Privacy Policy

ANN ARBOR CENTER FOR THE FAMILY

Notice of Privacy Practices

Effective April 24, 2003 / Revised December 10, 2004 / October 7, 2008 / June 21, 2010

This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

If you have questions about this Notice please contact our Privacy Officer,

Andrew Orosan-Weine, Ph.D.

(734) 995-5181

Please request a Notice of Privacy Practices from your therapist.

SUMMARY:

This Notice of Privacy Practices (NPP) describes how we may use, request, and disclose your Protected Health Information (PHI) in both paper and electronic forms and also describes your rights to access and control your Protected Health Information.

“Protected Health Information” is information about you, including demographic information, that may identify you or that relates to your past, present or future physical or mental health or condition and related health care services.

Generally, we use Protected Health Information to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. Most disclosures are limited to those that are reasonably necessary to accomplish the purpose of the use, request, or disclosure. But, in order to provide you with the best possible care and treatment, all professional staff involved in your treatment and employees involved in the health care operations of the Center may have access to your records.

REQUIREMENTS REGARDING THIS NOTICE:

We are required to provide you with this Notice that governs our privacy practices. We are required to abide by the terms of this Notice. We may change our policies or procedures in regard to privacy practices at any time. If changes occur, the changes will be effective for mental health information we have about you as well as any information we receive in the future. You can receive the most current Notice of Privacy Practices by:

  • accessing our website's Privacy Policy page where this document is posted;

  • calling the office, and requesting that a copy be sent to you by postal mail;

  • or asking for a copy at the time of your next appointment.

PURPOSE:

In order to protect patient privacy and provide the best possible care and treatment, Ann Arbor Center for the Family and its affiliates, employees, and trainees follow the privacy practices described in this Notice. The Center keeps your mental health information in records that will be maintained and protected in a confidential manner, as required by law.

HOW WILL ANN ARBOR CENTER FOR THE FAMILY HANDLE MY ELECTRONICALLY TRANSMITTED INFORMATION?

  • In order to maintain and improve our web site, we track your visit by collecting and storing your IP address, ISP, the date and time that you visit, and the URL's that you access from our web pages. We utilize this information for technical security and internal review only, and do not share that information with anyone else.

  • When you visit our web site, we might store some information on your computer. This information will be in the form of a "cookie" or similar file. Cookies are small pieces of information stored on your hard drive -- not on our site. Cookies do not spy on you or otherwise invade your privacy, and they cannot invade your hard drive and steal information. Rather, they help you navigate our web site as easily as possible.

  • We use secure socket layer (SSL) encryption to protect the privacy of information that you send us via the "Contact Us" page.

  • If you choose to use our "Contact Us" page to identify yourself, we will use the personal information that you transmit only to respond to your query -- never for marketing back to you, nor for any other interactive purpose. Only AACFF office staff and professional affiliates will have access to your information. We will never sell or distribute your information to any other party. Our individual therapists' intake procedures include safeguards to ensure that services are provided only with the informed consent of the patient or (if the patient is under 14 years of age) her or his legal guardian.

HOW WILL ANN ARBOR CENTER FOR THE FAMILY USE MY PROTECTED HEALTH INFORMATION?

When we collect information from you some of it will be Protected Health Information. Within the Center, we restrict the disclosure of this information to therapists, psychiatrists, and insurance and billing personnel. Outside the Center, we will disclose information only when you have specifically authorized such disclosure, expect for those individuals, agencies and entities for whom legal and administrative requirements demand disclosure.

WHAT ARE TREATMENT AND HEALTH CARE OPERATIONS DISCLOSURES?

Your treatment may include sharing information among mental health care providers who are involved in your treatment. For example, if you are seeing both a physician (psychiatrist) and a psychotherapist, they may share information in the process of coordinating your care. In addition, we may disclose your Protected Health Information to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your therapist, becomes involved in your care by providing assistance with your health care diagnosis or treatment.

WHAT ARE SOME EXAMPLES OF THE TYPES OF DISCLOSURES AACFF MAKES?

Examples of disclosures include but are not limited to:

•Appointment reminders or notification that an appointment is canceled or rescheduled by your therapist.

• Payment from a third-party insurance company. A bill may be sent to them that may include information that identifies you, as well as your diagnosis and procedures.

• Coverage by another mental health professional during vacations.

• Information needed by your pharmacy for prescriptions.

• Mental health oversight activities, e.g. audits, inspections or investigations of administration, and management of the Center.

• To carry out treatment and health care operations functions through medical transcription services.

• Alcohol and drug abuse information has special privacy protection. The Center will not disclose any information identifying an individual as being a client or provide any mental health or medical information relating to a client’s substance abuse treatment unless; 1) the client consents in writing; 2) a court order requires disclosure of the information; 3) medical personnel need the information to meet a medical emergency; 4) it is relevant in reporting a preventing a threat of harm to yourself or others.

• For public health purposes such as reporting child abuse or elder abuse or neglect.

• Lawsuits and disputes.

• Law enforcement (e.g., in response to a court order or other legal process).

• To prevent a serious threat to health or safety of yourself or others.

• To authorized federal officials for the conduct of lawful intelligence, counter intelligence, and other national security activities.

• As required by law.

YOUR AUTHORIZATION IS REQUIRED FOR OTHER DISCLOSURES.

Except as described previously, we will not disclose information from your record without your written authorization (permission). You may revoke your authorization (permission) at any time in writing, but it will be effective only after the date of your written revocation.

YOU HAVE RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION.

You have the following rights regarding your health information, provided that you make a written request to invoke the right on the correct form provided by the Ann Arbor Center for the Family.

• Right to request a disclosure restriction. You may request limitations on your mental health information we may disclose, but we are not required to agree to your request unless disclosure is prohibited by law. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment or disclosure is required under law.

• Right to confidential communications. You may request communications in a certain way or at a certain location, but you must specify how or where you wish to be contacted. Upon receipt of a request, we will attempt to be reasonably accommodating.

• Right to inspect and copy your record. You have the right to inspect and copy your mental health information regarding decisions about your care; however, psychotherapy notes (notes made by your therapist about your conversations) may not be inspected and copied. We may charge a fee for copying, mailing, and supplies. Under limited circumstances, your request may be denied; you may request review of the denial by another licensed mental health professional chosen by the Ann Arbor Center for the Family. The Center will comply with the outcome of their review.

• Right to request we clarify your record. If you believe the information we have about you is incorrect or incomplete you may ask to add clarifying information. You may ask for a form for that purpose and the form will require certain specific information. The Center is not required to accept the information that you propose.

• Right to accounting of certain disclosures. You may request a list of the disclosures of your mental health information that have been made to persons or entities other than for treatment or health care operations in the last six (6) years, but not prior to April 14, 2003. Under certain circumstances, disclosures for national security or intelligence purposes, disclosures to law enforcement officials, or for other legal purposes may not be able to be included in the accounting.

• Right to a copy of this Notice. You may request a paper copy of this Notice at any time, even if you have been provided with an electronic copy.

COMPLAINTS.

If you believe your privacy rights have been violated, you may file a complaint with the Ann Arbor Center for the Family. You will not be penalized or retaliated against in any way for making a complaint.

CONTACT.

Call Ann Arbor Center for the Family and ask to speak to the Privacy Officer if:

        • You have a complaint.

        • You have a question about this notice.

        • You wish to request restrictions on uses and disclosure for health care treatment or operations.

        • To obtain any of the forms mentioned to exercise the individual rights described above.

For more information about HIPAA contact:

Office for Civil Rights; US Department of Health & Human Services

233 N. Michigan Ave., Suite 240

Chicago, IL 60601

(312) 886-2359; (312) 353-5693 (TDD)

(312) 886-1807 (Fax)