HIPAA Policy

COMPLETE NOTICE OF PRIVACY PRACTICES

MBS Integrative Psychiatry (MBSIP) creates records of health care to provide quality services and to comply with legal requirements. MBSIP understands your health information is personal and private, and commits to safeguarding it to the extent reasonably and legally possible. The law requires MBSIP to keep your health information private and to provide you with this notice of our legal duties and privacy practices. The law also requires MBSIP to follow the terms of this notice. This notice outlines the limits on how MBSIP will handle your health information. Under federal law, MBSIP must provide a copy of this notice when you receive health care and related services from MBSIP, or participate in certain programs administered or operated by MBSIP. MBSIP reserves the right to change practices and make new provisions effective for all health information it maintains. You may request an updated copy of this notice at any time.

A. Use and Disclosure – General

Generally, except as otherwise specified below, MBSIP may use and disclose the following health information, as allowed by state and federal law:

1. For treatment. MBSIP uses and discloses health information about your condition and treatment to provide your health care and related services. For instance:

• Service providers, nurses, doctors, or other MBSIP employees may record your health information, and they may share such information with other MBSIP employees who are involved in your treatment.
• MBSIP may disclose health information to people outside MBSIP involved in your care who provide treatment and related services.
•  MBSIP may use and disclose health information to contact you to remind you about appointments for treatment or health care-related services.
•  In emergencies, MBSIP may use or disclose health information to provide you treatment. MBSIP will make its best effort to obtain your permission to use or disclose your health information as soon as reasonably practical.

2. Exceptions: For certain kinds of records, your permission may be needed even for release for treatment, payment and business operations. Even for these reasons, we will not disclose your information to anyone who does not need to know it, even if they work for us. And we will only give them as much of your information as they need to know to do their work.

3. Reporting births and deaths;

4. Reporting abuse or neglect of children, elders and dependent adults;

5. Reporting reactions to medications or problems with products;

6. Notifying people of recalls of products they may use; or, notifying a person exposed to or at risk to contract or spread a disease or condition.

7. For mandated reporting of abuse, neglect or domestic violence.

8. For health oversight activities necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

9. To the minimum extent necessary to comply with judicial and administrative proceedings when compelled by court order, or in response to a subpoena, discovery request or other lawful process as allowed by law.

10. To law enforcement:

•  To identify or locate a suspect, fugitive, material witness, or missing person;
•  About the victim of a crime if, under certain limited circumstances, MBSIP is unable to obtain the person’s agreement;
• About a death MBSIP believes may be the result of criminal conduct;
• About criminal conduct at a hospital where one of MBSIP’ clients is admitted; or,
• In emergency circumstances to report a crime, the location of a crime or crime victims, or the identity, description or location of a person who may have committed a crime.

11. To coroners, medical examiners and funeral directors as necessary for them to carry out their duties.

12. To avert serious threats to the health and safety of you or others.

13. To authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities.

14. For Workers Compensation or similar programs, to the minimum extent necessary.

Right to amend health records. If information MBSIP has about you is incorrect or incomplete, you may ask to amend it. Requests must be in writing, and provide a reason supporting your request. MBSIP may deny your request if it is not in writing, or does not include a reason supporting it. MBSIP may deny requests if the information you want to amend:

• Was not created by MBSIP; ○ Is not health information kept by or for MBSIP;
• Is not information you are permitted to inspect and copy; or,
• Is already accurate and complete.

Right to an accounting of certain disclosures. You have the right to ask for a listing of the last six years of disclosures of your health information since April 14, 2003, not pertaining to treatment, payment or health care operations. Requests must be in writing. The first list you request in a twelve-month period is free. MBSIP may charge you the cost of providing or reproducing additional lists. When told the cost, you may withdraw or modify your request.

Right to obtain a paper copy of the notice of privacy practices upon request.

Printed Name________________________                  Signature_________________________________

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