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.

This facility is committed to treating and using protected health information about you responsibly. This Notice 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 personal health information.

    This Notice of Privacy Practices is effective April 14, 2003, and applies to all protected health information as defined by federal regulations.

    Each time you visit this facility, a record of your visit is made.  This record is often referred to as your “medical record” or “health record” Typically, this record contains information such as:

• your medical and/or psychiatric history;
• your diagnosis(es);
• progress notes (treatment details);
• a plan for current and future care;
• treatment goals;
• records from others who treated you;
• information about medications you take;
• legal matters; and
• billing and insurance information.  

    The protected health information contained in your medical record serves as a:

• basis for planning your care and treatment.
• means of communication among the  health professionals who contribute to your care.
• legal document describing your treatment.
• means for you or a third party to verify that services billed were actually provided.
• a tool to educate health 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 data source for planning and marketing.
• a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

    Understanding what is in your medical record and how your health information is used helps to: ensure it’s accuracy; better understand who, what, when, where and why others may access your health information; and make more informed decisions when authorizing disclosure of your health information to others.

TO TOP   .:.   HOME

Although your medical record is the physical property of this facility, the information belongs to you. You have the right to:

• obtain a paper copy of this notice of privacy practices upon request;
• inspect and copy your medical record as provided in 45 CFR 164.524;
• amend your health record as provided in 45 CFR 164.528;
• obtain an accounting of disclosures of the health information in your medical record as provided in 45 CFR 164.528;
• request communication of your health information by alternative means or at alternative locations;
• request a restriction on certain uses and disclosures of your health information as provided by 45 CFR 164.522; and
• revoke your authorization to use or disclose health information except to the extent that action has already been taken.

TO TOP   .:.   HOME

In accordance with State and Federal laws, it is the responsibility of this facility to:

• maintain the privacy of your health information;
• provide you with this notice describing 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;
• accommodate reasonable requests you may have to communicate protected health information by alternative means or at alternative locations;
• not use of disclose your protected health information without your authorization, except as described in this notice; and
• discontinue to use or disclose your protected health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

TO TOP   .:.   HOME

As permitted by law, this facility reserves the right to change or amend our privacy practices and to make the new provisions effective for all protected health information we maintain.  Such changes may be required by changes in State or Federal HIPAA laws and regulations concerning protected health information.  Upon request, a copy of the most recently revised Notice of Privacy Practices will be provided to you.

TO TOP   .:.   HOME

When your PHI is viewed within this facility, it is called “use”.  When it is sent to or shared with others outside this facility, it is called “disclosure”.  In all circumstances, this facility will only disclose the minimum necessary PHI required for the needed purpose.

PHI Use and Disclosure With Your Consent

After you read this Notice, you will be asked to sign a separate Consent form to allow this facility to use and share your PHI.  In most cases, your PHI will be used at this facility or shared with others to provide treatment to you, arrange for payment for services, or other business functions called health care operations.  These three things are called TPO, and the Consent form allows us to use and disclose your PHI for TPO purposes.

In order for your treatment to begin, you must sign the Consent form which allows this facility to collect, use, and share information about you.  If you do not sign the Consent form,  we cannot treat you.  Several staff members at our facility may collect information about you and place it in your health record here.

For Treatment

We use your medical information to provide you with psychiatric treatment or services including individual, family or group therapy; psychological, educational, or vocational testing; treatment planning; or measuring the effects of our services.  We may also share or disclose your PHI to others who provide treatment to you including your personal physician and other treatment team providers, if applicable.  

In the event you are in need of special testing or treatments not available at this facility, you will be provided with a referral to an appropriate provider.  When this happens, this facility will share some of your PHI with your new provider, and they will provide this facility with results of their treatment.  All of this shared information will become a part of your medical record at each provider location.  Your PHI may also be shared with other care providers you may have in the future, who may, in turn, share their treatment information with this facility or other care providers.  These are examples of how your PHI is shared for treatment purposes.

For Payment

In order for this facility to be paid for treatment provided to you, your PHI may be used to bill you, your insurance company, or others.  Your insurance company may require some of your PHI including your diagnosis, treatment(s), expected treatment outcomes, treatment dates/times, treatment details/ progress, and other similar things.

For Health Care Operations

Your PHI may also be used in daily business functions of this facility called health care operations.  Examples include (1) use in this facility to find areas in need of improvement and (2) when required to disclose your PHI to government health agencies so they may study disorders and treatment for research.  If your PHI is disclosed for research, your name and identity will be removed from what is disclosed.

Other Uses In Healthcare
 

• Appointment Reminders:   Your PHI may be used/disclosed to remind you of appoint-ments for treatment or other care.  If you want restrictions on how you are contacted, simply tell any employee.

• Treatment Alternatives:     Your PHI may be used/disclosed to tell you about treatments or other care alternatives.

• Other Benefits & Services:     Your PHI may be used/disclosed to tell you about health related benefits or services.

• Business Associates:     Your PHI may be used/ disclosed to other persons, called Business Associates, who do things that we do not do at this facility.  All Business Associates sign a contract which includes their agreement to honor your right to privacy.

TO TOP   .:.   HOME

PHI Use and Disclosure Which Requires Your Authorization

This facility cannot use your PHI for any purpose other than TPO without your permission on a Authorization for Release of PHI form.  Such Authorizations expire after a certain period of time and can be revoked (canceled) by you, in writing, at any time.
 

TO TOP   .:.   HOME

PHI Use and Disclosure Not Requiring Consents or Authorizations
 

• When Required By Law:   Some State, Federal or local laws require that PHI be disclosed.

• Suspected child abuse must be reported.
• A subpoena or other lawful process may require PHI disclosure.
• PHI will be disclosed to government agencies to ensure this facility obeys the HIPAA privacy laws.

• Law Enforcement Purposes:    PHI may be disclosed to a law enforcement official to investigate a crime or criminal.

• Public Health Activities:     PHI may be disclosed to agencies who research diseases/injuries.

• Specific Government Functions:     PHI may be disclosed to military or veteran benefit programs, to Worker’s Compensation programs, or to government agencies for national security reasons.

• To Prevent A Serious Threat to Health or Safety:  If the staff of this facility believes that there is a serious threat to your health or safety or that of another person or the public, your PHI may be disclosed to persons who can prevent the danger.

TO TOP   .:.   HOME

A record is kept of all PHI disclosures including whom it was sent to, what was sent, and when it was sent.  You can get an accounting (a list) of many of these disclosures by requesting it from a staff member.

TO TOP   .:.   HOME

If you have questions or need additional information, please contact us at 225.292.4117 or email us here.
 

3700 Bayou Rapides Road   .:.   Alexandria, LA 71303   .:.   318.471.0863   .:.   CONTACT US HERE