Health and Healing Therapy PLLC
850 W. Bartlett Road Suite 14C Bartlett, IL 60103
Phone: (630) 864-7267
Notice Of Privacy Practices and Client Rights
This notice describes how health information about you may be used and disclosed and how you can get access to your individually identifiable health information. Please review this notice carefully.
Our Commitment to Your Privacy
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (also called Protected Health Information, or PHI). In conducting our services, we will create records regarding you and the treatment and services we provide to you. We respect your confidentiality and will only release confidential information about you in accordance with Illinois and Federal Law. This notice describes our practice policies related to the use of the records of your care generated by Health and Healing Therapy PLLC.
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past and for any of your records that we may create or maintain in the future. Our practice will have a copy of our current Notice in our office location at all times for you to review, and you may request a copy of our most current Notice at any time.
In order to effectively provide you care, there are times when we may need to share your confidential information with others. The following categories describe the different ways in which we may use and disclose your PHI.
With your written consent, we may use or disclose treatment information about you to provide, coordinate or manage your care or any related services, including sharing information with others outside our practice who we are consulting with or referring you to.
Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. The information provided to insurance and other third party payers may include information that identifies you as well as your diagnosis, type of service, date of service, provider name/identifier, and other information about your condition and treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
We may contact you to remind you of appointments and to tell you about treatments or other services which may be beneficial to you. We will contact you in accordance with the information that you provided on your assessment forms.
Health Care Operations
Our practice may use and disclose your PHI to operate our practice. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your PHI to other health care providers and entities to assist in their health care operations.
Disclosures Required by Law
Our practice will use and disclose your PHI when we are required to do so by federal, state, or local law. This includes but is not limited to: reporting child or elder abuse or neglect, when court-ordered to release information, when there is a legal duty to warn or take action regarding imminent to danger to others, when the client is a danger to self or others or is gravely disabled, when required to report certain communicable diseases and certain injuries; and when a Coroner is investigating a client’s death.
Health Oversight Activities
Our practice may disclose your PHI to a health oversight agency for activities authorized by law and necessary for the oversight of the healthcare system, government healthcare benefit programs, and regulatory programs or determining compliance with program standards. These oversight activities include for example: audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system and compliance with civil rights laws.
Crimes on the Premises or Observed by Us
Crimes that are observed by us, directed at us, or occur at our business location will be reported to law enforcement.
Except for certain minors, incompetent clients, or involuntary clients, protected health information cannot be provided to family members without the client’s consent. In situations where family members are present during a discussion with the client and it can be reasonably inferred from the circumstances that the client does not object, information may be disclosed in the course of the discussion. However, if you object, certain PHI will not be disclosed. If this is your desire, please discuss this further with your therapist.
In life threatening emergencies, we will disclose information necessary to avoid serious harm or death.
Client Authorization to Release of Information
We may not use or disclose PHI in any other way without a signed Authorization or Consent to Release Information. When you sign a consent to release information, it may later be revoked, provided that the revocation is in writing. The revocation will apply except to the extent we have already taken action.
Your Rights as a Client
Access to Protected Health Information (PHI)
You have the right to inspect and obtain a copy of the PHI that we have regarding you and the record. There are some limitations to this right which will be explained to you at the time of your request, if such a limitation applies. To make such a request, please contact our Privacy Officer/Practice Director & Owner Colleen Koncilja LCSW, CADC, ICGC-II, BACC.
Amendment of Your Record
You have the right to request that we amend your PHI. We are not required to amend the record if it is determined that the record is accurate and complete. You can appeal this decision in writing. The appeal process will be thoroughly explained to you upon request.
Release of Records
You may consent in writing to release your records to others for any purpose you choose. This could include your attorney, employer, or others who 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 in relevance on your prior consent/authorization.
Restriction of Record
You may ask us to not use or disclose part of your PHI. This request must be in writing. We are not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information.
Accounting of Disclosures
You have the right to receive an accounting of certain disclosures that we have made regarding your protected health information. That accounting does not include disclosures that were made for the purpose of treatment, payment, or healthcare operations. There are other exceptions that will be provided to you should you request an accounting.
Alternative Means of Receiving Confidential Communications
You have the right to request that you receive communications of PHI from us by alternative means or locations. For example, if you do not want bills sent to your home, you may request a different address.
You have the right to obtain another copy of this Notice upon request.
We are required by State and Federal Law to maintain the privacy of PHI. In addition, we are required by law to provide clients with notice of our legal duties and privacy practices with respect to PHI. That is the purpose of this notice.
Terms of Notice and Changes to the Notice
We are required to abide by the terms of this Notice and any amended notice that may follow. We reserve the right to change the terms of this notice and to make new Notice provisions for all PHI that it maintains.
If you desire additional information about your privacy rights, please contact our Practice Director/Owner Colleen Koncilja.
If you have questions about this information, please discuss it further with us. If you feel your privacy rights have been violated by us, please contact:
Office of Civil Rights
Illinois Department of Professional & Financial Regulation
U.S. Department of Health & Human Services
233 N. Michigan Avenue, Suite 240, Chicago, IL 60601
Phone (312) 886-2359
Fax: (312) 886-1807