Notice of Privacy Practices
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.
Understanding Your Health Record/Information
When you receive services through Clear Path Counseling (CPC), we create and obtain personal and health information about you that we keep in a medical record. We understand this information is private, and your record will be maintained and protected in a confidential manner, as required by law. Your records will be generated and maintained on a secure database for a minimum of five years past your last date of service.
This notice describes how CPC may use and disclose your information. It also explains your rights and the legal duties we have regarding your information as we are committed to protecting your personal information.
Your Health Information Rights
- You have the right to look at and/or get a copy of your health information, with a few exceptions. You can obtain a copy of these records for a copying fee. Please allow 14 business days to fulfill this request. If you are denied access, you will be notified of the reason.
- You have the right to ask CPC to correct any information you believe is wrong. We may add the information and make a note that the information is from you. You must explain why you believe the correction must be made. If we are unable to make the correction, you will be notified why in writing.
- You have the right to ask CPC to limit the use or disclosure of your health information. We will do our best to accommodate your request.
- You have the right to ask that CPC contact or communicate with you at the address or telephone number that you specify. We will do our best to accommodate your request.
- You have the right to revoke your written permission for CPC to disclose your health information. This needs to be done in writing and will be effective only after the date your written revocation was received.
- You have the right to a list of disclosures we have made of your health information that we are legally permitted to disclose.
- You have the right to ask for and receive a copy of this notice. If we change this notice, we will provide you with the new copy.
- You may have other rights that are granted to you by the laws of our state, and these may be the same or different from the rights described above.
You must ask CPC in writing if you want to access, amend, revoke an authorization, restrict, communicate with us in a special way, or have an accounting of disclosures of your health information.
CPC’s Responsibilities
- CPC is required by law to maintain the privacy of your health information and to give you notice of our legal duties and privacy practices with respect to your information.
- We will maintain your files for a minimum of five years for counseling services and seven years for forensic services.
- We are required to follow the terms of this notice or any use and/or disclosure limits.
- We will notify you if we are unable to agree to a limitation you request.
- We may use, disclose or ask for only the information about you that is needed to accomplish a specific purpose.
We have the right to change how we protect the privacy of your health information. If our privacy policies change, we will revise this notice and make it available to you in our office and on our website.
CPC may not use or disclose your health information without your written permission, except as described in this notice. This includes the information that you receive, or have received, services from us.
Examples of Use and Disclosure for Treatment, Payment and Agency Operations
CPC may use your health information to provide treatment to you, to receive payment, and for our own health care operations, as permitted by law.
Payment: We may use your health information to be paid for providing care to you or to provide benefits to you under a health plan such as Medicaid. We may use your information to contact a third party to verify your coverage and to determine what services may be covered. We may also need to disclose your diagnosis, services received, progress, and similar items in order to bill your insurance company for care provided to you. Any information provided by you may be subject to verification through matching programs.
Regular agency operations: We may use the information in your health record to assess the care and outcomes in your case and others like it. This information may be used to improve the care and service we provide. We may also discuss cases in case review meetings and practice groups to help assist in providing the best treatment for you. We make every effort to protect the specific identity of the case being discussed. Other professionals in the meeting or group are required by professional ethics to keep this information confidential. We may also use and disclose your health information if we are being audited by an organization that requires the use of your information to confirm that services are being delivered according to contract or other rules.
Other Uses and Disclosures
With your permission: If you would like your information, or we need to use your information, to be used for any purpose outside those listed in our Privacy Practices, we need your authorization on an Authorization Form. If you do authorize us to disclose your information, you have the right to revoke your permission at any time, in writing.
CPC may use and disclose your health information as allowed by privacy regulations and laws. Examples include communications for treatment and health care; working with Business Associates; disclosures required by state or federal law; reporting suspected child or elder abuse or neglect; disclosures to a government authority if we believe you are a victim of abuse; workers compensation; addressing a serious threat to health or safety; judicial and administrative proceedings; disclosures involving a minor or appointed guardian; and other possible disclosures described in the practice notice.
Non-Protected Health Information Services
If you are receiving Forensic Services, the records maintained are not health care records and are not subject to protection under federal privacy regulations. Examples of forensic services include, but are not limited to, child custody evaluations, court ordered services, and CPS services.
To File a Complaint
If you believe your privacy rights have been violated, you can file a complaint by contacting:
CPC’s Privacy Officer: 469.645.1375
Texas State Board of Examiners of Professional Counselors
Complaints Management and Investigative Section
P.O. Box 141369
Austin, Texas 78714-1369
1-800-942-5540
Texas Office of the Attorney General
P.O. Box 12548, Austin, TX 78711
800.463.2100
Arkansas Board of Examiners in Counseling
101 E Capital Ave, Ste 202
Little Rock, AR 72201
501-683-5800
Arkansas Attorney General
101 W Capitol Ave
Little Rock, AR 72201
501-682-2007
Secretary of the U.S. Department of Health and Human Services
Hubert H. Humphrey Building, 200 Independence Ave. S.W., Washington D.C. 20201
CPC will not retaliate against you for filing a complaint. If you would like additional information, you may contact CPC’s Privacy Officer at 469.645.1375.