Psychotherapy, Coaching, and Organizational Consulting
Notice of Privacy Practices (NPP)
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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.
Effective Date of this Notice: January 15, 2010
Our commitment to your privacy
Our practice is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have any questions about any part of this notice or if you want more information about our privacy practices, please contact Heidi Naumowicz at (847) 287-6416.
How we use and disclose your protected health information with your consent
We will use your Protected Health Information (PHI) that we collect about you mainly to provide you with treatment, to arrange payment for our services, and for some other business activities that are called, in the law, health care operations. After you have read this notice we will ask you to sign a consent form to let us use and share your information in these ways. If you do not consent and sign this form, we cannot treat you. If we want to use or send, share, or release your information for other purposes, we will discuss this with you and ask you to sign a separate authorization form to allow this.
Disclosing your health information without your consent
There are some times when the laws require us to use or share your information. For example:
1. We are required by law to report cases of suspected child and elder abuse to authorities
2. We are required by law to inform authorities if there is a serious threat of harm to yourself or someone else
3. Records may be subpoenaed by a court of law and released without your consent
4. If a law enforcement official requires us to do so.
Your rights regarding your health information
1. You have the right to request restrictions of certain uses or disclosures of your health information. We are not required to agree to the restriction that you requested.
2. You can ask us to communicate with you in a particular way or at a certain place that is more private for you. For example, you can ask us to call you at home, and not at work, to schedule or cancel an appointment. We will try our best to do as you ask.
3. You can ask us to limit what we tell people involved in your care or the payment for your care, such as family members and friends.
4. You have the right to look at the health information we have about you, such as your medical and billing records. You can get a copy of these records, but we may charge you for it. Contact our privacy officer to arrange how to see your records. See below.
5. If you believe that the information in your records is incorrect or missing something important, you can ask us to make additions to your records to correct the situation. You have to make this request in writing and send it to our privacy officer. You must also tell us the reasons you want to make the changes.
6. You have the right to a copy of this notice. If we change this notice, we will post the new version in our office, and you can always get a copy of it from the privacy officer.
7. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with our privacy officer and with the Secretary of the U.S. Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way. By law, we are required to comply with investigations of the Secretary of the Department of Health and Human Services to determine our compliance with the department of the Privacy Rule. Also, you may have other rights that are granted to you by the laws of our state, and these may be the same as or different from the rights described above. We will be happy to discuss these situations with you now or as they arise. If you have any questions regarding this notice or our health information privacy policies, please contact our privacy officer, who is Heidi Naumowicz and can be reached by phone at (847) 287-6416 or by e-mail at: firstname.lastname@example.org
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
Heidi Naumowicz, LCSW
11187 Dundee Road, Suite 103
Huntley, IL 60142
FAX (847) 984-9334