Neurofeedback and Counseling of Columbus  Columbus, Ohio

Hippa Policy

Neurofeedback and Counseling of Columbus

NOTICE OF USE OF PRIVATE HEALTH INFORMATION

Effective Date: April 14, 2003

FOR YOUR PROTECTION 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 CAREFULLY.

We understand that information we collect about you and your health is personal. Keeping your health information private is one of our most important responsibilities. We are committed to protecting your health information and following all laws regarding the use of your health information. The law says:

1. We must keep your health care information from others who do not need to know it.

2. You may ask that we not share certain health care information. (In some instances, we may not be able to agree with your request.)

WHO SEES AND SHARES MY HEALTH INFORMATION?

Your private health information may be used by health care providers such as doctors, nurses, therapists and social workers who take care of you. They may need your private health information in order to determine your plan of care. This may cover health care services you had before now, or services you may have later on. We may share health information about you in order to help you get services you may need. We may also use your information to contact you about appointment reminders or to tell you about treatment alternatives.

HOW IS PAYMENT MADE?

We may send a bill (also called a "claim") to an insurance company to get paid. The bill has all of the information about what services you had. We review health care information and bills to make sure that you get quality care and that all laws providing and paying for your health care are being followed.

MAY I SEE MY HEALTH INFORMATION?

You may see your health information, unless it is the private notes taken by a mental health provider or it is part of a legal case. Most of the time you can receive a copy if you ask. You may be charged a small amount for the copying costs.  If you think some of the information is wrong, you may ask in writing that it be changed or new information be added. You may ask that the changes or new information be sent to others who have received your health information from us. You may ask for a list of any places where health information may have been sent, unless it was sent for treatment, for payment, for checking to make sure you receive quality care, or to make sure the laws are being followed.

WHAT IF MY HEALTH INFORMATION NEEDS TO GO SOMEWHERE ELSE?

You may be asked to sign a separate form, called an authorization form, allowing your care information to go somewhere else if:

1. You want us to send it to another health care provider; or,

2. You want it sent to another person for you.

The authorization form tells us what, where and to whom the information must be sent.

NOTE: If you are less than 18 years old, your parents or guardians will receive your private health information, unless by law you are able to consent for your own health care treatment. If you are, then your private health information will not be shared with parents or guardians unless you sign an authorization form. You may also ask to have your health information sent to a different person that is helping you with your health care.

COULD MY HEALTH INFORMATION BE RELEASED WITHOUT MY AUTHORIZATION?

Your verbal communication and clinical records are strictly confidential except for a) information you and/or you child or children report about physical or sexual abuse; then, by Ohio State Law, I am obligated to report this to the Department of Children and Family Services, b) where you sign a release of information to have specific information shared and c) if you provide information that informs me that you are in danger of harming yourself or others d) information necessary for case supervision or consultation and e) or when required by law.

QUESTIONS OR COMPLAINTS?

If you have any questions about this notice, or you think that we have not protected your private health information and you wish to complain about it please contact Connie Welsh (614-203-0104)

If you feel we have not handled your questions adequately you can contact the following:

Office for Civil Rights

 U.S. Department of Health and Human Services

 200 Independence Avenue, S.W.

 Room 509F, HHH Building

 Washington, D.C. 20201-0004

Or by calling the Office for Civil Rights at: (800) 368-10194