This notice describes how Second Growth Counseling complies with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), which aims to protect the confidentiality and security of personal healthcare information.
Second Growth Counseling (“Second Growth Counseling”) respects participant’s confidentiality and when engaged in a formal therapeutic relationship through informed consent, will only release medical information about you in accordance with federal and state laws. This notice describes our policies related to the use of any clinical records of your care generated by Second Growth Counseling.
If you have any questions about this policy or your rights, please contact Second Growth Counseling at firstname.lastname@example.org. There may be times when you would like Second Growth Counseling to advocate or communicate with others in your network of care. You will fill out a Release of Information form, which can be provided by request or will be offered based on your presenting needs. The form gives us your permission and authorization for us to receive, provide, or exchange personal, sensitive, protected health information. This may include information around:
- Use of Services: Second Growth Counseling, may receive, disclose, or exchange information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside our practice that you would like us to communicate with or that we are consulting, connecting, or referring you to.
- Organizational Operations: We may use information about you to coordinate our organizational activities. This may include setting up your appointments, reviewing your care, and training staff.
Under Oregon and federal law, information about you may be disclosed without your consent in the following circumstances:
- Emergencies: Sufficient information may be shared to address the immediate emergency you are facing.
- Follow Up Appointments/Care: Second Growth Counseling will be contacting you to remind you of future appointments or information about treatment alternatives or other wellbeing-related benefits and services that may be of interest to you.
- As Required by Law: This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases, public health emergencies (ie., “contact tracing”) or suspected abuse and neglect such as child abuse, elder abuse, animal abuse or institutional abuse.
- We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations inspections and licensure. We are also required to share information, if requested with the Department of Health and Human Services to determine our compliance with federal laws related to health care.
- Criminal Activity or Danger to Others: If a crime is committed on our premises or against our personnel, we may share information with law enforcement to apprehend the criminal. We also have the right to involve law enforcement when we believe an immediate danger may occur to someone. Please note that within the scope of our care and responsibility, we intentionally do our best in good faith to not involve law enforcement. We do not endorse or voluntarily cooperate with U.S. Immigration and Customs Enforcement (ICE).
You have the following rights under state and federal law:
- Copy of Record: You are entitled to inspect any professional record generated about you as a result of our services. We may charge you a reasonable fee for copying and mailing your record.
- Release of Information: You may consent in writing to the release of your information/records to others, for any purpose you choose. This could include your health care providers, clergy member, attorney, employer, or others who you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.
- Restriction on Record: You may ask us not to use or disclose part of your personal, protected health information. This request must be documented in writing and confirmed on file with Second Growth Counseling. This can be done so by yourself, an advocate, or by Second Growth Counseling. The request should be submitted to email@example.com.
- Contacting You: You may request that we send information to another address or by alternative means. Second Growth Counseling will attempt to honor such request as long as it is reasonable, and we are able to confirm it is correct. We can also accommodate making information available by email, by request. If you wish us to communicate by email you are also entitled to a paper copy of this privacy notice.
- Amending Record: If you believe that something in the record you have with us is incorrect or incomplete, you may request we amend it. To do this, contact Second Growth Counseling, and ask for the Request to Amend Health Information form. In certain cases, Second Growth Counseling, may deny your request. If Second Growth Counseling, denies your request for an amendment you have a right to file a statement that you disagree. We will then file our response and your statement and our response will be added to your record.
- Accounting for Disclosures: You may request an accounting of any disclosures we have made related to your personal, protected health information, except for information Second Growth Counseling used for treatment, payment, or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release.
- Questions and Complaints: If you have any questions, would like a copy of this Policy, or have any concerns you would like to discuss, please contact Second Growth Counseling. You also may contact the Secretary of Health and Human Services if you believe Second Growth Counseling has violated your privacy rights. Second Growth Counseling will not retaliate against you for filing a complaint.