Privacy Practice

Notice of Privacy Practices Clearview Counseling Group

Effective Date: May 5, 2018 THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT

YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE

REVIEW IT CAREFULLY

Your Personal Health Information (PHI) is information about you created and received by Clearview

Counseling Group, including demographic information, that may reasonably identify you and that relates

to your past, present, or future physical or mental health condition, or payment for the provision of your

health care. Clearview Counseling Group is required by law to maintain the privacy of your PHI, and

adheres to the strictest privacy standards. You have the right to be informed and will receive notification

from Clearview Counseling Group in the event of any breach of the security of your PHI.

Clearview Counseling Group is also required by law to provide you with this notice of our legal duties

and privacy practices with respect to your PHI, as well as abide by the terms of the notice that is

currently in effect. However, Clearview Counseling Group reserves the right to revise our privacy

practices at any time, and in such an event, you will be provided with a revised copy of this privacy

notice. In such an event, the new revised notice of privacy practices will apply to all of your PHI

maintained by Clearview Counseling Group.

Clearview Counseling Group will ask you to sign a consent form that allows Clearview Counseling Group

to use and/or disclose your PHI for treatment, payment, and healthcare operations. You will also be

asked to sign a form acknowledging receipt of this privacy practices notice.

The following categories describe some of the ways Clearview Counseling Group may use and/or disclose

your PHI. Clearview Counseling Group believes protecting client confidentiality and responsibly

maintaining your individually identifiable health information and PHI are of the utmost importance,

therefore, we will make all reasonable efforts to limit access to your PHI to those persons or classes of

persons, as appropriate, in our workforce who need access to carry out their duties.

How We May Use or Disclose your Protected Health Information (PHI):

For treatment: Clearview Counseling Group may use and/or disclose your PHI to provide you with

medical treatment and related services. With your written consent your PHI may be used to refer you to

other providers or to send your records to another treating health care professional. If we are permitted

to do so, Clearview Counseling Group may also disclose your PHI to individuals or facilities that will be

involved with your care after you end treatment with Clearview Counseling Group, or for other

treatment-related reasons. Clearview Counseling Group may also use and/or disclose your PHI in an

emergency situation.

-For payment: Clearview Counseling Group may use and/or disclose your PHI to accurately bill and

receive payment for the treatment and related services you receive. For billing and payment purposes,

we may disclose your PHI to your payment source, including an insurance or managed care company, 2

Medicare, Medicaid, or another third-party payer. This information may include diagnosis, dates of

attendance, and treatment plans.

-For health care operations: Clearview Counseling Group may use and/or disclose your PHI as necessary

for operations of the practice, such as quality assurance, medical review, legal services, auditing

functions, and general administrative activities of Clearview Counseling Group.

-Business associates: Clearview Counseling Group may use some services provided by business

associates; such as billing, accounting, or legal consultants. We may disclose your PHI so that they can

perform the duties required of them by Clearview Counseling Group.

-Appointment reminders: Clearview Counseling Group may use and/or disclose your PHI to contact you

as a reminder for your appointments with Clearview Counseling Group.

-Individuals involved in your care or payment for your care: Unless you object, Clearview Counseling

Group may disclose your PHI to a family member, relative, close friend, or any other person you identify,

if the information relates to the person’s involvement in your healthcare, to notify the person of your

location or general condition or payment related to your health care. In addition, Clearview Counseling

Group may disclose your PHI to a public or private entity authorized by law to assist in a disaster relief

effort. If you are unable to agree or object to such a disclosure, Clearview Counseling Group may disclose

such information if we determine that it is in your best interest based on professional judgment, or if we

reasonably infer that you would not object.

-Public health activities: Clearview Counseling Group may disclose your PHI to a public health authority

that is authorized by law to collect or receive such information, such as: for the purpose of preventing or

controlling disease, injury, or disability, reporting births, deaths, or other vital statistics, reporting child

abuse or neglect, notifying a person who may have been exposed to a disease or may be at risk of

contracting or spreading a disease or condition.

-Health oversight activities: Clearview Counseling Group may disclose your PHI to a health oversight

agency for activities authorized by law, such as audits, investigations, inspections, licensure and

disciplinary actions.

-Judicial and administrative proceedings: If you are involved in a lawsuit or dispute, Clearview

Counseling Group may disclose your PHI in response to your signed Release of Information or a court or

administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or

other lawful process if such disclosure is permitted by law.

-Law enforcement: Clearview Counseling Group may disclose your PHI for certain law enforcement

purposes if permitted or required by law. For example, to report gunshot wounds, emergencies or

suspicious deaths, to comply with a court order, warrant, or similar legal process, or to answer certain

requests for information concerning crimes.

-To avert a serious threat to health or safety: Clearview Counseling Group may use and disclose your PHI

when necessary to prevent a serious threat to your health or safety, or the health or safety of the public

or another person. Any disclosure, however, would be to someone to be able to help prevent the threat.

-Coroners, medical examiners, funeral directors, organ procurement organizations: Clearview Counseling

Group may release your PHI to a coroner, medical examiner, funeral director, or, if you are an organ

donor, to an organization involved in the donation of organs and tissues.

-Military and National security: If required by law, if you are a member of the armed forces, Clearview

Counseling Group may use and disclose your PHI as required by military command authorities or the

Department of Veterans Affairs. If required by law, we may disclose your PHI to authorized federal

officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities

authorized by law. If required by law, we may disclose your PHI to authorized federal officials so they may

provide protection to the President, other authorized persons, or foreign heads of state or conduct

special investigations.

-Workers’ compensation: Clearview Counseling Group may disclose your PHI as permitted by laws

relating to workers’ compensation or related programs.

Special Rules Regarding Disclosure of Behavioral Health, Substance Abuse, and HIV-Related

Information

For disclosures concerning PHI relating to care for psychiatric conditions, substance abuse, or HIV related

testing and treatment, special restrictions may apply. For example, we generally may not disclose this

specially protected information in response to a subpoena, warrant, or other legal process unless you

sign a Release of Information or a court orders that disclosure.

- Behavioral health information: Certain behavioral health information may be disclosed for treatment,

payment, and health care operations as permitted or required by law. Otherwise, Clearview Counseling

Group will only disclose such information pursuant to an authorization, court order, or as otherwise

required by law. For example, all communications between you and a psychologist, psychiatrist, social

worker, and certain therapists and counselors will be privileged and confidential in accordance with State

and Federal law.

- Substance abuse treatment information: If you are treated in a specialized substance abuse program,

the confidentiality of alcohol and drug abuse related patient records is protected by Federal law and

regulations. Generally, Clearview Counseling Group may not say to a person outside the practice that you

are in treatment, or disclose any information identifying you as an individual being treated for drug and

alcohol abuse unless you:

1. You consent in writing

2. This disclosure is allowed by a court order

3. This disclosure is made to medical personnel in a medical emergency or to qualified personnel for

research or audit.

Violation of these Federal laws and regulations by Clearview Counseling Group is a crime. Suspected

violations may be reported to appropriate authorities in accordance with Federal regulation. * Federal

laws do not protect any information about a crime committed by a client at a substance abuse program,

or against any person who works for the program, or about any threat to commit such a crime. Federal

laws and regulations do not protect any information about suspected child abuse or neglect from being

reported under State law to appropriate State or local authorities.

- HIV-related information: Clearview Counseling Group may disclose HIV-related information as

permitted or required by State law.

Minors: Clearview Counseling Group will comply with State law when using or disclosing PHI of minors.

Clearview Counseling Group may not use or disclose your protected health information:

Except as described in this notice, or as permitted by State or Federal law, we will not use or disclose

your protected health information (PHI) without your written authorization indicated on a signed

Release of Information Form provided to you by your therapist.

Your Release of Information will specify particular uses or disclosures that you choose to allow. If you do

authorize Clearview Counseling Group to use or disclose your PHI for reasons other than treatment,

payment, or health care operations, you may revoke your Release of Information in writing at any time

by contacting Clearview Counseling Group. If you revoke your Release of Information, we will no longer

use or disclose your PHI for the purposes covered by the authorization, except where Clearview

Counseling Group has already relied on the authorization.

Examples of uses and disclosures that require your authorization:

- Psychotherapy notes: A signed Release of Information is required for the use or disclosure of

psychotherapy notes except for our own use to treat you, for training programs, and to defend Clearview

Counseling Group in a legal action or other proceedings.

- Sale of protected health information: Clearview Counseling Group will not sell your PHI unless we

receive a signed authorization from you.

- Uses and disclosures not described in this notice: Unless otherwise permitted by Federal or State law,

other uses and disclosures of your protected health information (PHI) that are not described in this

notice will be made only with your signed authorization.