Notice to Patients
To Protect the Privacy of Your Health Information
THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I.Uses and Disclosures for Treatment, Payment, and Health Care Operations
HBI may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
- “PHI” refers to information in your health record that could identify you.
- “Treatment, Payment and Health Care Operations”
– Treatment is when HBI provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when HBI consults with another health care provider, such as your family physician or another psychologist.
– Payment is when HBI obtains reimbursement for your healthcare. Examples of payment are when HBI discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
– Health Care Operations are activities that relate to the performance and operation of HBI. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
- “Use” applies only to activities within HBI, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
- “Disclosure” applies to activities outside HBI, such as releasing, transferring, or providing access to information about you to other parties.
I.Uses and Disclosures Requiring Authorization
HBI may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when HBI asks for information for purposes outside of treatment, payment and health care operations, HBI will obtain an authorization from you before releasing this information. HBI will also need to obtain an authorization before releasing your psychotherapy notes.
“Psychotherapy notes” are notes HBI clinicians have made about conversations during a private, group, joint, or family counseling session, the HBI Clinician must keep these notes separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) HBI has relied on that authorization; 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.
II.Uses and Disclosures with Neither Consent nor Authorization
HBI may use or disclose PHI without your consent or authorization in the following circumstances:
- Child Abuse: If HBI has reasonable cause to believe that a child has been abused or neglected, HBI must report this and relevant information, within 24 hours, to the Division of Child and Family Services, the county agency which provides child welfare services or a law enforcement agency.
- Adult and Domestic Abuse: If HBI has reasonable cause to believe that an older person has been abused, neglected, exploited or isolated, HBI must make a report to the local office of the Nevada Department of Human Resources Division of Aging Services, the police department or sheriff’s office, or other appropriate agency within 24 hours after becoming aware of this information.
- Health Oversight: If HBI receives a request from the Nevada Board of Psychological Examiners with respect to an inquiry or complaint about professional conduct, HBI must make available any record relevant to such inquiry.
- Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law, and HBI will not release this information without written authorization from you or your legally-appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.
- Serious Threat to Health or Safety: HBI may disclose confidential information from your records if I believe such disclosure is necessary to protect you or another person from a clear and substantial risk of imminent, serious harm. HBI may only disclose such information and to such persons as are consistent with the standards of the mental health and substance abuse profession in addressing such problems.
- Worker’s Compensation: If you file a worker’s compensation claim, and if HBI provides treatment to you relevant to that claim, then HBI must submit to your employer’s insurer or a third party administrator, a report on services rendered.
III.Patient’s Rights and Therapist’s Duties
- Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, HBI is not required to agree to a restriction you request.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing an HBI clinician. Upon your request, HBI will send your bills to another address.)
- Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. HBI may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. You may file an appeal with the HBI appeals process.
- Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. I may deny your request. On your request, HBI personnel will discuss with you the details of the amendment process.
- Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, HBI will discuss with you the details of the accounting process.
- Right to a Paper Copy – You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.
HBI Therapist’s Duties:
- HBI is required by law to maintain the privacy of PHI and to provide you with a notice of legal duties and privacy practices with respect to PHI.
- HBI reserve the right to change the privacy policies and practices described in this notice. Unless HBI notifies you of such changes, however, HBI is required to abide by the terms currently in effect.
- If HBI revises policies and procedures, HBI will provide you with the information.
If you are concerned that HBI have violated your privacy rights, or you disagree with a decision HBI has made about access to your records, you may contact the HBI Privacy Officer at 702-248-8866 ext. 202.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed above can provide you with the appropriate address upon request.
This notice will go into effect on 4-1-03
HBI reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that HBI maintains. HBI will provide you with a revised notice before the changes take place and before you receive and treatment under the revised terms. Information will be given to you before your therapy visit for your signature of the new terms.
“Notice to Patients Regarding the Destruction of Health Care Records”
HUMAN BEHAVIOR INSTITUTE pursuant to the provisions of subsection 7 of NRS 629.051 (SB17):
- The health care records of a person who is less than 23 years of age may not be destroyed; and
- The health care records of a person who has attained the age of 23 years may be destroyed for those records which have been retained for at least 5 years or for any longer period provided by federal law; and
- Except as otherwise provided in subsection 7 of the NRS 629.051 and unless a longer period is provided by federal law, the health care records of a patient who is 23 years of age or older may be destroyed after 5 years pursuant to subsection 1 of NRS 629.051.
CIVIL RIGHTS NON-DISCRIMINATION STATEMENT
Pursuant to Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Americans With Disabilities Act (ADA) of 1990, HUMAN BEHAVIOR INSTITUTE does not discriminate in admissions, provision of services, hiring and employment on the basis of race, color, national origin, sex, religion, age or disability (including AIDS and related conditions).
For further information or to file a complaint please contact
Dr. Anis Abi-Karam, PhD
President of HUMAN BEHAVIOR INSTITUTE
The Office for Civil Rights
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100 San Francisco, CA 94103
Voice Phone (415) 437-8310 · FAX (415)437-8329 · TDD (415)437-8311