Protecting You Privacy is our Highest Priority
Welwynn takes your privacy very seriously and takes every appropriate measure to afford you optimum discretion and confidentiality. The law protects the relationship between a client and a clinician, and information cannot be disclosed without written permission by the client, a parent or legal guardian.
Welwynn Outpatient Center will maintain sufficient records to justify thorough and appropriate treatment. The information you give us is confidential and release or disclosure of any identifiable information to any individual or agency is prohibited except under the following ethical and legal conditions:
- Client/legal representative has signed a valid authorization for release of information to a third party. (INFORMED CONSENT)
- In the interest of public safety. (It is determined by a clinical staff member that the client presents a danger to self or others.)
- In response to a court order and/or subpoena.
- In response to a medical emergency.
- State and federal laws require reporting of child abuse, disabled adult abuse, gunshot/knife wounds and/or communicable diseases.
- Crimes committed at the program. Crimes against any employee or client of the program, and any threat to commit such a crime.
- In the event of an investigation of an elected official’s being threatened.
HIPAA Privacy Notice Form
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.
Protecting your privacy
Psychiatrists, Clinicians, Therapists and Educators have always managed records with great concern for privacy and confidentiality. Although the security of records has continuously been addressed by Psychology Codes of Ethics as well as State and Federal laws, the rules have been considerably strengthened by the provisions of the Health Insurance Portability and Accountability Act (HIPAA). The following information provides details about the provisions of the HIPAA and your rights concerning privacy and your psychological records.
Who will observe these rules?
The following individuals are required by HIPAA to comply with the privacy rules:
- Any staff, employee and/or subcontractor of Welwynn Outpatient Center.
- Any administrative assistant or office staff who may have some access to your identifying information (such as your name, address, telephone number, etc.).
- Any billing agency that handles information about you (name, address, diagnostic codes, treatment codes, consultation dates, but not actual clinical records).
Your Rights Regarding Medical Information About You
You have the following rights regarding your medical information:
- The right to inspect and obtain a copy of your medical record. According to the rules of HIPAA, your consultations are documented in two ways:
- The clinical record (required) may include the date of your consultations, your reasons for seeking therapy, diagnosis, therapeutic goals, treatment plan, progress, medical and social history, treatment history, functional status, any past records from other providers, as well as any reports to your insurance carrier;
- Psychotherapy notes (optional), consisting of the specific content or analysis of therapy conversations, how they impact the therapy (including sensitive information that you may reveal that is not required to be included in your clinical record) and notes of your therapist that may assist in treatment.
- The right to inspect and obtain a copy of your clinical record. Viewing the record is best done during a professional consultation in order to clarify any questions that you might have at the time. Psychotherapy notes, however, if they are created, are not disclosed to third parties, HMOs, insurance companies, billing agencies, clients, or anyone else. They are for the use of a treating therapist in tracking the many details of the consultations that are far too specific to be entered into the clinical record.
- The right to request a correction or add an addendum to your record. If you believe that there is an inaccuracy in your clinical record you may request a correction. If the information is accurate, however, or if it has been provided by a third party (previous therapist, primary care physician, etc.), it may remain unchanged, and the request may be denied. In this case you will receive an explanation in writing with a full description of the rationale. You also have the right to make an addition to your record if you think it is incomplete.
- The right to an accounting of disclosures of your information to third parties. You have the right to know if, when and to whom your information has been disclosed (exclusive of treatment, payment and health care operations). However, you likely would already be aware of this, as you would have signed consent forms allowing such disclosures (e.g., disclosures to other psychotherapists, primary care physicians, specialists, etc.). This accounting must extend back for a period of six years.
- The right to request restrictions on how your information is used. You have the right to request restrictions on certain uses or disclosures of your information. These requests must be in writing. These requests will most likely be honored, although in some cases they may be denied. This office does not use or release your protected health information for marketing purposes or any other purpose aside from treatment, payment, healthcare operations and other exceptions specified in this notice.
- The right to request confidential communications. You have the right to request that your therapist communicate with you about your treatment in a certain way or at a certain location. For example, you may prefer to be contacted at work instead of at home to schedule or cancel an appointment, or you may wish to receive billing statements at a post office box rather than your home address.
- The right to receive a copy of this notice upon request. You have the right to have a copy of this Notice of Privacy Practices.
How We May Use and Disclose Information About You
For treatment: We will use information about you to assist in the continuity of treatment and services. This information will not be shared with other health care professionals, however, unless you specifically request or agree to it and sign a consent form to that effect.
For payment: With your authorization, we may use and disclose information about you for billing purposes. This is generally restricted to your name and other personal identifiers (address, and other relevant information such as social security number or Medicare number, or other needed information), diagnostic and treatment codes, dates of service and similar information.
For health care operations: We may share basic identifying information with an administrative assistant or other office staff to assist in scheduling or other treatment procedures. This would not normally include the contents of your record.
As required by law: It is possible (but unlikely) that the Department of Health and Human Services may review how we comply with the regulations of HIPAA. In such a case, your personal health information could be reviewed as a part of providing evidence of compliance.
Business associates: We may contract with a billing agency or attorneys to attend to business aspects on an as needed basis. In this case, there will be a written contract in place with the agency requiring that it maintain the security of your information, in compliance with the rules of HIPAA.
Our Responsibilities Further Explained
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information, please visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
CHANGES TO THIS NOTICE: Please note that this privacy notice may be revised from time to time. You will be notified of changes in the laws concerning privacy or your rights as we become aware of them. In the meantime, please do not hesitate to raise any questions or concerns about confidentiality with us at any time.
COMPLAINTS: If you believe we have violated any of your rights or have complaints about your services, we encourage you to first address your complaint with your clinician or the Welwynn Clinical Director. Please include your full name, date of birth, and contact information in your complaint.
If you believe we have violated your privacy rights, you also have the right to file a complaint in writing at:
United States Secretary of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Welwynn’s identifying information is:
Welwynn Outpatient Center
P.O. Box 2530
Raleigh, NC 27615