may disclose PHI for purposes outside of regular treatment, payment, or health care operation only when you sign a specific authorization for that purpose. An “authorization” is written
permission above and beyond the general consent that permits the normal PHI disclosures. An example would be if one of your family members wanted to know about your treatment. You may revoke such authorizations for disclosures at any time, but it must be done in writing. You may not revoke an
authorization to the extent that (1) I have already followed through on the action you authorized; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to
contest the claim under the policy.
RIGHT TO INSPECT AND COPY- You have the right to look at and/or obtain a copy of your PHI for as long as your PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases you may
have this decision reviewed. If you desire copies, I will charge a fee for costs associated with your request including the cost of copies, mailing or other supplies in accordance with Federal and/or State regulations
RIGHT TO AMEND: You have the right to request an amendment of your PHI by submitting your request in writing. You must state the reasons you want the make the changes. I may decline your request, but I’ll tell you why in writing within 60 days.
RIGHT TO AN ACCOUNTING OF DISCLOSURES- You generally have the right to receive an accounting of the disclosures of your PHI in the past six years, who I shared it with and why, except for disclosures for treatment, operations and payment, disclosures pursuant to a signed release, disclosure made to you, and disclosures for national security or law enforcement. I’ll provide a list within 60 days of receiving your written request. One list per year is free, after which I will charge a reasonable, cost-based fee.
RIGHT TO REQUEST RESTRICTIONS ON USES AND DISCLOSURES OF YOUR HEALTHCARE INFORMATION: You have the right to ask me not to use or share certain health information for treatment, payment or operations. I am
not required to agree, and I may decline if I think it would affect your care.
RIGHT TO COMPLAIN: f you are concerned that I have violated your privacy rights, or you disagree with a decision made about your access to records, you may contact J. Kristin McIntyre, MS, LPC, NCC at 417-848-5574.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.I will not retaliate against you for filing a complaint.
RIGHT TO RECEIVE CHANGES- Privacy practices may be updated from time to time to comply with federal law and state laws. An updated Notice may be requested at any time from me. The current Notice will also be posted on my website and available in my physical office.