Acceptance Counseling of North Texas, PLLC dba Open Acceptance Counseling, PLLC / Valerie Akins, LCSW, LCDC

NOTICE OF PRIVACY PRACTICES

Effective date of this notice: Updated on January 16, 2023.

This notice describes how health information may be used and disclosed and how you can get access to this information. Please review it carefully.

1.     Provider Pledge Regarding Health Information: Your provider is committed to protecting health information about you. Your record is to provide you with quality care and to comply with certain legal requirements. Your provider is required by law to:

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

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

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

·        Provider can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in office, and on the website.

2.     How Provider May Use and Disclose Health Information About You: The following categories describe different ways that your provider can use and disclose health information. Not every use or disclosure in a category will be listed.

·       For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment, or health care operations. Providers may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, to assist the clinician in diagnosis and treatment of your mental health condition.

·       Disclosures for treatment purposes are not limited to the minimum necessary standard: Because therapists and other health care providers need access to the full record and/or full and complete information to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

·       Lawsuits and Disputes: If you are involved in a lawsuit, your provider may disclose health information in response to a court or administrative order. Provider may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

·       For Appointments and Services: To remind you of an appointment or tell you about treatment alternatives or health related benefits or services.

·       With your written authorization providers may use or disclose mental health information for the purposes not described in this notice.

3.     Certain Uses and Disclosures Do Not Require Your Authorization: Subject to certain limitations in the law, your provider can use and disclose your PHI without your Authorization for the following reasons:

·       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.

·       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.

·       For health oversight activities, to governmental, licensing, auditing and accredited agencies as authorized or required by law including audits; civil, administrative or criminal investigations; licensure or disciplinary actions; and monitoring of compliance with law.

·       For judicial and administrative proceedings, including responding to a court or administrative order, subpoenas, discovery requests or other legal process. Your providers preference is to obtain an Authorization from you before doing so. If Valerie Akins, LCSW, LCDC and Acceptance Counseling of North Texas, PLLC and/or your clinician is subpoenaed to appear in court and provide testimony regarding our knowledge and experience of you and our assessment, we will assert privilege on your behalf. Nevertheless, if the judge insists we testify, we will testify truthfully and honestly to our thoughts and professional opinion.

·       For law enforcement purposes, including reporting crimes occurring on the premises. Or, to assist in an involuntary hospitalization process.

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

·       For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition. Subject to a special review process, and the confidentiality of state and federal law.

·       Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

·       To the State Legislative Senate or Assembly Rules Committees for legislative investigations.

·       To prevent a serious threat to health or safety of yourself. All clients are required to have an updated emergency contact on file. If your provider believes that you may be a threat to yourself, someone else, or is experiencing a crisis, then your emergency contact will called. If your emergency contact is unable to be reached, 911 will be called to follow up regarding welfare. Your provider will only share the minimum amount of information necessary to achieve the purpose of the disclosure.

·       To prevent a serious threat to health or safety of an individual. We may notify the person, tell someone who could prevent the harm, or tell law enforcement officials.

·       For workers’ compensation purposes. Although the preference is to obtain an Authorization from you, your provider may provide your PHI in order to comply with workers’ compensation laws.

·       Appointment reminders and health related benefits or services: Your provider may use and disclose your PHI to contact you to remind you that you have an appointment with me. Your provider may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits offered.

4.     Certain Uses and Disclosures Require You to Have the Opportunity to Object:

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

5.     Unexpected therapist absence: In the event of my (Valerie Akins, LCSW, LCDC)’s unplanned absence from practice, whether due to injury, illness, death, or any other reason, I maintain a detailed Professional Will with instructions for an Executor to inform you of my status and ensure your continued care in accordance with your needs. The Executor of my Professional Will is Ashley Jones, LPC, and the Secondary Executor (i.e., the person who would take on the Executor role if the named Executor is unavailable) is Jennifer Timm, LPC. You authorize the Executor and Secondary Executor to access your treatment and financial records only in accordance with the terms of my Professional Will, and only in the event that I experience an event that has caused or is likely to cause a significant unplanned absence from practice.

6.     You Have the Following Rights with Respect to Your PHI:

·       To Request Limits on Uses and Disclosures of Your PHI: You have the right to ask your provider not to use or disclose certain PHI for treatment, payment, or health care operations purposes. You must put your request in writing. Providers not required to agree to your request, and may say “no” if believed it would affect your health care. If we do agree with the request, we will comply with your request except to the extent that disclosure has already occurred or if you need emergency treatment and the information is needed to provide emergency treatment.

·       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.

·       To Choose How Providers Send PHI to You: You have the right to ask to be contacted in a specific way (for example, home or office phone) or to send mail to a different address, and your provider will agree to all reasonable requests.

·       To See and Get Copies of Your PHI: You have the right to inspect and request a copy of your mental health record except in limited circumstances. A fee will be charged to copy your records. You must put your request for a copy of your records in writing. If you are denied access to your mental health record for certain reasons, we will tell you why and what your rights are to challenge that denial.

·       To Get a List of the Disclosures Made: You have the right to request a list of instances in which your PHI has been disclosed for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. Your provider will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list includes disclosures made in the last six years unless you request a shorter time.

·       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 to 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.

·       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.

Contact Information: If you have any questions about this Notice, please contact the office manager, Valerie Akins, LCSW, LCDC / Acceptance Counseling of North Texas, PLLC at 469-756-0880. If you believe your privacy rights have been violated, you may contact the Texas Behavioral Health Executive Council at 1-800-821-3205. You may also send a written complaint with the form listed below:

<https://www.bhec.texas.gov/wp-content/uploads/2020/07/BHEC-Complaint-Form.pdf>

You will not be penalized for filing a complaint.​