Notice of Privacy Practices for Protected Health Information
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.
Behavior Consultants (DBA Stephen H. Blum, Ph.D., Judith Corkum, Ph.D., Allen Davis, L.S.C.S.W., Cynthia Turnbull, Ph.D., and Mahasen DeSilva, M.D.) is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations without your authorization. Protected health information is the information created and obtained by Behavior Consultants in order to provide our services to you. We will only release the minimum amount of information as necessary.
Such information may include documenting your symptoms, history, test results, diagnoses, treatment, billing documents and applying for future care or treatment. Psychotherapy notes are a certain type of note that is more stringently protected than other health information, and are only a part of your health record and not subject to release under any circumstances.
Examples of Uses of Your Health Information for Treatment Purposes are:
During the course of your treatment, the clinician may determine that he/she will need to consult with another specialist in the area. He/she will share the information with such specialists and obtain his/her input. During any such consultation, your identity will be kept confidential.
Example of Use of Your Health Information for Payment Purposes:
The minimum necessary of your protected health information, not to include psychotherapy notes, will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services that we recommend for you, such as, making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for psychological or neuropsychological testing may require that your relevant protected health information is disclosed to the health insurance plan to obtain approval for the testing. Only the minimum necessary amount of information will be released. We will not release treatment records without your direct permission.
Example of Use of Your Information for Health Care Operations:
We may use or disclose, as needed, the minimum necessary amount of protected health information in order to support the business activities of Behavior Consultants. These activities include, but are not limited to, quality assessment, employee review activities, licensing, and conducting or arranging for other business activities. We may also call you by name in the waiting room when your clinician is ready to see you. We may use or disclose the minimum necessary amount of protected health information, to contact you to remind you of your appointment. We may use fax or e-mail to confer with other clinicians involved in your care.
We will share the minimum necessary amount of protected health information, not including psychotherapy notes, or psychotherapy note content without your specific agreement, with third party "business associates" that perform various activities, such as billing or transcription services for Behavior Consultants. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we have a written contract with the business associate that contains terms that will protect the privacy of your protected health information.
Uses and Disclosures of Protected Health Information Based upon your Written Authorization:
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization at any time, in writing, except to the extent that your clinician or the practice has taken an action in reliance on the use or disclosure indicated in the authorization
Other Permitted and Required Uses and Disclosures that May Be Made with Your Consent, Authorization or Opportunity to object:
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your clinician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the minimum necessary amount of protected health information that is relevant to your health care will be disclosed.
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person that you identify, the minimum necessary amount of protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based upon professional judgment. We may use or disclose the minimum necessary of protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your location, general condition, or death. Finally, we may use or disclose the minimum necessary amount of protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Other Permitted and Required Uses and Disclosures That May be Made Without Your Consent, Authorization or Opportunity to Object:
We may use or disclose the minimum necessary amount of protected health information in the following situations without your consent or authorization. These situations include:
•Required by Law: We may use or disclose the minimum necessary amount of protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures. •Law Enforcement: We may also disclose the minimum necessary amount of protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include: 1) legal processes and otherwise required by law, 2) limited information requests for identification and location purposes, 3) pertaining to victims of a crime, 4) suspicion that death has occurred as a result of criminal conduct, 5) in the event that a crime occurs on the premises of this practice, and 6) medical emergency, not on the premises of this practice, and it is likely that a crime has occurred. •Criminal Activity: Consistent with applicable federal and state laws, we may disclose the minimum necessary amount of protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. •Legal Proceedings: We may disclose the minimum necessary amount of protected health information in the course of any judicial or administrative proceeding, in response to a court order or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process. •Coroners: We may disclose the minimum necessary amount of protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. •Abuse or Neglect: We may disclose the minimum necessary amount of protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose the minimum necessary amount of protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the government entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. •Health Oversight: We may disclose the minimum necessary amount of protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws. •Public Health: We may disclose the minimum necessary amount of protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose the minimum necessary amount of protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority. •Communicable Diseases: We may disclose the minimum necessary amount of protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. •Food and Drug Administration: We may disclose the minimum necessary amount of protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required. •Workers' Compensation: The minimum necessary amount of protected health information may be disclosed by us as authorized to comply with workers' compensation laws and other similar legally-established programs. •Military Activity and National Security: When the appropriate conditions apply, we may use or disclose the minimum necessary amount of protected health information of individuals who are Armed Forces personnel: 1) for activities deemed necessary by appropriate military command authorities; 2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or 3) to foreign military authority if you are a member of that foreign military services. We may also disclose the minimum necessary amount of protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized. •Required Uses and Disclosures: Under the law, we must make disclosures when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et.seq.
Behavior Consultants is required to:
•Maintain the privacy of your health information as required by law; •Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you; •Abide by the terms of this Notice; •Notify you if we cannot accommodate a requested restriction or request; and, •Accommodate your reasonable requests regarding methods to communicate health information with you.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our "Notice" or by visiting our office and picking up a copy.
Your Health Information Rights:
You have a right to request a restriction on certain uses and disclosures of your health information by delivering the request to Behavior Consultants -- we are not required to grant the request, but we will comply with any requests that are granted.
You have a right to obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office.
You have a right to request that you be allowed to inspect and copy your health record and billing record; you may exercise this right by delivering a signed and dated paper request to our office. Requests do not include psychotherapy notes. Not all requests are granted; your clinician may determine, in the exercise of professional judgment, that the access requested is likely to endanger the life or physical safety of the patient or another patient.
There is a fee associated with materials and labor as well as per page costs. You are responsible for these fees and will be billed for the expense of making copies, which will be paid prior to receipt of copies.
You have the right to request communication of protected health information by alternative means or at alternative locations.
You have a right to appeal a denial of access to your protected health information, except in certain circumstances.
You have a right to request that your health care record be amended to correct incomplete or incorrect information by delivering a request to our office. We may deny your request if you ask us to amend information:
•that was not created by us, unless the person or entity that created the information is no longer available to make the amendment; •if the information is psychotherapy notes; •if the requested change is not part of the health information kept by or for Behavior Consultants; •if the information is not part of the information that you would be permitted to inspect and copy; •if the requested amendment of the information will alter information that is accurate and complete; or, •if the information could cause harm to yourself or another individual, in which case you will be provided the right to have such a denial reviewed by a licensed health care professional for a second opinion.
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.
You have a right to obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a request to our office. An accounting will not include uses and disclosures of information for treatment, payment, or operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures made in a facility directory or to family members or friends relevant to that person's involvement in your care or in payment for such care; or, uses or disclosures to notify family or others responsible for your care of your location, condition, or your death.
You have a right to revoke authorizations that you made previously to use or disclose information by delivering a written revocation to our office, except to the extent information has been disclosed or action has already been taken.
If you want to exercise any of the above rights, please contact the Compliance Officer, at 835 SW Western Avenue, Topeka, KS 66606; (785)233-9400, in person or in writing, during regular, business hours. They will inform you of the steps that need to be taken to exercise your rights.
To Request Information or File a Complaint:
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact the Behavior Consultants Compliance Officer at (785)233-9400.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to the Behavior Consultants Corporate Compliance Committee. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services, whose street and e-mail address is:
Region VII, Office for Civil Rights,
U.S. Department of Health and Human Services
601 East 12th Street, Room 248
Kansas City, MO 64106
We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from this office.
We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Other uses and disclosures, besides those identified in this Notice, will be made only as otherwise required by law or with your written authorization and you may revoke the authorization as previously provided in this Notice under "Your Health Information Rights."
Effective Date: March 30th, 2003; Most Recent Revision: May 7th, 2009.
Stephen H. Blum, Ph.D., Compliance Officer