River Centre Clinic (RCC) is required by law to maintain the privacy of your protected health information and to provide individuals with this Notice describing our legal duties and privacy practices with respect to your protected health information. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related healthcare services. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.

We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change our practices and the terms of this Notice at any time, and to make the new notice effective for all protected health information that we maintain. Upon request, we will provide you with any revised Notice of Privacy Practices.

1. Uses and Disclosures of Protected Health Information

Uses and Disclosures of Protected Health Information Based Upon Your Written Consent
Once you have consented to the use and disclosure of your protected health information for treatment, payment, and healthcare operations by signing the consent form, your protected health information may be used and disclosed by your therapist, our office staff, and others outside of our office who are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operation of RCC.

The following are examples of the types of uses and disclosures of your protected healthcare information that the therapist office is permitted to make once you have signed our consent form.

Treatment
We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that has already obtained your permission to access your protected health information.

Payment
Your protected health information will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services that we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

Healthcare Operations
We may use or disclose, as needed, your protected health information in order to support the business activities of your therapist’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, or other business activities.

Emergencies
We may use or disclose your protected health information in an emergency treatment situation.

Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization, at any time, in writing, except to the extent that your therapist’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information to the extent that such use or disclosure is required by law. This includes uses and disclosures for the following:

for public health activities
to avert a serious threat to health or safety
reporting about victims of abuse, neglect, or domestic violence
judicial and administrative proceedings
law enforcement purposes

Please contact our Privacy Rights Officer if you have any questions about the uses and disclosures of your protected health information.


Your Rights
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. Please contact our Privacy Rights Officer if you have any questions about these rights.

You have the right to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other record. Under federal law, however, you may not 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 protected health information that is subject to law that prohibits access to protected health information. We may charge a fee for the costs of copying, mailing, and supplies that are necessary to fulfill your request.

You have the right to request restrictions on certain uses and disclosures
However, we are not required to agree to those restrictions and may decide not to accept the restrictions and not to treat the individual.

You have the right to amend confidential information held by us
However, we may deny an individual’s request for an amendment.

You have the right to receive confidential communications from us by alternative means.
We will accommodate all reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request.

You have the right to obtain a paper copy of this Notice from us, upon request, even if you have agreed to accept this Notice electronically.

You have the right to make a complaint if you believe your privacy rights have been violated.
You may file a complaint with us by notifying our Privacy Rights Officer. We will not retaliate against you for filing a complaint.