Client Rights
You have the right to:
Receive appropriate treatment without regard to race, religion, sex, age, disability, or ethnic background
Receive treatment in the least restrictive environment available
Actively participate in the development of a treatment plan that is specific to your needs, including discharge planning and/or follow up services
Be told about the risks, side effects, and benefits of all treatment procedures
Be told about all aspects of your treatment n a language or method in which you thoroughly understand
Be treated with dignity, consideration, and respect and to be served in a prompt and courteous manner
Have access to your medical records to the extent permitted by law
Request a second opinion from an outside consultant, and other professional about your treatment plan, but at your own expense
Refuse treatment and services to the extent permitted by law
Receive complete confidentiality regarding your treatment, participation, and medical records except as may be required by law
Have your bill explained to you
Client Responsibilities
You are responsible to:
Actively participate in the development of your treatment plan
To follow through with your treatment plan instruction
To keep your scheduled appointment
To inform your therapist of any problems you have in following your treatment plan
Speak up if you have questions or concerns, and if you do not understand the answer to your question, ask again.
Pay attention to the care you are receiving. Make sure you are getting the right treatment.
Educate your self about your diagnosis and your treatment plan.
Confidentiality
Information about your treatment is kept confidential in accordance with state and federal regulations. Information will be released only under the following conditions:
- If information discloses that a violent act has occurred, is threatened or that abuse/neglect is suspected
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If you sign a written consent form specifying what information is to be released, to whom and for what reason
- If a judge signs an order requiring the release of records to the court.
During the course of your treatment, you may encounter other clients in the office. Please give them the same courtesies you expect for yourself. You should not tell others that you saw them in this office.
Group therapy presents a unique treatment opportunity. In order for the group process to work best, all members should feel free to share during the group session. Please remember that ALL information shared by group members is confidential.
Confidentiality of Alcohol and Drug Abuse Records
Federal law and regulations protect the confidentiality of alcohol and drug abuse clients' records. Generally, we may not say to persons outside the program that you attend the program, or disclose any information identifying you as an alcohol or drug abuser UNLESS:
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You consent in writing
- The disclosure is allowed by a court order
- The disclosure is made to medical personnel in a medical emergency
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You commit, or threaten to commit, a crime either at the program or against any persons who works for the program.
Violation of the Federal law and regulations by a program is a crime. Suspected violation may be reported to the United States Attorney in the district where the violation occurs.
Federal law and regulations do not protect any information about suspected child abuse or neglect from bring reported under State law to appropriate State or local authorities.
Reaching Us
You are welcome to call the office at any time. We will return calls throughout out the day as time permits.
Emergency Procedures
If you have an emergency after regular business hours, please go to the nearest hospital emergency room. Some of the nearby hospitals are Jane Todd Crawford, Taylor Regional Hospital and Lincoln Trail Behavioral Health Hospital. You may also call the crisis line at Lincoln Trail (800-274-7374).
Payment for Services
Payment is expected at the time of services. . There will be a $25 fee for checks returned for insufficient funds. Both the check and fee must be paid prior to another appointment being scheduled.
Missed Appointments
Please call to let us know if you will not be able to keep your appointment. If you do not call and do not keep your appointment, you will be charged for the session at your regular fee. Another session will not be scheduled until you have paid that fee.
Discharge Criteria
Your file will be closed at your request when you complete treatment or when you are no longer seeking treatment. Your file may also be closed if you are non-compliant with treatment.
Complaints
If you have complaints about the treatment you receive, please share those concerns with us. Often issues can be resolved quickly and to the satisfaction of both parties.
Copies of Your Records
We provide copies of your records in accordance with our Notice of Privacy Practices. Please review the Notice for limitations on our ability to release records. Any copies we provide will cost 0.10 per page, and you must pay the fee before the records are released to you. You will be expected to arrange pick up of those records. We request a minimum of two weeks notice to review your request and prepare your copies.
HIPAA Notice of Privacy Practices
As required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
This Notice of Privacy Practices describes how we may use and disclose your protected health information (
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by our practice, our office staff and others outside of our office that may be involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bill, to support operation of the organization or any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, the use of credit or debit cards, or personal checks to pay for the services you have received will be identified with our practice.
HealthCare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our practice. These activities include, but are not limited to, quality assessment activities, conducting case reviews, consultations or supervision activities. We may also call you by name while you are at our office. We may use or disclose your protected health information, as necessary, to contact you regarding your care.
We may use or disclose your protected health information in the following situations without your authorization: As required by law, public health issues as required by law, communicable diseases, health oversight, abuse or neglect, Food & Drug Administration requirements, legal proceedings, law enforcement, criminal activity, inmates, military activity, national security, and worker’s compensation.
Required uses and disclosure: Under the law, we must make disclosures to you and when required by the Secretary of the Department or Health and Human Service to investigate or determining our compliance with the requirements of Section 164.500
Other permitted and required uses and disclosure will be made only with your consent, authorization or opportunity to object, unless required by law.
Associated companies, with whom we may do business, are given only enough information to provide the necessary service to you. No medical information is provided.
You may revoke this authorization, at any time, in writing, except to the extent that your therapist or this practice has taken action in reliance on the use or disclosure indicated in the authorization.
Your rights
Following is a statement or your rights with respect to your protected health information
You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following record: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. All requests for records access require a minimum of 14 days to review and complete if you are requesting copies of the record. Records will be copied and provided at a reasonable copy fee.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to a family member or friends who may be involved in your care or for notification purpose as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Our practice is not required to agree to a restriction that you may request. If our practice believes, it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another healthcare professional.
Your have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively.
You may have the right to have our practice amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosers we have made, if any, of your protected health information.
All requests for amendments or accounts of disclosure will be reviewed and responded to within 60 days.
We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice. You may also request a revised copy from office personnel.
Complaints:
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. If you request a response to your complaint, you will receive a response within 60 days. We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information, if you have any questions concerning or objections to this form, please ask to speak with our privacy contact in person, or by phone at 270-469-9069. You may also submit a complaint to the US Department of Health and Human Services at 1-800-368-1019.
We welcome your comments: Please feel free to call us if you have any questions about how we protect your privacy. Our goal is always to provide you with the highest quality services.
This notice was published and becomes effective on/or before
