This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Lotus Trauma Care (LTC) is committed to maintaining client confidentiality. LTC will only release healthcare information about you in accordance with federal and state laws and ethics of the
counseling profession. LTC is required to give you this notice, which describes policies related to the use and disclosure of your healthcare information, your rights and our responsibilities. We will review this notice with you at your first session.
TREATMENT
LTC may need to use or disclose health information about you to provide, manage or coordinate your care or related services, which could include consultants, contractors and potential referral sources. In all cases LTC will not disclose identifying information without explicit written
permission from you.
PAYMENT
LTC may need to use or disclose health information about you to provide the information needed to verify insurance coverage and/or benefits with your insurance carrier to process your claims as well as information needed for billing and collection purposes. If your insurance plan is a family plan, LTC may bill the person in your family who pays for your insurance, the “primary insured” individual and/or a guarantor that you specify on your contact form.
HEALTHCARE OPERATIONS
LTC may need to use information about you to review our treatment procedures and business activity. Information may be used for certification, compliance and licensing activities. In all cases
LTC will not disclose identifying information without explicit written permission from you.
There are other uses or disclosures of your information that do not require your consent:
Emergencies. Sufficient information may be shared to address an immediate emergency.
Judicial and Administrative Proceedings. LTC may disclose your personal health information in the course of a judicial or administrative proceeding in response to a valid court order or other lawful process, including if you were to make a claim for Workers Compensation.
Public Health Activities. If LTC felt you were an immediate danger to yourself or others, LTC may disclose health information about you to the authorities, as well as alert any other person who may be in danger. Child/Elder Abuse. LTC may disclose health information about you related to the suspicion of child and/or elder abuse or neglect. By state law, LTC is obligated to report this to the appropriate authority.
Criminal Activity or Danger to Others. LTC may disclose health information if a crime is committed on our premises or against our personnel or associates, or if we believe there is
someone who is in immediate danger.
National Security, Intelligence Activities, and Protective Services to the President and Others. LTC may release health information about you to authorized federal officials as authorized by law in order to protect the President or other national or international figures, or in cases of national security.
Clinical Supervision. Under certain circumstances, LTC may use and disclose health information for the clinical supervision of personnel and associates.
Your Rights Regarding Your Health Information
Right to Receive Appropriate Treatment
LTC strives to offer treatment that is appropriate and helpful. You have the right to terminate treatment if you are not satisfied.
Right to Request How LTC Contacts You
It is LTC’s typical practice to communicate with you at your home or cell phone number, email address and home address. LTC may communicate about health matters, such as appointment
scheduling. Sometimes LTC may leave messages on your voicemail or use text messaging. You have the right to specify the way that you prefer LTC to communicate with you and to leave messages for you.
Right to Inspect and Copy Records
You have the right to look at or get copies of your health information, with limited exceptions. Your request must be in writing. If you request a copy of the information, a reasonable charge may be made for the costs incurred.
Right to Release Your Medical Records
You may consent in writing to release your records to other providers. You have the right to revoke this authorization, in writing, at any time. However, this revocation will not affect any of the
communications made prior to the revocation.
Right to Correct Your Medical Records
You have the right to request that we add or amend your health information. Your request must be in writing, and it must explain why the information should be amended. We have the right to deny your request under certain circumstances and LTC will tell you why in writing within 60 days.
Right to Get a List of All Instances in Which LTC has Shared Your Information
You have the right to receive a list of instances in which LTC has disclosed your health information for a purpose other than treatment, payment, or health care operations or when you have asked LTC to disclose. To request an accounting of disclosures, you must submit your request in writing. Such accountings remain available for six years after the last date of service.
Right to Ask Us To Limit What We Use or Share
You have the right to request a restriction or limitation on the health information LTC use or disclose about you. For example, you could ask that LTC not share information with an insurance
company, in which case you would be responsible to pay in full for the services provided. While you are in treatment, a written request should be made with your therapist. To request a restriction after therapy is completed, you must make a written request. LTC is not required to agree to your request but will consider the request very seriously. If LTC agrees, LTC will abide by the agreement unless the information is needed in an emergency or by law.
Right to Obtain a Paper Copy of this Notice
You have the right to receive an electronic or paper copy of this notice and any amended notice upon request. Other uses and disclosures not set out in the information above will be made only with written authorization. You may revoke a written authorization for release of information at any time. The revocation must be in writing and will become effective when it has been received by LTC and will only be for disclosures not already completed.
Right to Receive Changes in Policy
We reserve the right to change privacy practices provided such changes are permitted by applicable law. If LTC revises policies, LTC will notify existing clients in writing and post our notice in the LTC lobby.
Right to Be Notified of a Breach in Security of Confidential Information
LTC makes every effort to maintain security of all confidential information at all times. In the unlikely case that a breach of security occurs that compromises your confidentiality, LTC will
promptly notify you and follow all policies and procedures outlined by HIPAA.
Right to Ask Questions or File Complaints
If you believe your privacy rights have been violated, you may file a complaint with LTC by contacting our Privacy Official, Worsham El, LCSW, at (312) 757-0608 or
[email protected]. If you are not satisfied with the response to your complaint, you may file a complaint with the U. S. Department of Health & Human Services at their website at
https://www.hhs.gov/hipaa/for-professionals/privacy/index.html. To obtain additional information or to file a complaint with us, contact
[email protected] or call (312) 757-0608. LTC will not retaliate in any way if you choose to file a complaint.
Your therapist will discuss this notice with you at your first session, and you will be asked to sign a document stating that you have read and understand this notice. If you have further questions, please contact our Privacy Officer, Privacy Official, Worsham El, LCSW, at (312) 757-0608 or [email protected].
This Notice of Privacy Practices is effective 10/15/2017. LTC can change the terms of this notice, and the changes will apply to all information LTC has about you. The new notice will be available upon request.
