This Notice of Privacy Policies applies to Sycamore Counseling Services, 2820 W. Maple Rd, Ste 128, Troy, MI 48084 and 2836 W. Jefferson Ave. Ste 108, Trenton, MI 48183.
HIPAA AND CLIENT RIGHTS: 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.
HOW YOUR INFORMATION IS USED
Treatment: We will use and disclose your protected health information to provide, coordinate, manage your health care and any related services.
Health Care Operations: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us.
ADMISSABLE UNUATHORIZED DISCLOSURES
Law: When required by local, state, or federal law.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of the court and to the extent that such disclosure is expressly authorized, or in certain conditions in response to a subpoena or other lawful process.
Child Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.
Public Health and Safety Issues: We may disclose protected health information to prevent or reduce a serious threat to anyone’s health or safety, including in the event of threatened self- or other-harm or a medical emergency.
You have the right to inspect and copy your protected health information You can ask to see or get a paper or electronic copy of your health information. We will provide a copy, or a summary of your health information, usually within 15 days of your request. We may charge a reasonable, cost-based fee as permissible by law.
Exceptions to record release: Psychotherapy process notes; information deemed harmful, unless required by law; information compiled in reasonable anticipation of, or use in, civil, criminal, or administrative action or proceeding or that are subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health information You may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or mental health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care. We will say “yes” unless required by law to share information.
You have the right to request to receive confidential communications from us by alternative means. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
You have the right to request an amendment of your protected health information You can ask us to correct health information about you that you think is incorrect or incomplete. In certain cases we may deny your request for an amendment and will provide a written explanation to you within 60 days of your request.
You have the right to request an accounting of certain disclosures we have made, if any, of your protected health information You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as those you asked us to make). We will provide one accounting a year for free, but will charge a reasonable, cost-based fee for additional requests within a 12-month period.
You can choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
You have a right to obtain a paper copy of this form from us.
You have the right to file a complaint if you feel your rights are being violated. You can contact us directly to discuss concerns you have about how your health information and your rights associated with such information. If we are unable to resolve your concerns, you have the right to file a complaint with the U.S. Department of Health and Human Services Office of Civil Rights. We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy and security of your protected health information We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information We must follow the duties and privacy practices described in this notice and provide you with a copy, if requested We will not use or share your information other than as described here unless you authorize us to do so. If you provide such an authorization, you can revoke your authorization at any time. Let us know in writing if you change your mind. We can change the terms of this notice, and the changes will apply to all information that we have about you. The new notice will be available upon request, in our office, and on our website.
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