Services :: Disclosure and Privacy Policies

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.

This practice is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices please contact:

Jacqueline L. Falls M.Ed., LPC
Effective Date of This Notice: April 14th 2003

How the practice may Use or Disclose Your Health Information

This practice collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of the practice, but the information in the medical record belongs to you. The practice protects the privacy of your health information. The law permits the practice to use or disclose your health information for the following purposes:

1. Treatment: I will use the health care information we learn about you to provide you with health care services.

(i) The following people in my office will have access to your information:

a. Medical staff - doctors, physician assistants, and nurse practitioners
b. Nursing staff - registered nurses, licensed practical nurses, and medical assistants
c. Other clinical staff - phlebotomists, laboratory technologists and technicians
d. Reception staff
e. Medical records personnel

(ii) I have established standards and procedures that limit various staff members' access to your health information according to their primary job functions. These standards and procedures may change from time to time. All of my staff is required to sign a confidentiality statement.

(iii) I will share your health care information with other health care providers involved in your care.

1) When we admit you to the hospital, I will share your health care information with personnel of that hospital. That hospital will have a privacy and confidentiality policy like this one. If you have questions about their policy, you should ask them.

2) When I refer you to a specialist, I will share your health care information with them. I will send this information whether you actually see the specialist (for example, a surgeon) or whether you do not (for example, if we send a specimen to a laboratory for analysis). That specialist will have a privacy and confidentiality policy like this one. If you have questions about their policy, you should ask them.

3) When I submit laboratory specimen to reference laboratories, and/or pathologists.

(iv) I will share your health care information with other people associated with your care at my office.

These include:

1. Family members you involve in your care
2. Friends you choose to include in your care
3. Other caregivers you choose to involve in your care
4. Other parties actively involved in your care

2. Payment: I will use and disclose your health care information to seek reimbursement for services I render you and members of your household. In this process, other parties may have access to the information you give me.

(i) In this context, these parties include:

1) My business office staff
2) The insurance organizations involved in your care
3) An organization that mails my statements to you
4) If one is required, the collection agency I use to collect unpaid balances.
5) Other firms that become involved in the process of processing or reviewing payment activities.