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| Amy H. Olson, L.C.S.W., C.E.D.S., P.A. |
Privacy Practices
Posted as required by HIPPA law in effect April 14, 2003. You will receive
a hard copy of this policy and be required to sign acknowledgement of
receipt prior to beginning treatment.
Amy Hedberg Olson, L.C.S.W., P.A.
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 THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. This
information about you that may identify you and that relates to your past, present or future
physical or mental health or condition and related health care services is referred to as
Protected Health Information ("PHI"). This Notice of Privacy Practices describes how we
may use and disclose your PHI in accordance with applicable law and the NASW Code of
Ethics. It also describes your rights regarding how you may gain access to and control
your PHI.
We are required by law to maintain the privacy of PHI and to provide you with notice of
our legal duties and privacy practices with respect to PHI. We are required to abide by the
terms of this Notice of Privacy Practices. We reserve the right to change the terms of our
Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be
effective for all PHI that we maintain at that time. We will provide you with a copy of the
revised Notice of Privacy Practices by posting a copy on our website, sending a copy to
you in the mail upon request or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment. Your PHI may be used and disclosed by those who are involved in your
care for the purpose of providing, coordinating, or managing your health care treatment and
related services. This includes consultation with clinical supervisors or other treatment
team members. We may disclose PHI to any other consultant only with your authorization.
For Payment. We may use and disclose PHI so that we can receive payment for the
treatment services provided to you. This will only be done with your authorization.
Examples of payment-related activities are: making a determination of eligibility or
coverage for insurance benefits, processing claims with your insurance company, reviewing
services provided to you to determine medical necessity, or undertaking utilization review
activities. If it becomes necessary to use collection processes due to lack of payment for
services, we will only disclose the minimum amount of PHI necessary for purposes of
collection.
For Health Care Operations. We may use or disclose, as needed, your PHI in order to
support our business activities including, but not limited to, quality assessment activities,
employee review activities, licensing, and conducting or arranging for other business
activities. For example, we may share your PHI with third parties that perform various
business activities (e.g., billing or typing services) provided we have a written contract
with the business that requires it to safeguard the privacy of your PHI. For training or
teaching purposes PHI will be disclosed only with your authorization. PHI may be
disclosed to remind you of appointments or to provide information about treatment
alternatives or other health-related benefits and services. For example, if you miss an
appointment, I may call your preferred telephone number and request to speak with you or
leave a message identifying myself and reminding
you that an appointment was missed. If you have specific requests regarding how I may or
may not contact you, please discuss at your first session and accommodations will be made.
Required by Law. Under the law, we must make disclosures of your PHI to you upon your
request. In addition, we must make disclosures to the Secretary of the Department of
Health and Human Services for the purpose of investigating or determining our compliance
with the requirements of the Privacy Rule.
Without Authorization. Applicable law and ethical standards permit us to disclose
information about you without your authorization only in a limited number of other
situations. The types of uses and disclosures that may be made without your authorization
are those that are:
· Required by Law, such as the mandatory reporting of child abuse or neglect, elder abuse or
neglect, or abuse and neglect of other vulnerable populations or mandatory government
agency audits or investigations (such as the social work licensing board or the health
department)
· Required by Court Order
· Necessary to prevent or lessen a serious and imminent threat to the health or safety of a
person or the public. If information is disclosed to prevent or lessen a serious threat it will
be disclosed to a person or persons reasonably able to prevent or lessen the threat, including
the target of the threat.
Verbal Permission
We may use or disclose your information to family members that are directly involved in
your treatment with your verbal permission.
With Authorization. Uses and disclosures not specifically permitted by applicable law
will be made only with your written authorization, which may be revoked.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding PHI we maintain about you. To exercise any of
these rights, please submit your request in writing to the Privacy Officer, Amy H.
Olson, L.C.S.W., 1320 S.E. Maynard Road, Suite 101, Cary, NC 27511:
· Right of Access to Inspect and Copy. You have the right, which may be restricted in
exceptional circumstances, such as review of psychotherapy notes, to inspect and copy PHI
that may be used to make decisions about your care. Your right to inspect and copy PHI
will be restricted only in those situations where there is compelling evidence that access
would cause serious harm to you. We may charge a reasonable, cost-based fee for copies.
· Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete,
you may ask us to amend the information although we are not required to agree to the
amendment.
· Right to an Accounting of Disclosures. You have the right to request an accounting of
certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if
you request more than one accounting in any 12-month period.
· Right to Request Restrictions. You have the right to request a restriction or limitation on
the use or disclosure of your PHI for treatment, payment, or health care operations. We are
not required to agree to your request.
· Right to Request Confidential Communication. You have the right to request that we
communicate with you about medical matters in a certain way or at a certain location.
· Right to a Copy of this Notice. You have the right to a copy of this notice.
COMPLAINTS
If you believe we have violated your privacy rights, you have the right to file a complaint in
writing with our Privacy Officer Amy Hedberg Olson, L.C.S.W.,
1320 S.E. Maynard Road, Suite 101, Cary, NC 27511 or with the Secretary of Health and
Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by
calling (202) 619-0257.
We will not retaliate against you for filing a complaint.
The effective date of this Notice is April 14, 2003.
Posted as required by HIPPA law in effect April 14, 2003. You will receive
a hard copy of this policy and be required to sign acknowledgement of
receipt prior to beginning treatment.
Amy Hedberg Olson, L.C.S.W., P.A.
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 THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. This
information about you that may identify you and that relates to your past, present or future
physical or mental health or condition and related health care services is referred to as
Protected Health Information ("PHI"). This Notice of Privacy Practices describes how we
may use and disclose your PHI in accordance with applicable law and the NASW Code of
Ethics. It also describes your rights regarding how you may gain access to and control
your PHI.
We are required by law to maintain the privacy of PHI and to provide you with notice of
our legal duties and privacy practices with respect to PHI. We are required to abide by the
terms of this Notice of Privacy Practices. We reserve the right to change the terms of our
Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be
effective for all PHI that we maintain at that time. We will provide you with a copy of the
revised Notice of Privacy Practices by posting a copy on our website, sending a copy to
you in the mail upon request or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment. Your PHI may be used and disclosed by those who are involved in your
care for the purpose of providing, coordinating, or managing your health care treatment and
related services. This includes consultation with clinical supervisors or other treatment
team members. We may disclose PHI to any other consultant only with your authorization.
For Payment. We may use and disclose PHI so that we can receive payment for the
treatment services provided to you. This will only be done with your authorization.
Examples of payment-related activities are: making a determination of eligibility or
coverage for insurance benefits, processing claims with your insurance company, reviewing
services provided to you to determine medical necessity, or undertaking utilization review
activities. If it becomes necessary to use collection processes due to lack of payment for
services, we will only disclose the minimum amount of PHI necessary for purposes of
collection.
For Health Care Operations. We may use or disclose, as needed, your PHI in order to
support our business activities including, but not limited to, quality assessment activities,
employee review activities, licensing, and conducting or arranging for other business
activities. For example, we may share your PHI with third parties that perform various
business activities (e.g., billing or typing services) provided we have a written contract
with the business that requires it to safeguard the privacy of your PHI. For training or
teaching purposes PHI will be disclosed only with your authorization. PHI may be
disclosed to remind you of appointments or to provide information about treatment
alternatives or other health-related benefits and services. For example, if you miss an
appointment, I may call your preferred telephone number and request to speak with you or
leave a message identifying myself and reminding
you that an appointment was missed. If you have specific requests regarding how I may or
may not contact you, please discuss at your first session and accommodations will be made.
Required by Law. Under the law, we must make disclosures of your PHI to you upon your
request. In addition, we must make disclosures to the Secretary of the Department of
Health and Human Services for the purpose of investigating or determining our compliance
with the requirements of the Privacy Rule.
Without Authorization. Applicable law and ethical standards permit us to disclose
information about you without your authorization only in a limited number of other
situations. The types of uses and disclosures that may be made without your authorization
are those that are:
· Required by Law, such as the mandatory reporting of child abuse or neglect, elder abuse or
neglect, or abuse and neglect of other vulnerable populations or mandatory government
agency audits or investigations (such as the social work licensing board or the health
department)
· Required by Court Order
· Necessary to prevent or lessen a serious and imminent threat to the health or safety of a
person or the public. If information is disclosed to prevent or lessen a serious threat it will
be disclosed to a person or persons reasonably able to prevent or lessen the threat, including
the target of the threat.
Verbal Permission
We may use or disclose your information to family members that are directly involved in
your treatment with your verbal permission.
With Authorization. Uses and disclosures not specifically permitted by applicable law
will be made only with your written authorization, which may be revoked.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding PHI we maintain about you. To exercise any of
these rights, please submit your request in writing to the Privacy Officer, Amy H.
Olson, L.C.S.W., 1320 S.E. Maynard Road, Suite 101, Cary, NC 27511:
· Right of Access to Inspect and Copy. You have the right, which may be restricted in
exceptional circumstances, such as review of psychotherapy notes, to inspect and copy PHI
that may be used to make decisions about your care. Your right to inspect and copy PHI
will be restricted only in those situations where there is compelling evidence that access
would cause serious harm to you. We may charge a reasonable, cost-based fee for copies.
· Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete,
you may ask us to amend the information although we are not required to agree to the
amendment.
· Right to an Accounting of Disclosures. You have the right to request an accounting of
certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if
you request more than one accounting in any 12-month period.
· Right to Request Restrictions. You have the right to request a restriction or limitation on
the use or disclosure of your PHI for treatment, payment, or health care operations. We are
not required to agree to your request.
· Right to Request Confidential Communication. You have the right to request that we
communicate with you about medical matters in a certain way or at a certain location.
· Right to a Copy of this Notice. You have the right to a copy of this notice.
COMPLAINTS
If you believe we have violated your privacy rights, you have the right to file a complaint in
writing with our Privacy Officer Amy Hedberg Olson, L.C.S.W.,
1320 S.E. Maynard Road, Suite 101, Cary, NC 27511 or with the Secretary of Health and
Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by
calling (202) 619-0257.
We will not retaliate against you for filing a complaint.
The effective date of this Notice is April 14, 2003.
| Growth...healing...recovery |