SWIBH Privacy Practices
SOUTHWEST INTEGRATED BEHAVIORAL HEALTH NOTICE OF POLICIES AND PRACTICES TO PROTECT THE PRIVACY OF YOUR
HEALTH INFORMATION (PER HIPAA AND NEW MEXICO STATE REGULATIONS
THIS NOTICE DESCRIBES HOW YOUR PSYCHOLOGICAL AND MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Uses and Disclosures for Treatment, Payment and Health Care Operations We may use or disclose your protected health information (PHI), for treatment, payment, and health care operation purposes with your written authorization. To help clarify these terms, here are some definitions:
1. “PHI” refers to information in your health record that could identify youTreatment is when we provide, coordinate, or manage your health care and other services related to your health care. An example of treatment would be when we consult or communicate with another health care provider, such as your family physician or another treating doctor. Payment is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
2. Health Care Operations are activities that relate to the performance and operation of my practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination. “Use” applies only to activities within our office such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
3. “Disclosure” applies to activities outside of our office such as releasing, transferring, or providing access to information about you to other parties.
4. “Authorization” is your written permission to disclose confidential mental health information. All authorization to disclose must be on a specific legally required form.
Other Uses and Disclosures Requiring Authorization
We may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when we are asked for information for purposes outside of treatment, payment, or health care operations, we will obtain an authorization from you before releasing this information. We will also need to obtain an authorization before releasing your Psychotherapy Notes (if applicable). “Psychotherapy Notes” are notes made about conversations during a private, group, joint, or family counseling session, which we have kept separate from the rest of your record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorization (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.
Uses and Disclosures without Authorization
We may disclose PHI without your consent or authorization in the following circumstances:
1. Child Abuse: If we have reasonable cause to believe that a child known to us in our professional capacity may be an abused child or neglected child, we must report this belief to the appropriate authorities.
2. Adult and Domestic Abuse: If we have reason to believe that an individual (who is protected by state law) has been abused neglected, or financially exploited, we must report this belief to the appropriate authorities.
3. Health Oversight Activities: We may disclose protected health information regarding you to a health oversight agency for oversight activities authorized by law, including licensure or disciplinary actions.
4. Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information by any party about your evaluation, diagnosis and treatment and the records thereof, such information is privileged under state law, and we must not release such information without a court order. We can release the information directly to you upon your request. Information about all other psychological services is also privileged and cannot be released without your authorization or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You must be informed in advance if this is the case.
5. Serious Threat to Health or Safety: If you communicate to us a specific threat of imminent harm against another individual or if we believe that there is clear, imminent risk of physical or mental injury being inflicted against another individual, we may make disclosures that we believe are necessary to protect that individual from harm. If we believe that you present an imminent, serious risk of physical or mental injury or death to yourself, we may make disclosures we consider necessary to protect you from harm.
6. Worker’s Compensation: We may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.
Patient’s Rights and Health Care Provider’s Duties
Patient’s Rights:
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information. However, we are not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing us. On your request, we will send your bills to another address.)
Right to Inspect and Copy: You have the right to inspect or obtain a copy (or both) of PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record and Psychotherapy Notes. On your request, we will discuss with you the details of the request for access process.
Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process.
Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI. On your request, we will discuss with you the details of the accounting process.
Right to a Paper Copy: You have the right to obtain a paper copy of the notice from us upon request, even if you have agreed to
receive the notice electronically.
Health Care Provider and Duties:
We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI. We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect. If we revise our policies and procedures, we will make the revised notice available in our office, and upon request, will mail you a copy of the revised notice.
Professional Consultation, Instruction, and Research
We sometimes find it helpful to consult about a case with other professionals; in these consultations, every effort is made to avoid revealing the identity of a client. It should also be assumed that a discussion of the results of the evaluation, a copy of the written report, and similar information will be added to the medical record and shared directly with the professional who referred you or your child for this evaluation, as is customary in insurance and other referred cases.
It may be possible that records will be used for instructional or research purposes. Should this be the case, your or your child’s identity will be redacted from any and all materials and with the highest level of confidentiality maintained.
SWIBH offers multiple services, and patients may connect with one or more services or providers during the course of their treatment at SWIBH. Due to collaborative nature of multidisciplinary clinic, the patient understands that providers will consult with one another when a patient is being treated by 1 or more services/providers within the SWIBH system. This includes provider-driven internal referrals and patient-driven self-referrals to SWIBH services. Sharing information is beneficial for treatment planning purposes and for continuity of care. Please be aware that internal referrals DO NOT GUARANTEE placement with the service to which you/your child have been referred, as placement with additional services is determined by a variety of factors, including but not limited to provider skills and availability.
Records Requests
HIPAA entitles every person the right to access his or her medical records, receive copies of them, and request amendments to them. To ensure information is released according to the patient’s wishes, we are required to verify the identity and confirm that he or she is legally authorized to access or transfer the records.
To request records, a completed and signed “authorization for disclosure of protected health information” form is mandatory for all records requests. An incomplete or unassigned request will not be fulfilled. If requesting records in person, you will be required to show a valid government-issued photo ID at either the time of your request or when picking up the records.
Once the authorization form has been signed and identification has been verified, each of these requires personal attention.
Processing your request can take up to 5-10 business days for completion.
Questions and Complaints
If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy, you may contact Southwest Integrated Behavioral Health at (505) 247-4900, 5951 Jefferson St NE, Suite C, Albuquerque, NM 87109 for further information or discussion.
If you believe that your privacy rights have been violated and wish to file a complaint with our office, you may send your written complaint to Southwest Integrated Behavioral Health at the above address.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The entity listed above can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file a complaint.
Effective Date, Restrictions, and Changes to Privacy Policy
This notice will go into effect on May 31, 2011.
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. Upon your request, we will provide you with a revised notice by U.S. mail if such a change is made.