Notice of Privacy Practices

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.

This Notice specifically describes the policies of Elizabeth Ruegg’s CounselingWorks practice. Affiliated providers (for example, counselors other than Elizabeth Ruegg who rent space in this office) may have different privacy practices from those described in this Notice. Please contact affiliated providers directly for more information about their privacy practices. References to "we," "our" or "us" in this Notice refer specifically to the policies and practices of Elizabeth Ruegg, LCSW, BCD, CAP, CT, CCFS.

Acknowledgment of Receipt of This Notice
When you become a client of this counseling office, you will be asked to provide a signed acknowledgment of receipt of this Notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your services will not depend upon your signed acknowledgment. If you decline to sign an acknowledgment, we will continue to provide you with services. However, we will also use and disclose your protected health information for provision, payment, and reporting of services, when necessary, as described in this Notice.

Our Duties and Responsibilities Regarding Your Protected Health Information
We understand that your medical and health information is personal and that protecting your health information is important. "Protected health information" is individually identifiable health information which includes items such as name, age, address, social security number, e-mail address, etc. We follow strict federal and state laws that require us to maintain the confidentiality of your health information. We are required by law to do the following:

Maintain the privacy of your health information
Provide this Notice that describes the ways that we may use and share your protected health information
Follow the terms of the Notice currently in effect

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Your records will be retained by us for approximately seven years after your last date of service at this office. After that time has elapsed, your records will be erased, shredded, burned or otherwise destroyed in a way which protects your privacy. Copies of mental health records generated by this office which have been distributed to other entities may continue to exist under the privacy policies established by those entities. Until your records are destroyed, they may be used for the following purposes:

For Required Uses and Disclosures
We may disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.

For Treatment
We may use and disclose your protected health information to provide your care and any related services. This includes the coordination or management of your health care with a third party. For example, we might disclose your protected health information to a therapist who is co-leading a therapy group in which you have asked to participate at this office. We might also disclose your information to a professional colleague who provides us with clinical consultation services. Any person or entity with whom your information is shared will also be required to comply with federal privacy practices regarding your protected health information.

To Obtain Payment
Your protected health information will be used, as needed, to obtain payment for your health care services. For example, your information may be shared with an insurer who provides reimbursement for your services at this office.

For Health Care Operations
We may use or disclose, as needed, your protected health information to support quality assessment activities. For example, your information may be used in our self-monitoring exercises for the purpose of continuing improvement. We also may use or disclose your protected health information to provide you with appointment reminders or information about other health-related programs and services. For example, your name and address may be used to mail you mental health newsletters or periodic announcements about therapy groups or workshops sponsored by this office which might be of interest to you.

As Required by Law
We may use or disclose your protected health information if law or regulation requires the use or disclosure of your information.

For Public Health and Safety
We may disclose your protected health information to a law enforcement or human welfare authority or other entity in order to: report suspected abuse or neglect of any individual in a "protected population" (minor children, disabled individuals, or the elderly); or to protect you and others if we believe you are at imminent risk of harm to yourself or others.

In Legal Proceedings
We may disclose protected health information during lawsuits or disputes; in any judicial or administrative proceeding; in response to a court order or administrative tribunal; and, in certain conditions, in response to a subpoena, discovery request, or other lawful process.

To Assist Law Enforcement
We may disclose protected health information for law enforcement purposes, including, but not limited to, the following: responses to legal proceedings; information requests for identification and location; deaths suspected from criminal conduct; circumstances pertaining to victims of a crime; crimes occurring at this office; to identify an individual being sought by authorities, or to cooperate with ongoing law enforcement investigations.

To Protect National Security
We may disclose protected health information for national security purposes, including, but not limited to, to following: requests for information from military command authorities if you are a member of the armed forces or a member of a foreign military authority; national security and intelligence activities; protection of the President or other authorized person for foreign heads of state.

Your Authorization is Required for Other Disclosures.
Except as described previously, we will not use or disclose information from your record unless you provide us with written authorization to do so. You may revoke your consent to disclose information by providing us with written revocation.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You may exercise the following rights by submitting a written request to us. Please be aware that your request might be denied; however, you may seek a review of the denial.

Right to Request Restriction
You may request limitations on the mental health information we may disclose, but we are not required to comply with your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to Confidential Communication
You may request communications from this office in a certain way (for example, you may request that we leave necessary messages on your cell phone instead of your home phone), but you must make these requests in writing and specify exactly how you wish to be contacted when we need to do so.

Right to Inspect and Copy
You may have a right to inspect and obtain a copy of your protected health information that is contained in your client record for as long as we maintain that information. A client record contains financial and service information such as session dates and times; modalities and frequencies of treatments furnished; diagnosis; functional status; symptoms; prognosis, and progress to date. However, narrative-content psychotherapy notes may not be inspected or copied. We may charge you a $.25 fee per page for copying records requested by you. Under certain circumstances, such as protected health information that is subject to law that prohibits access, you may be denied access to your information. You may request a review of this denial by another licensed mental health professional chosen by us, and we will comply with the outcome of the review.

Right to Request Clarification
If you believe the information we have about you is incorrect or incomplete, you may ask to add clarifying information to the record. However, we are not required to accept the information that you propose or to add it to your record.

Right to Accounting of Disclosures
For up to seven years from your last date of service at this office, you may request a list of the disclosures of your mental health information that have been made to persons or entities other than for treatment, payment or health care operations.

Right to a Copy of this Notice
You may request a paper copy of this Notice at any time, even if you have already been provided with a copy. You may print out a copy of this Notice from our website at any time.

REQUIREMENTS REGARDING THIS NOTICE
The effective date of this Notice is April 14, 2003. We reserve the right to revise this Notice and to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. Should this Notice change, the revised version will be posted in our office and will also be available on our website at counselingworks.biz. Upon request, a copy of the revised Notice will be provided to you. If you are concerned that your privacy rights have been violated or disagree with a decision that was made about access to your health information, contact Elizabeth Ruegg, LCSW, BCD, CAP, CT, CCFS at 727-967-3320 to request a review. You may also file a written complaint with the Office of Civil Rights of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a good-faith complaint.