Privacy Notice
During your initial consultation
at Ware Wellness Group, your
psychologist will review with you
confidentiality issues regarding
therapy. Generally speaking,
unless you provide written consent
for Ware Wellness Group to release
information regarding your
psychological treatment, no
information is divulged.
Exceptions include:
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If you inform a mental health
professional at Ware Wellness
Group that a member of a
protected group (children, an
elderly person, or disabled
person) is being abused or
neglected, the mental health
professional will report that
information to the appropriate
agency.
In addition to the
above general issues, please
read this statement regarding
Ware Wellness Group's
confidentiality and privacy
regulations. It is a
federally required
notice of your rights
regarding personal health
information.
NOTICE OF PRIVACY PRACTICES FOR
PERSONAL
HEALTH INFORMATION
THIS NOTICE DESCRIBES
HOW PSYCHOLOGICAL AND MEDICAL
INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW
IT CAREFULLY.
Summary
This Notice describes
how your personal health
information (PHI) is protected,
and how we may use and disclose
this information. PHI includes
personally identifiable
information that relates to your
past, present, or future health,
treatment, or payment for health
care services. Our employees and
professional staff are required
to comply with this privacy
policy, and have access to this
information only when there is
an appropriate reason to do so,
such as to confer with other
health care providers or to
submit claims for these
services.
Under the Health
Insurance Portability and
Accountability Act (HIPAA), you
are afforded privacy rights
regarding the use and disclosure
of your health information.
These include:
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A right to receive this
written notice that explains
how we may use and disclose
your protected health
information, your rights
under HIPAA ’s privacy rule,
and Dr. Ware’s
responsibilities as a
covered entity under HIPAA;
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A right to amend your
record, to restrict what
information from your record
is disclosed to others, and
to receive an accounting of
disclosures of this
information that were made
without your authorization,
other than for treatment,
payment or health care
operations;
As a health care
provider, Ware Wellness Group
makes a good faith effort to see
that you or your representative
have received and acknowledged
this notice of privacy
practices. If you are seen for
emergency treatment, you will
receive this notice as soon as
practically possible afterward.
I. Disclosures
for Treatment, Payment, and
Health Care Operations
Ware Wellness Group may
use or disclose your
protected health information
(PHI), for certain
treatment, payment, and health
care operations purposes
without your authorization.
To help clarify these terms,
here are some definitions:
-
Treatment
is when a mental health
provider diagnoses or treats
you. An example of treatment
would be consultation with
another health care
provider, such as your
family physician or another
psychologist, regarding your
treatment.
-
Health
Care Operations
is when Ware
Wellness Group discloses
your PHI to your health care
service plan (for example
your health insurer), or to
your other health care
providers contracting with
your plan, for administering
the plan, such as case
management and care
coordination.
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Use
applies
only to activities within
Ware Wellness Group, such as
sharing, employing,
applying, utilizing,
examining, and analyzing
information that identifies
you.
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Disclosure applies to
activities outside of Ware
Wellness Group, such as
releasing, transferring, or
providing access to
information about you to
other parties.
II. Uses and
Disclosures Requiring
Authorization
Ware Wellness Group may
use or disclose PHI for purposes
outside of treatment, payment,
and health care operations when
your appropriate authorization
is obtained. In those instances
when Ware Wellness Group is
asked for information for
purposes outside of treatment
and payment operations, Ware
Wellness Group will obtain an
authorization from you before
releasing this information.
You may revoke or
modify all such authorizations
of PHI at any time, provided
each revocation is in writing;
however, the revocation or
modification is not effective
until Ware Wellness Group
receives it. You may not revoke
an authorization to the extent
that (1) Ware Wellness Group has
relied on that information; or
(2) if the authorization was
obtained as a condition of
obtaining insurance coverage,
and the law provides the insurer
the right to contest the claim
under the policy.
III. Uses and
Disclosures with Neither
Consent nor Authorization
Ware Wellness Group may
use or disclose PHI without your
consent or authorization in the
following circumstances:
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Child Abuse:
Whenever a
mental health professional
has knowledge of or observes
a child known or reasonably
suspected to have been the
victim of child abuse or
neglect, the mental health
professional must
immediately report such to a
police department or
sheriff’s department, county
probation department, or
county or state welfare
department.
-
Adult and
Domestic Abuse:
If a mental
health professional has
knowledge of or observes an
incident that reasonably
appears to be physical
abuse, abandonment,
abduction, isolation,
financial abuse or neglect
of an elder or dependent
adult, or if a mental health
professional is told by an
elder or dependent adult
that he or she has
experienced these, or if a
mental health professional
reasonably suspects such,
the mental health
professional must report the
known or suspected abuse
immediately to the local
ombudsman or the local law
enforcement agency.
-
Health
Oversight: If a complaint is
filed against a mental
health professional with the
State Board that licenses
the profession, the Board
has the authority to
subpoena confidential mental
health information relevant
to that complaint.
-
Serious Threat
to Health or Safety:
If you communicate to a
mental health professional a
serious threat of physical
violence against an
identifiable victim, the
mental health professional
must make reasonable efforts
to prevent harm, which may
include communicating that
information to the potential
victim, and the police. If a
mental health professional
has reasonable cause to
believe that you are in such
a condition as to be
dangerous to yourself or
others, the mental health
professional may release
relevant information as
necessary to prevent the
threatened danger.
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Judicial or
Administrative
Proceedings:
If you are
involved in a court
proceeding and a request is
made about the professional
services that Ware Wellness
Group has provided you, Ware
Wellness Group must not
release your information
without:
1)
your written authorization or
the authorization of your
attorney or personal
representative; or
2) a court order
The privilege does not
apply when you are being
evaluated for a third party or
where the evaluation is
court-ordered. Ware Wellness
Group will inform you in advance
if this is the case.
IV. Patient’s
Rights and Provider’s Duties
Patient ’s Rights:
-
Right to Receive
Confidential
Communications by
Alternative Means and at
Alternative Locations –You have the right
to request and receive
confidential communications
of PHI by alternative means
and at alternative
locations. (For
example, you may not want a
family member to know that
you are receiving services
at Ware Wellness Group and
may request that Ware
Wellness Group not telephone
your residence).
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Ware
Wellness Group may deny
your access to PHI under
certain circumstances, but
in some cases you may have
this decision
reviewed. On your request,
Ware Wellness Group will
discuss with you the details
of the request and denial
process.
-
Right to an
Accounting –You generally have
the right to receive an
accounting of disclosures of
PHI for which you have
neither provided consent nor
authorization (as described
in Section III of this
Notice). On your
request, Ware Wellness Group
will discuss with you the
details of the accounting
process.
Duties of Mental
Health Professional:
Ware Wellness Group is
required by law to maintain the
privacy of PHI and to provide
you with a notice of legal
duties and privacy practices
with respect to PHI.
Ware Wellness Group
reserves the right to change the
privacy policies and practices
described in this notice. Unless
Ware Wellness Group notifies you
of such changes, however, Ware
Wellness Group is required to
abide by the terms currently in
effect.
If Ware Wellness
Group revises policies and
procedures, Ware Wellness Group
will provide you with a written
copy of the revised policies and
procedures at the earliest
possible opportunity following
this revision, in person or by
mail.
V. Complaints
If you are concerned
that Ware Wellness Group has
violated your privacy rights, or
you disagree with a decision
made about access to your
records, you may contact the
Compliance Officer for further
information.
For complaints,
contact Dr. Ware at
214-256-9273, or at the
following address:
P.O.
Box 801408
Dallas, TX 75380
You may also send a
written complaint to the
Secretary of the U.S. Department
of Health and Human Services.
The person listed above can
provide you with the appropriate
address upon request.
VI. Effective
Date, Restrictions, and
Changes to Privacy Policy
This notice became
effective April 14, 2003. Ware
Wellness Group reserves the
right to change the terms of
this notice and to make the new
notice provisions effective for
all PHI that is maintained. Ware
Wellness Group will provide you
with a revised notice by mail,
at the earliest opportunity
following the revision.
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