Client Notice of Privacy Practices
The Federal Health Insurance Portability and Accountability Act (HIPAA) requires that we give you this notice of our privacy practices. It describes how your information may be used and disclosed and how you can obtain that information. Our Informed Consent states most of the important information that you need to know. Legally we must safeguard your protected health information (PHI) which includes any information that could reasonably identify you as a client, including data about your health condition, the services we provide, and the payment for those services. Use of your PHI applies to the examining, analyzing, sharing, or utilizing of information within the practice, and disclosure refers to the transfer of that information to a third party outside the practice.
HIPAA Notice of Privacy Practices (Effective May 2017)
Client Privacy Statement:
Thank you for choosing Better Together Psychological Services, LLC. As a valued client, we want you to be informed about our Notice of Privacy Practices and how it affects you. By signing the acknowledgment of receipt form, you have confirmed that you have received our current Notice of Privacy Practices. A copy of the notice is available on our website, www.btpsychservices.com.
Our Pledge:
This notice applies to all clients receiving services from Better Together Psychological Services, LLC. Better Together Psychological Services is committed to improving the wellness and health of our clients and community. We want you, our clients, to feel supported and informed about your care. This includes explaining how we use, manage, and safeguard your information and your rights and choices related to your information.
Your Information:
This notice describes how your health information may be used and disclosed and how you are able to access this information. Please review it carefully. Protecting our clients’ privacy has always been essential to this practice. A new federal and state law entitled the Health Insurance Portability and Accountability Act (HIPAA) went into effect on April 14, 2003, and requires us to inform you of our policy. At Better Together Psychological Services, we carefully keep your protected health information (PHI) secure and confidential. This law requires us to continue maintaining your privacy, to give you this notice, and to follow the terms of this notice. The law permits us to use or disclose your health information to those involved in your treatment; for example, a review of your file by a physician specialist, with whom we may be interested in your care plan.
Under HIPAA, we may use and disclose your PHI for the following reasons:
We may use your information to contact you. For example, we may send emails or other information to you. We may also want to call and remind you about appointments. If you are not home, we may leave this information on your answering service or with the person who answers the telephone unless you have instructed us otherwise. In an emergency, we may disclose your health information to a family member or another person responsible for your care. We may release some or all of your health information when required by law. Except as described above, this practice will not use or disclose your health information without your prior written authorization. You may request in writing that we not use or disclose your health information as described above. We will advise you if we are able to fulfill your request.
You have the right to know of any uses or disclosures we make with your health information beyond normal uses. As we will need to contact you occasionally, we will use your preferred address or telephone number. You have the right to transfer copies of your health information to another practice. You have the right to see or receive a copy of any of your health information. You have the right to request an amendment or change to your health information. Supply us, in writing, your request to make changes. If you request to include a statement in your file, please submit it to us in writing. We reserve the right to make the changes or not, however, we will accommodate your request by including your statement in your file. If we agree to an amendment or change, we will not remove or alter earlier documents but will add new information.
For Treatment:
With written consent, we may disclose your PHI to others outside this practice including but not limited to physicians, psychologists, educators, and other healthcare professionals to coordinate care. For health care operations we may disclose your PHI for efficient operation of the practice. For example, we may use it to evaluate performance or ensure we comply with applicable laws. To obtain payment for treatment we may use or disclose your PHI to bill and collect payment for services we provide. We have no knowledge about or control over what happens to your PHI once it has been released to an insurance company. If you choose to use your medical benefits, we are obligated to supply them with your PHI. At this time, all clients are expected to pay out of pocket.
Your Individual Rights:
You have a right to restrict certain disclosures of your protected health information if you pay out of pocket in full for the services provided to you. When disclosure is required by federal, state, or local law. If disclosure is compelled or permitted by the fact that you are in such a mental or emotional condition as to be dangerous to yourself or the person or property of others, we determine that disclosure is necessary to prevent the threatened danger. If disclosure is mandated by the child abuse/neglect reporting laws or the elder/dependent adult abuse reporting laws of your state: If we have a reasonable suspicion that abuse or neglect has occurred, we must report. If an arbitrator or arbitration panel compels disclosure when arbitration is lawfully requested by either party, pursuant to subpoena or any other provisions authorizing disclosure. If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law.
Disclosures to family, friends, or others:
With written consent, we may provide your PHI to a family member, friend, or other individuals that you wish to be involved in your care or responsible for the payment of your health care. You have the right to object in whole or part and we will reasonably comply. Retroactive consent may be obtained in emergency situations.
Written Authorization:
Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing to stop any future disclosures.
Public health and safety issues:
We share your information with public health authorities or other authorized agencies in certain situations such as:
• Prevent disease
• Report suspected abuse, neglect, domestic violence, or crimes
• Prevent or reduce a serious threat to anyone’s health or safety
• Help with health system oversight, such as audits or investigations
• Comply with special government functions such as military, national security, presidential protective services, and disclosures to correctional facilities.
Our Responsibilities:
•We protect your information because your privacy is important to us and because it is the law.
•We must follow the responsibilities and privacy practices described in this notice.
•We must make this notice available to you when you become a client and must post it online at btpsychservices.com
•We will let you know in accordance with the law if a breach (unauthorized access, use, or sharing) occurs that may have put the privacy of your information at risk.
•We will not use or share your information except as covered in this notice unless you tell us we can in writing. You may revoke your authorization at any time. Let us know in writing if you change your mind.
•When the law requires us to get your permission in writing before we use or share your information, we will do so.
•We will not use your genetic information to decide whether we will give you coverage and the price of that coverage.
Get a copy of this notice:
We reserve the right to change this notice. The changes will apply to all information we have about you. If we make any changes, we will post the new notice on the Better Together Psychological Services website. We are required to ask you to sign an acknowledgment that you have received this notice. You can ask for a paper copy of this notice at any time even if you agreed to receive this notice electronically. We will provide it as requested. Additionally, the NPP will always be linked for download below.
How to complain about my privacy practice:
If you feel Better Together Psychological Services has violated your privacy rights or if you object to a decision we have made about access to your PHI, you are entitled to file a complaint. If you believe your privacy health rights have been violated, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W./ Washington, D.C. 20201/ telephone 202-619-0257 or toll-free 877-696-6775. If you file a complaint, we will take no retaliatory action against you. If you believe that your privacy has been compromised or if you are seeking more assistance regarding your personal health information and you are a client receiving services from Better Together Psychological Services, please email at drniekema@btpsychservices.com or by phone at 321.413.8039.
Changes in policy:
The Practice reserves the right to change its Privacy Policy based on the needs of the Agency and changes in state and federal law. BTPS reserves the right to update the policy at any time. Any updates will be posted on the website so our clients are always aware of what information we collect, use, and disclose. We encourage clients to frequently check this page for any changes and to stay informed about our privacy policy. You acknowledge and agree that it is your responsibility to review this privacy policy periodically to remain informed and knowledgeable regarding modifications.
Effective: October 5, 2023