PsychWorks, Inc.
™
Behavioral Healthcare For
The 21st Century
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PsychWorks, Inc. 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 carefully. PsychWorks, Inc. is committed to mental healthcare excellence. That includes safeguarding your privacy by keeping your medical information secure. We request the minimum amount of information needed in order to provide you with quality healthcare and to determine and process payment required by law to take reasonable steps to protect the privacy of your Protected Health Information (PHI) and to provide you with notice of legal duties and privacy practices with respect to PHI. PHI is 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. PHI includes mental health records maintained by PsychWorks, Inc. This notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted with respect to PHI about you. PsychWorks, Inc. is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you. Your Health Information Rights You have the following rights with respect to PHI about you: Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact the Privacy Officer, PsychWorks, Inc., 1515 University Drive, Ste 115A, Coral Springs, FL 33071. You may also obtain a copy at the PsychWorks office. Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you by completing the Request for Restriction form and giving it to our staff for review. We are not required to agree to the restriction. If the restriction is possible, the PsychWorks will process the request. The Request for Restriction form is available upon request from PsychWorks, Inc. Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as PsychWorks maintains the PHI. The designated record set usually includes progress notes and billing records. To inspect or copy PHI about you, you must compete the Request to Access Protected Health Information form and give it to a staff member for review. If the request can be granted, then a PsychWorks associate will provide you with a report detailing the PHI about you contained in our designated record set. The Request to Access Protected Information form is available upon request at our office. We may charge you a fee for the costs of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed. Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must complete the Request to Amend a Record form and give it to a PsychWorks associate for review. If the request can be granted, PsychWorks will amend the appropriate record(s). The Request to Amend a Record form is available upon request at our office. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement. Receive an accounting of disclosure of PHI. You have the right to receive an accounting of the disclosures we have made of OHI about you after April 14, 2003. This accounting includes only those disclosures required to be accounted for under the federal privacy standards for health information (45 CFR Part 164). Those standards do not require accountings for disclosures for treatment, payment or health care operations purposes, among others. The accounting will exclude certain disclosures, such as disclosure made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, disclosures for notification purposes, and routine disclosures made to regulatory or law enforcement agencies. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a request in writing to the Privacy Officer, PsychWorks, Inc., 1515 University Drive, Suite 115A, Coral Springs, Fl 33071. Your request must specify the time period, but may not be longer than six (6) years. The first accounting you request within a 12 months period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time. Request communications of PHI by alternative means or at alternative locations. You have the right to request communications by alternative means or at alternative locations. For instance, you may request that we contact you about you medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must complete the Request for Confidential Communications form and give it to PsychWorks, Inc. for review. If the request can be granted, then we will make the appropriate changes. We will accommodate all reasonable requests; however in case of emergency situations, we may contact you by whatever means we deem necessary. The Request for Confidential Communications form is available at our office. Examples of How We May Use and Disclose PHI The following are descriptions and examples of ways we use and disclose PHI: We will use PHI for treatment. Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations, and referrals between one or more of your providers. Example: information obtained by our office will be used in the course of your treatment. We will document in your records information related to the treatment and services provided to you. We will use PHI for health care operations. Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating or reviewing insurance contracts. It also includes disease management, case management, conducting or arranging for medical review, legal services and auditing functions, including fraud and abuse compliance programs, business [planning and development, business management and general administrative activities. Example: PsychWorks, Inc. may use information in your health record to monitor performance of the staff providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and services we provide. |
