NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL AND CLINICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We respect client confidentiality and only release confidential information about you in accordance with state and federal law. This notice describes our policies related to the use of the records of your care at Associated Therapeutic Services. Privacy Contact: If you have any questions about this policy or your rights, you may contact our Privacy Officer, Becky Kroeker, at 580-242-4673.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
In order to effectively provide your care, there are times when we will need to share information about your care (also called Protected Health Information) with others outside ATS. These times include:
Treatment: We may use or disclose clinical information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside ATS with whom we are consulting or to whom we are referring you.
Payment: This agency may use and disclose your health information to others for the purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and your treatment. We also have a right to verify that the payment information you are providing is correct.
Healthcare Operations: We may use information about you to coordinate our quality assurance activities. This may include setting up your appointments, reviewing your care, and training staff.
Information Disclosed without Your Consent.
Under Oklahoma and federal law, information about you may be disclosed without your consent in the following circumstances:
You or your legal guardian ask that information be given to another professional and sign a form allowing it to be given.
You or your legal guardian automatically releases information by bringing legal charges against this provider.
Information is about a criminal act or a violation of the law or an indication that you have been a victim or subject of a crime or a possibility of physical harm to the client or someone else.
A court order exists requiring that the Psychological Technician release information.
Treatment planning information is required by your insurance company.
Information is shared in staff meetings of this agency to ensure that appropriate diagnosis and treatment decisions are made for each client.
We may leave appointment information on your home answering machine or cell phone voicemail unless you tell us not to.
We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.
PATIENT RIGHTS
You have the following rights under Oklahoma and federal law:
Copy of Record: You are entitled to inspect the clinical record ATS has generated about you.
Release of Records: You may consent in writing to the release of your records to others, for any purpose you choose. This could include your attorney, employer, or others whom you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken by ATS based upon your prior authorization.
Restriction of Records: You may ask us not to use or disclose part of the clinical information. This request must be in writing. The agency is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. Your request should be given to our Privacy Contact.
Contacting You: You may request that we send information to another address or by alternative means. We will honor such a request as long as it is reasonable and we are assured it is correct.
Amending Record: If you believe that something in your record is incorrect or incomplete, you may request we add an amendment to it. To make this request, contact the Privacy Contact, and ask for the Request to Amend Health Information form. In certain cases, we may deny your request. If we deny your request for an amendment, you have a right to file a statement that you disagree with us. Your request, our response, and your statement will be added to your record.
Accounting for Disclosures: You may request an accounting of any disclosures we have made related to your confidential information, except for information that we used for treatment, payment, or health care operations, or that we shared with you or your family, or information that you gave us specific consent to release. Please submit your request in writing to our Privacy Contact. We will notify you of the cost involved in preparing this list.
Questions or Complaints: If you have any questions, or wish a copy of this Policy, or have any complaints, you may contact our Privacy Contact in writing at our office for further information. You may also contact the LPC Licensing Board, State Department of Health. We will not retaliate against you for filing a complaint.
Changes in Policy: This agency reserves the right to change its Privacy Policy based on the needs of ATS and changes in state and federal law. Revised notices will be posted in all agency facilities and copies made available upon request.
