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Notice of Privacy Practices

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Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

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Halcyon Crest, LLC (“we”, “our”) is committed to protecting health information about you. A record of the services provided to you will be created to provide you with quality service and to comply with certain legal requirements. This notice applies to all of the records of your services generated by this professional coaching and educational consultation practice. This notice will tell you about the ways in which your health-related information may be used or disclosed, your rights, and certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

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  • Make sure that protected health information (“PHI”) that identifies you is kept private.

  • Give you this notice of our legal duties and privacy practices with respect to health information.

  • Follow the terms of the notice that is currently in effect.

  • We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, from our office, and on our website.

 

I. Ways your PHI may be disclosed:

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The following categories describe different ways that your PHI may be used and disclosed.

  1. For Healthcare Services or Healthcare Operations: Your PHI could be disclosed to other healthcare professionals who are providing you healthcare.

  2. For Management of Services: Your PHI may be used to aid in improving service delivery, your care, for referral to a healthcare provider, to contact you when necessary, to bill a third party (e.g. employer’s EAP) for your services, if applicable.

  3. Legal Actions: Your PHI may be disclosed in response to a court or administrative order.

 

II.  CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

  1. Progress Notes. Any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
    a. For our use in providing services to you.
    b. For our use in training or supervision.
    c. For our use in legal defense proceedings instituted by you.
    d. For use by the Secretary of Health and Human Services to investigate compliance with HIPAA.
    e. Required by law and the use or disclosure is limited to the requirements of such law.
    f. Required by law for certain health oversight activities pertaining to the originator of the progress notes.
    g. Required by a coroner who is performing duties authorized by law.
    h. Required to help avert a serious threat to the health and safety of others.

  2. Marketing of PHI. Your PHI will not be used or disclosed for marketing purposes.

  3. Sale of PHI. Your PHI will not be sold in the regular course of business.

 

III.  CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.

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Subject to certain limitations in the law, your PHI can be used and disclosed without your Authorization for the following reasons:

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  1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

  2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

  3. For health oversight activities for activities authorized by law.

  4. For judicial and administrative proceedings, including responding to a court or administrative order.

  5. For law enforcement purposes or with a law enforcement official.

  6. For special government functions such as military, national security, and presidential protective services

  7. To coroners or medical examiners when such individuals are performing duties authorized by law.

  8. For workers’ compensation claims.

  9. Appointment reminders and health related benefits or services. Your PHI may be used to contact you to remind you that you have an appointment with our service.

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IV.  CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

Disclosures to family, friends, or others. Your PHI may be disclosed to a family member, friend, or other person that you indicate is involved in your care or the payment for your services, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

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 V.  YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

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  1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to request certain PHI not be used or disclosed for services, payment, or health care operations purposes. We are not required to agree to your request and may say “no” if there are concerns it may affect your health care.

  2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

  3. The Right to Choose How PHI is Sent You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.

  4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your health record and other information we have about you. We will provide you with a copy of your record, or a summary of it within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.

  5. The Right to Get a List of the Disclosures We Have Made.  You have the right to request a list of instances in which we have disclosed your PHI for purposes other than services, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, We will charge you a reasonable cost-based fee for each additional request.

  6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but will tell you why in writing within 60 days of receiving your request.

  7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

 

This notice went into effect February 2021.

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