Story Wellness

Notice of Privacy Practices
HIPAA Disclosures
Individual and Group Confidentiality Policies

Your Rights

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• 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 can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
  • We will say “yes” unless a law requires us to share that information. 

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy  promptly.

• 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.
• We will make sure the person has this authority and can act for you before we take any action.

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your Choices

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory
• Contact you for fundraising efforts

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

• We can use your health information and share it with other professionals who are treating you.

• We can use and share your health information to run our practice, improve your care, and contact you when necessary.

• We can use and share your health information to bill and get payment from health plans or other entities.

• We can share health information about you for certain situations such as:
  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

• We can use or share your information for health research.

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• We can share health information about you with organ procurement organizations.

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

• We can use or share health information about you:
  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

• 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 give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of This Notice

HIPAA 

• Sharing test results with other health care providers for confirmation of a diagnosis;
• Providing your diagnosis or other information about your health to your insurance provider or our billing service to obtain payment for the health care services we provide;
• Reviewing information as part of our quality improvement program.

• Providing you with information related to your health;
• Contacting you regarding appointments, information about treatment alternatives, or other health related services;
• Incidental uses or disclosures (e.g., listing your name on a sign-in sheet, etc.); 
• Compliance with all laws (including reports of suspected abuse, neglect or violence);
• Providing certain specified information to law enforcement or correctional institutions;
•  Providing information to a coroner, medical examiner, funeral director or organ procurement organization;
• Public health activities when requested by a public health authority or the FDA.  Responding to health oversight agencies;
• Responding to court or administrative tribunal orders, subpoenas, discovery requests or other lawful process;
• Research activities;
• When necessary to avert a serious threat to health or safety;
• Military affairs, veterans affairs, national security, intelligence, Department of State, or presidential protective service activities;
• Providing information to public or private disaster relief agencies; or Information to a family member, other relative, or close personal friend when: notification of your location, general condition or death; to assist in your health care (e.g. pick-up prescriptions or other documents, note follow-up care instructions, etc.)

• Request restrictions on certain uses and disclosures.  However, Story Wellness is not obligated to agree to requested restrictions;
• Receive confidential communications or protected health information;
• Inspect and copy your protected health information with some limited exceptions;
• Amend your health information;
• Receive an accounting of disclosures of your health information;
• Obtain a copy of this notice.

• Story Wellness is required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information.
• Story Wellness is required to abide by the terms of the privacy notice that is currently in effect.
• Story Wellness reserves the right to change a privacy practice described in this notice and to make such change effective for all protected health information.  Revised notice will be posted in our office and available upon request.

1. Group issues are not discussed with others outside your group.
2. Do not discuss group issues with your roommate unless he/she is in your group.
3. Do not discuss at any outside meetings or places where others may overhear you.

Confidentiality & Limits of Confidentiality of Mental Health, Alcohol & Drug Abuse Client Records 

1. The Client consents in writing;
2. The disclosure is allowed by a court order, or
3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation.
4. Suspected child or elderly abuse or neglect from being reported under State law to appropriate State of local authorities.
5. Any information about a crime committed by a Client either at the program or against any person who works for the program or about any threat to commit such a crime.
6. Any threats to self or to others.