OUR PLEDGE REGARDING HEALTH CARE INFORMATION We understand that treatment information about you and your care is personal. OSHKOSH COUNSELING WELLNESS CENTER (A division of Oshkosh Counseling Center, Inc.), is committed to protecting the privacy of our clients’ confidential information. We are required by law to: - Maintain the privacy of your treatment information.
- Provide you with this notice of our legal duties and privacy practices with respect to your personal information.
We create a record of the care and services you receive at OCWC. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by OCWC, whether made by staffing personnel or your personal therapist.
This notice will tell you about the ways in which we may use and disclose treatment information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of treatment information.
HOW WE MAY USE AND DISCLOSE TREATMENT INFORMATION
The following categories describe different ways that we use and disclose treatment information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure will be listed; however, all of the ways we are permitted to use and disclose information will fall within one of the categories.
FOR TREATMENT: We may use or disclose your treatment information for quality and comprehensive service purposes. While you are a client at our facility, we may find it necessary to share your treatment information with your physician, nurses, lab technicians, and others involved in your care. FOR PAYMENT: We may use and disclose treatment information about you so that the services you receive at OCWC may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about the treatment you will be receiving so your health plan will pay us or reimburse you for your treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover treatment.
FOR HEALTH CARE OPERATIONS: Your treatment information may be used for our organizational operations that are necessary to ensure that we provide the highest quality of care and to fulfill our state mandated obligations of supervision, diagnostic review by a psychologist, audits, accreditations, certification, licensure and credentials we need to serve you. These activities are necessary for the government to monitor the health care system and compliance with civil rights laws.
TREATMENT ALTERNATIVES: We may use and disclose treatment information to tell you about or recommend possible treatment options or alternatives that we or an affiliated entity provides that may be of interest to you. We may use your treatment information to assist us in communicating with you appointment reminders, test results, and treatment information. Our communications to you may be by phone or by mail. INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: We may release treatment information about you to a family member/significant other who is involved in your care. If you are unable or unavailable to agree or object, our therapists will use their best judgment in communication with your family and others. We may also give information to someone who helps pay for your care.
AS REQUIRED BY LAW: We will disclose your treatment information when required to do so by federal, state or local law. Examples of situations where we may be required or permitted to release your treatment information include: To report child and/or adult abuse, neglect, or domestic violence. For judicial and administrative proceedings. To avert a serious threat to health or safety of the general public. Any disclosure, however, would Only be to someone able to help prevent the threat. For worker’s compensation purposes. LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose treatment information about you in response to a court or administrative order. We may also disclose treatment information to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
In any other situations not covered by this Notice as noted above, we will ask for your written authorization before using or disclosing information about you. If you choose to authorize disclosure of information about you, you can later revoke that authorization at any time by notifying us in writing of your decision
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
As a client of the OSHKOSH COUNSELING WELLNESS CENTER you have certain rights with regard to the treatment information that is maintained by our organization. These rights are as follows: ACCESS: With few exceptions, you have the right to access and receive a copy of your treatment information. The request must be made in writing. If you request a copy, it should be requested in advance and we may charge a fee for the cost of copying, postage and/or other related supplies. In certain situations, we may deny your request. If we deny your request, we will tell you in writing why your request was denied and explain to you your right to have the denial reviewed. Another licensed health care professional chosen by OCWC will review your request and the denial. The person conducting the review will not be the person who denied you request. We will comply with the outcome of the review. RIGHT TO AMEND: If you feel the treatment information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by OCWC.
To request an amendment, your request must be made in writing and submitted to OCWC’s Privacy Officer. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is ot made in writing or does not include a reason to support the request. In addition if you ask us to amend information that: Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; Is not part of the treatment information kept by OCWC; Is not part of the information which you would be permitted to inspect or copy; Is accurate and complete. RIGHT TO AN ACCOUNTING OF DISCLOSURES: You have the right to receive a list or accounting of those disclosures, which OCWC has made regarding your treatment information for purposes other than treatment, payment, healthcare operations, information provided directly to you, and information disclosed as a result of mandated government functions. The request must be made in writing. Your request for the accounting must state a specific time period which may not be longer than six years and may not include dates before April 14, 2003. The first accounting in a 12-month period is free; other requests may be charged according to our cost for producing the information. You may choose to withdraw or modify your request at that time before any costs are incurred.
RIGHT TO REQUEST RESTRICTIONS: You have the right to request a restriction or limitation on the treatment information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the treatment information we disclose about you to someone who is involved in your care. For example, you could ask that we not divulge certain confidential information. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to OCWC’s Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to request that we communicate with you about treatment matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to OCWC’s Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
RIGHT TO A PAPER COPY OF THIS NOTICE: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice contact an office staff member. CHANGES TO THIS NOTICE: We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for treatment information that we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the Waiting Room. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register we will offer you a copy of the current notice in effect.
COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with the Oshkosh Counseling Center of with the Secretary of the Department of Health and Human Services. To file a complaint with OCWC, contact the Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION: Other uses and disclosures of treatment information not covered by this notice or the laws that apply to us will be made only with you written permission. If you provide us permission to use or disclose treatment information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose treatment information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you. |
