HIPAA 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.
J. Noel Trapp, MA, LPC, (the “Provider”) is committed to protecting your privacy. The Provider is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Provider is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Provider's legal duties and privacy practices and your rights regarding PHI that the Provider collects and maintains.
I: YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Provider at the address noted below (Section I, Part 8).
1. To inspect and copy PHI.
• You may, in writing, request an electronic or paper copy of your PHI. The Provider may charge you a reasonable fee, not exceeding $0.25 per page. The Provider may, in some circumstances, approve a summary or explanation of your PHI, provided you agree to both the summary and/or explanation and associated cost in advance.
• The Provider may deny your request if the Provider believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.
2. To amend PHI.
• You can ask to correct PHI you believe is incorrect or incomplete. The Provider may require you to make your request in writing and provide a reason for the request.
• If your request to amend your PHI is approved by the Provider, the Provider will make the change(s) to your PHI; the Provider will inform you of changes made, as well as advise any others who need to know about said changes to your PHI.
• The Provider may deny your request in writing in the event the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not a part of the Provider’s records, or (d) written by someone other than the Provider. The Provider will send a written explanation for the denial within 60 business days from receipt of your request and allow you to submit a written statement of disagreement.
3. To request confidential communications.
• You can ask the Provider to contact you in a specific way. The Provider will say “yes” to all reasonable requests, provided the Provider is able to provide you the PHI in the requested format without undue inconvenience.
• Example: Requesting PHI be mailed to your work, rather than home address, or via electronic communication, rather than through traditional mail.
4. To limit what is used or shared.
• You can ask the Provider not to use or share PHI for treatment, payment, or business operations. The Provider is not required to agree if it would affect your care. You do not have the right to limit uses and disclosures the Provider is legally required or permitted to make.
• If you pay for a service or health care item out-of-pocket in full, you can ask the Provider not to share PHI with your health insurer.
• You can ask for the Provider not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.
• If the Provider agrees to your request, the Provider will document any limits in writing and abide by said limits except in emergency situations.
5. To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
• An accounting list does not include disclosures (a) for treatment, payment, or health care operations, (b) to you or your family, (c) made for national security purposes, to corrections or law enforcement personnel, (d) prior to the Provider’s Privacy Rule compliance date, (e) made greater than 6 years immediately preceding the accounting request.
• The Provider will respond to your accounting of disclosures request within 60 business days from receipt of your request.
6. To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
7. To choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
8. To file a complaint if you feel your rights are violated.
• You can file a complaint by contacting the Provider using the following information:
Attn: J. Noel Trapp, MA, LPC, Chronologue Counseling, PLLC, 5210 E. Pima St., Suite 105-C, Tucson, AZ, 85712, (Five Two Zero) 641-2210
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• The Provider will not retaliate against you for filing a complaint.
9. To opt out of receiving fundraising communications.
• The Provider may contact you for fundraising efforts, but you can ask not to be contacted again.
II: PROVIDER USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
The Provider is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of the Provider's business. The Provider typically uses or shares your health information in the following ways:
A) To treat you.
• The Provider can use and share PHI with other professionals who are treating you.
• Example: Your primary care doctor asks about your mental health treatment.
B) To run the health care operations.
• The Provider can use and share PHI to run the business, improve your care, and contact you. The Provider may also provide your PHI to the Provider’s consultants, legal counsel, accountants, and others to insure the Provider complies with applicable laws.
• Example: The Provider uses PHI to send you appointment reminders if you choose.
C) To bill for your services.
• The Provider can use and share PHI to bill and get payment from health plans or other entities.
• Example: The Provider gives PHI to your health insurance plan so it will pay for your services.
D) Other disclosures.
• The Provider may use and share PHI if you are in need of emergency treatment, so long as the Provider attempts to obtain your consent after treatment is rendered. If the Provider attempts to obtain your consent and you cannot communicate (e.g., due to loss of consciousness, debilitating pain) and the Provider has a reasonable belief that you would consent to treatment, if possible, the Provider may disclose your PHI.
2. Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object
The Provider may use or disclose PHI without your authorization or an opportunity for you to object, including:
A) To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: The Provider may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine Provider compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
• Serious threat to health or safety: To prevent a serious and imminent threat.
• Abuse or Neglect: To report suspected or confirmed abuse or neglect of minors, elders, or vulnerable adults.
B) To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law.
• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
• Law enforcement: For law locate and identify you or disclose information about a victim of a crime.
• Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
• National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
• Workers' Compensation: To comply with workers' compensation laws or support claims.
C) To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized duties.
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional review board.
• Inmates: The Provider created or received your PHI in the course of providing care.
• Business Associates: To organizations that perform functions, activities or services on behalf of the Provider.
• If disclosure is otherwise specifically required by law.
• If the Provider dies or becomes incapacitated, the Provider’s Professional Executor may take control of your records and contact you in accordance with the Provider’s Professional Will to ensure continuity of care and record keeping.
3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object
Unless you object, the Provider may disclose PHI:
• To your family, friends, or others if PHI directly relates to that person's involvement in your care, unless you object in whole or in part. In emergency situations, retroactive consent may be obtained.
4. Uses and Disclosures of PHI Based Upon Your Written Authorization
The Provider will request your written authorization to use and/or disclose PHI in situations not described in Provider Uses and Disclosures Sections 1-3. You may revoke your authorization at any time by contacting the Provider in writing (using the above information) to stop additional future use and disclosure of your PHI by the Provider. The Provider will not use or share PHI other than as described in Notice unless you give your permission in writing.
III: PROVIDER RESPONSIBILITIES
• The Provider is required by law to maintain the privacy and security of PHI.
• The Provider is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Provider will abide by the more stringent law.
• The Provider reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by the Provider. Should the Provider make changes, you may obtain a revised Notice by requesting a copy from the Provider, using the information above (Section I, Part 8), or by viewing a copy on the website https://www.chronologuecounseling.com/hipaa-notice-of-privacy-practices.
• The Provider will inform you if PHI is compromised in a breach.
This Notice is effective on April 8th, 2024.