PRIVACY PRACTICES POLICY

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Introduction

SkyForestCounselingLLC iscommittedtotreating and using protected health information (PHI) about you responsibly.     

This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information.  It also describes your rights as they relate to your protected health information.  This Notice is effective April 14, 2003, and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/Information.    Each time we provide a service to or for you, a record of thatserviceismade.  Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatment.  This information, often referred to as your health or medical record, serves as a:

· Basis for planning your care and treatment,

· Means of communication among the many health professionals who contribute to your care,

· Legal document describing the care you received,

· Means by which you or a third-party payer can verify that services billed were actually provided,

· A tool in educating the health care professionals

· A source of data for medical research

· A source of information for public health officials charged with improving the health of this state and the nation,

· A source of data for planning and marketing,

·A tool with which we can assess and continually work to improve the care we render the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to:  ensure its accuracy, better understand who, what, when, where and why others may access protected health information, and make more informed decisions when authorizing disclosures to others.

Your Health Information Rights.     Although your health record is the physical property of Sky Forest Counseling LLC, the information belongs to you.  You have the right to:

·Obtain a paper copy of this notice of information practices on request,

·Inspect and receive a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes as provided for in 45 CFR 164.524. You must make your request in writing to Privacy Officer (208)  ________.   Our agency may charge a fee ($.25 per page) for the costs of copying, mailing, labor and supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.

·Amend your health record as provided in 45 CFR 164.528,

·Obtain an accounting of your healthinformationas provided in 45 CFR 164.528,

·Request communications of your health information by alternative means or at alternative locations,

·Request a restrictiononcertainusesanddisclosures ofyour information as provided by 45 CFR 164.522, and

·Revoke yourauthorization touse or disclose health information except to the extent that action has already been taken.

Our Responsibilities.      Sky Forest Counseling LLC is required to:

·Maintain the privacy of your PHI,

·Provide you with this notice as to our legal duties and privacy   practices   with   respect   to   information   we collect and maintain about you,

·Abide by the terms of this notice,

·Notify you if we are unable to agree to a requested restriction, and

·Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change we will notify you of updated practices. We will not use or disclose your PHI without your authorization, except as described in this notice. We will also discontinue to use or disclose PHI after we receive a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem

If you have questions and would like additional information you may contact our Privacy Officer at:

Sky Forest Counseling LLC,  

600 E. Riverpark Lane, #125, Boise, ID 83706

(208) 704-2166

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or with the Office for Civil Rights.

Office for Civil Rights  

U.S. Department of Health and Human Services

200 Independence Avenue,

S.W. Room 509 F, HHH Building

Washington, D.C. 2020

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.  For example:   

Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your treatment professional will document in your record his or her expectations of the members of your health care team and will then record the actions taken and observations. In that way, the treatmentprofessional will know how you are responding to treatment. We will also provide your physician or subsequent health care provider with copies of various reports that should assist in your treatment.  This is to include all health care providers in our practice and those assisting in coverage of our practice.

We will use your health information for payment.   For example: 

A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information thatidentifies you, as well as your diagnosis, procedures, and supplies used.  

We will use your health information for regular health operations.   For example: 

Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your caseand others like it.   This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Business Associates: 

There are some services provided in our organization through contacts with business associates.  Examples might include a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for servicesrendered.  To protect your health information, however, we require the business associate to appropriately safeguard your information.

Notification:  

We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition. We may leave amessage on your voicemail as a means of communication.  We may mail you a postcard or written notice as a means of communication. We may e-mail you as a means of communication.

Communication with  family:   

Health  professionals, using their bestjudgment,  maydisclosetoafamily member,  other relative,  closepersonalfriendorany other person you identify, health information relevant to thatperson’sinvolvement in your care or payment related to your care.

Research: 

We may disclose information to researchers when research has been approved by an institutional review board that has reviewed the research proposal and established protocols to insure the privacy of PHI.

Fund raising:  

We may contact you as part of a fund-raising effort.

Food and Drug Administration (FDA):   

We may disclose to the FDA, health information relative to adverse events re: food, supplements, product and product defects, or post marketing surveillance info. to enable recalls, repairs, or replacement.

Workers  compensation:   

We may disclose health information to the extent authorized by and to the extent necessary tocomply with laws relating to workers compensation or other similar programs establishedby law.

Public health:  

As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Law enforcement: 

We may disclose health information for law enforcement purposed as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.