Notice of Privacy Practices
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.
If
you have any questions about this notice, or wish to exercise any of the rights
described in this notice, please contact me at
Steve
Franklin,MSW, LCSW
6829
Gravois Ave
St.
Louis, MO 63116
314-517-8383
SteveFranklin@JUNO.com
My Legal, Ethical and Clinical Duty
The Health Insurance Portability and
Accountability Act (HIPPA) establishes legal requirements regarding the privacy of protected health
information. This includes advising you
of the uses, disclosures and policies regarding your information. I also have a professional, ethical duty,
and I believe it is my clients’ best clinical interest for me to establish and
follow rules that protect your privacy.
This Notice of Privacy Practices (“Notice”) describes my duties and
practices regarding protected health information. This Notice will be available to clients no later than the date
of the first service delivery, including service delivered electronically.
Uses of information
Your
health information is collected at time of intake, and as part of the record of
your treatment, as notes, correspondence and reports. I may receive information from third parties as you may
authorize, such as insurance companies and others Your information is
1.
A legal record of your treatment;
2.
Documentation of services to the any third party payment source ;
3.
A means of measuring the progress of your treatment;
4. A reminder of the information you have
provided and my observations;
5.
A basis for planning further treatment.
Who Will Abide by this Notice
This
Notice describes my practices and those of any staff who I may hire to assist me
in my practice. Third party payers,
such as insurance companies, Medicare, Medicaid or other programs, will have
similar privacy standards for the information they receive from and about you,
but they are required to establish and communicate their own policies.
Understanding Your Protected Health
Information
Each
time you are treated by a healthcare professional, a record is made. For a psychotherapy session, this typically
includes: Name of clients attending
Attending ,Date/Time Health Insurance ID, Diagnosis/Nature of Illness,
Procedure (i.e., individual, family or couples therapy)
Information you provice
about Medications , Location, History, 
Current/Recent Events (Symptoms/behaviors related to diagnosis or goals), Issues
(Addressed; Underlying roles, conflicts or patterns ) Identified , Other
observations/interpretations, Therapist Intervention/Idea/Suggestions, Homework/Plans/Date of Next Session,
Payment Received; Progress toward treatment plan goals.
Your
record may also include other communication from yourself or with other
parties, as well as questionnaires or diagnostic tools you may have
completed. Understanding the contents
of your record will help you make more informed decisions about authorizations
to disclose it to others.
Your Rights Regarding Your Protected
Health Information
Your
health record is my physical property, but the information belongs to you.
You
have the right to:
1.
request restrictions regarding disclosures of your information;
2.
request and keep a copy of this notice of information practices, and look at or
obtain a copy of your health record;
3.
add information to the health record, to supplement or correct the information;
4.
get a record of who has obtained disclosures of your health information;
5.
withdraw any authorization you had previously granted to share information
My Responsibilities and Policies
I
am committed to protecting the privacy of your information to the extent
allowed by law. This notice applies to all of my records of your care.
I
am required by law to:
1.
Protect the privacy of your health information;
2.
Provide you with this notice of my legal duties and privacy practices regarding
your information ;
3.
Adhere to this notice;
4.
Give you notification if I cannot comply with your request;
5.
Reasonably accommodate your requests to communicate health information by
alternative means or at alternative locations;
6.
Only disclose your health information with your authorization, except as
otherwise described in this notice.
For More Information or to Report a Problem
As
a solo practitioner, I also function as the HIPAA Compliance Officer. You may
submit any questions or complaints to me in writing. If you believe your
privacy rights have been violated, you can file a complaint with the
Secretary of Health and Human Services. There will be no retaliation for filing
a complaint.
How
Will I Use and Disclose Health information About You
I will use your health information for treatment
I
will record plans, actions, outcomes and observations from our work
together.
I
can share information with others you see for treatment, or anyone else, if you
specifically authorize and request it.
I
will use your health information for payment
I
will use and disclose your health information to bill you or, if authorized,
third parties such as insurance companies.
Usually, billing information includes date and type of service and a
diagnosis, as well as identifying information such as address, member number, etc. You may choose to restrict how much nformation
is shared, but this could affect whether the third party feels they have enough
information to verify and authorize coverage and payment.
Appointment
reminders
We
may make phone calls to remind you of an appointment, using the identifying and
scheduling information you have provided.
Business
Associates
Some
insurance companies contract with business associates to process billing
information. Such businesses would also
be required to protect the privacy of your information.
Notification
I
may use or disclose information to notify a person identified as your
“emergency contact” in an emergency situation.
Public
health
As
required by law, I may be required to report child abuse or neglect, or elder
abuse to appropriate government agencies.
Professional Misconduct
If
you report an incidence of apparent misconduct by a mental health professional,
I may choose to disclose the information to a licensing board.
Law
enforcement
I
may disclose health information in response to a valid subpoena, court order,
warrant, summons or similar process. I
will request that you sign a release of information, and if you do not want to
I will attempt to protest the order. However,
I will comply if still ordered to release information by the court. I may also report health information under a
“duty to warn” if you threaten to harm or commit a crime against someone. I may also report health information if I
feel you are in immediate danger of mortal harm to yourself.
Lawsuits
and disputes
I
may disclose health information for the purposes of collecting legally due
payment from for services, if necessary to give notice, inform an agent for
collection purposes, or legally pursue resolution of a billing dispute.
National
security and intelligence activities
I
may release health information about you to authorized federal officials for
intelligence, counterintelligence, and other national security activities
required by law.
Protective
services for the President and others
I
may disclose health information about you to authorized federal officials, as
required by law, so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special investigations.
Your Rights Regarding Your Protected
Health information
Right
to inspect and copy
You
may inspect and copy health information used to make decisions about your care.
This may include medical and billing records, but does not include
psychotherapy notes. To obtain this information, you must submit your request in
writing to me. I may charge a fee for the costs of copying, mailing, or other
supplies associated with your request. If there is a need to limit the
information or deny the request, you will be provided with a valid reason.
Right
to amend
If
you feel there is inaccuracy in your health information, you may submit a
request, in writing, to amend the information.
For me to allow amendment, the information must have been created by me,
part of the health information I maintain, be information you would normally be
allowed to inspect and copy, and be accurate and complete.
Accounting
of disclosures
You
may request an "accounting of disclosures"; i.e. a list of requests
for health information about you that I have previously responded to. You must
submit your request in writing to me. Your request must specify a time period
not longer than six years and no earlier than February 26, 2003. Requests specifying a broader time period
may be considered at my discretion. You
should specify whether you prefer paper or electronic information. There will
be no charge for the first list you request within a 12 month period. I reserve the right to charge for the costs
of providing additional lists.
Right
to request restrictions
You
may request a restriction or limitation on the health information disclose
about you for treatment or payment. You may also request a limit on the health
information we disclose about you to someone who is involved in your care or
the payment for your care. To request
restrictions, make your request to me in writing, specifying (1) what
information you want to limit; (2) whether you want to limit use, disclosure or
both; and (3) to whom you want the limits to apply.
You
may request that we communicate with you in a certain way or at a certain
location. (For example: only contact you at work or by mail.) You must make your request in writing to me.
It is not necessary of provide a reason for your request. I will accommodate all reasonable requests.
Right
to a paper copy of this notice
You
may ask for a copy of this notice at any time. It is also available for
inspection at my web site.
Changes
to this notice
This
notice may be changed at any time. A
copy will be posted in my waiting room and on my web site.
Notices
or requests may be submitted to me at
Steve
Franklin, MSW, LCSW
6829
Gravois Ave
St.
Louis, MO 63116
Email SteveFranklin@JUNO.com
FAX
203-738-4036
My
web site is www. SteveFranklinMSW.com
Revised
4/20/2012
