IMPORTANT NOTE: The Nelson Counseling Center can only provide counseling services to students who currently and physically reside in Texas as state licensure limitations dictate.  Contact the Nelson Counseling Center for any questions.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT CLIENTS MAY BE USED AND DISCLOSED AND HOW THEY CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY AND KEEP A COPY FOR A RECORD.

I. OUR RESPONSIBILITIES: We are required by applicable federal and state law to maintain the privacy of clients' health information and inform them of our privacy practices, legal obligations, and their rights concerning their health information. We reserve the right to change this Notice of Privacy Practices and to make any new Notice of Privacy Practices effective for all protected health information that we maintain. Any new Notice of Privacy Practices adopted will be posted on our website and can be made available at each client's next appointment.

II. WHAT IS "PROTECTED HEALTH INFORMATION" (PHI)? Protected health information ("PHI") is demographic and individually identifiable health information that will or may identify the client and relates to the client's past, present or future physical or mental health or condition and related health care services.

USES AND DISCLOSURES OF INFORMATION: Under federal law, we are permitted to use and disclose protected health information, excluding psychotherapy notes, without authorization for treatment, payment and health care operations.

III. WHAT DOES "HEALTH CARE OPERATIONS" INCLUDE? Health care operations include activities such as communications among health care providers, conducting quality assessment and improvement activities; evaluating the qualifications, competence, and performance of health care professionals; training future health care professionals; other related services that may be a benefit to clients such as case management and care coordination; contracting with insurance companies: conducting medical review and auditing services; compiling and analyzing information in anticipation of or for use in legal proceedings; and general administrative and business functions.

IV. HOW MEDICAL INFORMATION MAY BE USED FOR TREATMENT, PAYMENT OR HEALTHCARE OPERATIONS

-  Medical information may be used to justify needed patient care services, (i.e., treatment protocols).

-  We will use medical information to establish a treatment plan.

-  We may disclose protected health information to another provider for treatment (i.e. referring physicians, specialists and providers, therapists, etc.)

-  We may use medical information for the supervision of LPC Associates and LMSW Associates or in consultation with other professionals.

-  We may submit claims to clients' insurance companies containing medical information and we may contact their utilization review department to receive pre-certification (prior approval for treatment). We will submit only the minimum amount of information necessary for this purpose.

-  We may use the emergency contact information clients provided to contact them if the address of record is no longer accurate.

-  We may contact clients to remind them of their appointment by calling, emailing, or texting them.

-  We may contact them to discuss treatment alternatives or other health related benefits that may be of interest.

V. WHAT ARE PSYCHOTHERAPY NOTES? Psychotherapy notes are notes recorded (in any medium) by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session that are separated from the rest of the patient's medical record. Psychotherapy notes exclude medication prescription and monitoring, counseling session start and stop times, modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date. Psychotherapy notes will be used only by a client's clinician and will not otherwise be used or disclosed without their written authorization.

VI. WHAT IS PSYCHOSOCIAL INFORMATION? Psychosocial information is information provided regarding a client's social history and counseling or psychiatric services they have received before treatment at the Nelson University Counseling Center.

VII. SHARING INFORMATION WITH BUSINESS ASSOCIATES

There are some services provided through contracts with business associates. Examples include billing services and receptionist services. When these services are contracted, we may disclose information as relevant to the business associate so that they can perform the job we have contracted them to do.

VIII. WHEN IS ONE'S AUTHORIZATION / CONSENT NOT REQUIRED?

The law requires that some information may be disclosed without  authorization in the following circumstances:

- In case of an emergency

- If a client appear to pose an imminent threat to themselves or others, in order to reduce the likelihood of harm

- When there are communication or language barriers

- When ordered to do so by a court, grand jury, or administrative tribunal. Under certain conditions, we may disclose information in response to a subpoena or other legal process, even without a court order

- When required by law

- When there are risks to public health

- To conduct health oversight activities

- To report suspected child abuse or neglect or abuse/neglect to other disabled persons

- To specified government regulatory agencies including proof of compliance with regulations that safeguard a client's information

- To coroners, funeral directors, and for organ donation

IX. CLIENT'S PRIVACY RIGHTS

The following is a statement of a client's rights with respect to their protected health information and a brief description of how they may exercise these rights.

1. Clients have the right to inspect and copy your health information.

This means Clients may inspect and obtain a copy of their PHI that is contained in a "designated record set" for so long as we maintain the PHI. A designated record set contains medical and billing records and any other records that we use in making decisions about their healthcare. All requests must be in writing. We reserve the right to deny access to their records. We will charge a fee for the costs of copying and sending them any records requested. They may not however, inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding, and certain PHI that is subject to laws that prohibit access to that PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, they may have the right to have this decision reviewed. Please contact the Director of the Counseling Center with questions about access to a medical record.

2. Clients have the right to request a restriction of their health information.

This means they may ask us to restrict or limit the medical information we use or disclose for the purposes of treatment, payment or healthcare operations. We are not required to agree to a restriction that they may request. We will notify them if we deny their request. If we do agree to the requested restriction, we may not use or disclose their PHI in violation of that restriction unless it is needed to provide emergency treatment. They may request a restriction (such as non-disclosure to health insurance) by contacting their counselor.

3. They have the right to request to receive confidential communications by alternative means or at alternative locations.

We will accommodate reasonable requests. We may also condition this accommodation by asking them for an alternative address or other method of contact. We will not request an explanation from them as the basis for the request. Requests must be made in writing to the Director of the Counseling Center.

4. They have the right to request amendments to their health information.

This means they may request an amendment of PHI about them in a designated record set for as long as we maintain this information. In certain cases, we may deny their request for an amendment. If we deny their request, they have the right to file a statement of disagreement with the Director of the Counseling Center and we may prepare a rebuttal to their statement and will provide them with a copy of this rebuttal. If they wish to amend their PHI, please contact the Director of the Counseling Center. Requests for amendment must be in writing and explain why the information should be amended.

5. They have the right to receive an accounting of disclosures of their health information.

They have the right to request an accounting of certain disclosures of their PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Privacy Notice. We are also not required to account for disclosures that they requested, disclosures that they agreed to by signing an authorization form, to family or friends involved in their care, or certain other disclosures we are permitted to make without their authorization. The request for an accounting must be made in writing to the Director of the Counseling Center. The request should specify the time period sought for the accounting. Accounting requests may not be made for periods of time in excess of six years.

6. They have the right to receive a paper copy of this Notice of Privacy Practices.

X. WHAT ABOUT QUESTIONS/COMPLAINTS?

If they have questions regarding their privacy rights, they should speak to their counselor directly. If they believe their privacy rights have been violated, they may file a complaint by contacting their counselor, or with the Secretary of the Department of Health and Human Services. They will not be penalized for filing a complaint. The address for the Secretary of the Department of Health and Human Services is:

Office of Civil Rights, U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth St., S.W., Atlanta, GA 30303-8909, (404) 562-7886 (phone), (404) 562-7881 (fax), (404) 331-2867 (TDD), www.hhs.gov/ocr/hipaa

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

In our Notice of Privacy Practices, we provide clients information about how the Nelson University Counseling Center can use or disclose their mental health and medical information. As described in our Notice of Privacy Practices, we request the client's consent for any use or disclosure of mental health and medical information necessary to carry out treatment, payment or health care operations. Be advised that their Notice of Privacy Practices is subject to change.  The most recent version will always be at our website at www.nelson.edu.   If clients have any questions about their Notice of Privacy Practices or if they need to request a copy, please contact us at the address and /or phone number below.

Clients have the right to revoke this Consent in writing at any time, except where we have already used or disclosed their health information in reliance upon this Consent.

I acknowledge receipt of the Notice of Privacy Practices of the Nelson University Counseling Center and consent to the use and disclosure of my/my child's personal health information for treatment, payment or health care operations, as described in the Notice of Privacy Practices.     

Signature:  ______________________________________       Date: ___________________

                            (patient)  

Signature:  ______________________________________       Date: ___________________

                            (parent/conservator/guardian)  

 This Notice is effective as of August 1, 2014.