Consumer Privacy Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have questions about this notice, or would like to exercise one or more of these rights, please contact a FCCS representative at 530-518-1406. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. For uses beyond that, we must have your written authorization unless the law permits or requires us to make the use or disclosure without your authorization. . "Protected health information" (PHI), is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. If we disclose your PHI to an outside entity in order for that entity to perform a function on our behalf, we must have in place an agreement from the outside entity that it will extend the same degree of privacy protection to your information that we must apply to your PHI. It also describes your rights to access and control your PHI. Who Will Follow This Notice: This notice describes the practices of Family Intervention & Counseling Services (FCCS), Inc. and that of any programs associated with FCCS. Any health care / mental health care professional authorized to enter information into your file or record and all employees, staff and other personnel will follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or facility operation purposes described in this notice. Our Pledge Regarding Your Information: We understand that information about you and your health and wellbeing is personal. We are committed to protecting medical/ mental health information about you. We create a record of the care and services you receive in our facility. We need this record to provide you with quality care and to comply with certain legal regulations. This notice will tell you the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosures of medical information. We are required by law to: • Make sure that medical information that identifies you is kept private; • Give you this notice of our legal duties and privacy practices with respect to medical / mental health information about you; and • Follow the terms of the notice that is currently in effect. Health Information Rights • Right to Inspect and Copy: You have the right to see and have a copy of the health information that FCCS has about you. It will not include information needed for civil, criminal, administrative actions and proceedings, or psychotherapy notes. • Right to Request an Amendment: If you feel the health information we have about you is wrong or incomplete, you may ask us in writing to amend the information. We may say no to your request if • it is not in writing • it does not include a reason, or if the information • was not created by us • is not part of the medical information kept by our agency • is not part of the information which you would be permitted to inspect and copy; • is determined to be correct and complete. You may add a 250 word statement to your file concerning any information you deem to be incorrect. • Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures,” a list of the names we gave your health information to, other than disclosures for purposes of treatment, payment or operations. Your request must not go back more than six years. • Right to Request Restrictions: You have the right to ask us to either not give or partially give your health care information used for treatment, payment or health care operations. We do not have to agree to your request. If we do agree, we will follow your request for restriction unless the information is used to provide you emergency care. To request a restriction or limitation not included on the authorization, your request must be made in writing and submitted to the Privacy Officer. • Right to Request Confidential Communication: You have the right to ask that we talk with you about health care matters in a certain way or at a certain place. For example, you can ask that we only contact you at work. FCCS will work to meet all reasonable requests. • Right to a Paper Copy of this Notice: You have the right to ask for a paper copy of this notice. You may also print a copy of this notice from our website. How We May Use And Disclose Your Medical Information: The following categories describe different ways that we use and disclose medical information. Each category of uses or disclosures will be explained but not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Whenever an arrangement between FCCS and a third party ("business associate") involves the use or disclosure of your protected health information, we will have a written contract with the business associate. The contract contains terms that will protect the privacy of your protected health information. For Treatment: We may use medical information about you to provide you with medical treatment or substance abuse services. We may disclose medical information about you to other personnel who are involved in taking care of you. Different departments of our agency also may share medical / mental health information about you in order to coordinate excellent care. Communication with Family: We may disclose medical information about you to people outside the agency who may be involved in your medical care, such as a designated family member in case of an emergency or others we use to provide services that are part of your care, such as your insurance company or your caseworker. Only the minimally necessary information will be revealed during disclosures. For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or third party. For example, we may need to give your health plan information about treatment you received so your health plan will pay us or reimburse you. We may also tell your health plan about treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. For health care operations: We may use/disclose your PHI in the course of agency operations. These uses and disclosures are necessary to run the agency and make sure that all of our clients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff. We may also combine medical information about many agency clients to decide what additional services the agency should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to mental health providers in training and other agency personnel for review and learning purposes. We may disclose your PHI to our accountant or attorney for audit purposes. In the event that this practice is sold or merged with another agency, your PHI in your file will become the property of the new owner. Appointment Reminders: We may also use and disclose health information to contact you as a reminder that you have an appointment or missed an appointment for treatment in order to reschedule the appointment. We will use the number you provide to contact you. We may leave a message regarding the date and time of your appointment or a request for you to return a call. Uses and Disclosures Requiring Authorization: For uses and disclosures beyond treatment, payment and operations purposes we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions. Authorizations can be revoked at any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization. We need the revocation in writing. A revocation cannot be backdated or made retroactive. Uses and Disclosures of PHI from Mental Health Records Not Requiring Consent or Authorization: The law provides that we may use/disclose your PHI from mental health records without consent or authorization in the following circumstances: Research: Under certain circumstances, we may use and disclose minimally necessary information about you for research purposes. All research projects, however, are subject to a special approval process. Before we use or disclose medical information for research, you must sign a research authorization form. As Required By Law: We will disclose minimally necessary information about you when required to do so by federal, state or local law (for example, for the reporting of child or elder abuse or to respond to judicial proceedings). To Avert A Serious Threat To Health Or Safety: We may use and disclose minimally necessary information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. Known as the “Duty to Warn” law. Public Health and Safety: We may disclose minimally necessary medical information about you to prevent or control disease, injury or disability to the general public, such as, but not limited to, AIDS, hepatitis, syphilis. Health Oversight Activities: We may disclose minimally necessary medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose minimally necessary information about you in response to a proper court order or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Law Enforcement: We may release minimally necessary medical information about you if asked to do so by a law enforcement official: • In response to a proper court order or similar process; • In response to an arrest warrant; • About criminal conduct involving our facility; and • In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime if the crime is on the premises or against the therapist or any personnel or associate. Medical Examiners: We may also release minimally necessary information about you to a medical examiner or funeral director. This may be necessary, for example, to identify a deceased person or determine the cause of death. National Security and Intelligence Activities: We may release minimally necessary information about you to authorized federal officials for intelligence, counterintelligence, and other security activities authorized by law.
State and Federal laws require me/us to maintain the privacy of your health information and to give you this notice of our legal duties and privacy practices. By law, we will follow the terms of this notice. I/we have the right to change this notice. We keep the right to make any changed notice effective for the health information we already have about you, as well as any information we get in the future. We will give you a copy of any new notices within 60 days. We will also post a copy of the current notice on our website.
Violation of the Federal law and regulation by a program is a crime. Suspected violations may be reported to appropriate authorization in accordance with Federal regulations. Federal law and regulations do not protect any information about a crime committed by a patient at the program, against someone who works for the program, or about any threat to commit such a crime. Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities. If you believe that your privacy has been violated, you may… File a complaint with:
You need to do this within 180 days of when the problem that caused concern happened. There will be no punishment for filing a complaint. If you are unsatisfied with how your complaint is handled, you may file a formal complaint …
FCCS is directed by Melinda Haynes, MA, California LMFT license number 102308. Oklahoma LMFT license number 1153. North Carolina LMFT license number 2143.