Notice of Privacy Practice
The Well Behavioral Health LLC
This notice describes how The Well Behavioral Health, LLC (“The Well BH”) and your clinician may use and disclose your health information and how you can get access to this information. Please review it carefully.
We have a legal duty to safeguard your protected health information. We will protect the privacy of the health information that we maintain that identifies you, whether it deals with the provisions of health care. We must provide you with this "Notice" about our privacy practices. It explains how, when and why we may use and disclose your health information. With some exceptions, we will avoid using or disclosing any more of your health information than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this "Notice", which is currently in effect. However, we reserve the right to change the terms of this "Notice" and our privacy practices at any time. Changes will apply to any of your health information that we already have. Before we make an important change to our policies, we will promptly change this Notice and post a new Notice on our HomePage of our website. You may also receive, at any time, a copy of our Notice of Privacy Practices that is in effect at any given time, from your clinician. (You may also view and obtain an electronic copy of this Notice on our website at dtclinicianconnect.com.)
We would like to take this opportunity to answer some common questions concerning our privacy practices:
Question: How will The Well BH and my clinician use and disclose my protected health information?
Answer: We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your specific authorization. Below, we describe the different categories of our uses and disclosures.
A. Uses and Disclosures Relating to Treatment, Payment, and Healthcare Operations. We may, by federal law, use and disclose your health information for the following reasons:
1. For Treatment: which means providing, coordinating, or managing your care and related services.
2. To Obtain Payment for Treatment: which means such activities as obtaining reimbursements for services, confirming coverage billing or collection activities, and utilization review.
3. For Health Care Operations: include the business aspects of running this service, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment.
B. Certain Other Uses and Disclosures are Permitted by Federal Law. We may use and disclose your health information without your authorization for the following reasons:
1. When a Disclosure is Required by Federal, State or Local Law, in Judicial or Administrative Proceedings or by Law Enforcement. For example, we may disclose your protected health information if we are ordered by a court, or if a law requires that we report that sort of information to a government agency or law enforcement authorities, such as in the case of a dog bite, suspected child abuse or a gunshot wound.
2. For Public Health Activities. Under the law, we need to report information about certain diseases, and anything about deaths, to government agencies that collect that information. With the possible exception of information concerning mental health disorders and/or treatment, drug and alcohol abuse and/or treatment and HIV status (for which we may need your specific authorization), we are also permitted to provide some health information to the coroner or a funeral director, if necessary, after a client’s death.
3. To Avoid Harm. If one of the clinicians believes that it is necessary to protect you, or to protect another person or the public as a whole, from suicide, homicidal threats, abuse and/or neglect for the elderly, disabled, or children, we may provide protected health information to the police or others who may be able to prevent or lessen the possible harm.
4. For Specific Government Functions. With the possible exception of information concerning mental health disorders and/or treatment, drug and alcohol abuse and/or treatment and HIV status (for which we may need your specific authorization), we may disclose the health information of military personnel or veterans where required by U.S. military authorities. Similarly, we may also disclose a client’s health information for national security purposes, such as assisting in the investigation of suspected terrorists who may be a threat to our nation.
5. For Workers Compensation. We may provide your health information as described under workers’ compensation law, if your condition was the result of a workplace injury for which you are seeking workers’ compensation.
6. Appointment Reminders and Health Related Benefits or Services. Unless you tell us that you would not prefer to receive them, we may use or disclose your information to provide you with appointment reminders or to give you information about alternative programs and treatments that may help you.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
1. Disclosures to Family, Friends or Others Involved in Your Care. We may provide a limited amount of your health information to a family member, friend or other person known to be involved in your care or in the payment for you care, unless you tell us not to. For example, if a family member comes with you to your appointment and you allow them to come into the counseling session with you, we may disclose otherwise protected health information to them during the appointment, unless you tell us not to.
2. Other Uses and Disclosures Require Your Prior Written Authorization. In situations other than those categories of uses and disclosures mentioned above, or those disclosures permitted under federal law, we will ask for your written authorization before using or disclosing any of your protected health information. In addition, we need to ask for your specific written authorization to disclose information concerning your mental health, drug and alcohol abuse and/or treatment, or to disclose your HIV status. If you choose to sign an authorization to disclose any of your health information, you can later revoke it to stop further uses and disclosures to the extent that we haven’t already taken action relying on the authorization.
II. Question: What Rights Do I Have Concerning My Protected Health Information?
Answer: You have the following rights with respect to your protected health information.
A. The Right to Request Limits on Uses and Disclosures of Your Health Information. You have the right to ask us to limit how we use and disclose your health information. We will certainly consider your request, but you should know that we are not required to agree to it. If we do agree to your request, we will put limits in writing and will abide by them, except in the case of an emergency. Please note that you are not permitted to limit the uses and disclosures that we are required or allowed by law to make.
B. The Right to Choose How We Send Health Information to You or How We Contact You. You have the right to ask that we contact you at an alternate address or telephone number (for example, sending information to your work address instead of your home address) or by an alternate means (for example, by email/mail instead of telephone). We must agree to your request so long as we can easily do so.
C. The Right to See or to Get a Copy of Your Protected Health Information. In most cases, you have the right to look at or get a copy of your health information that we have, but you must make the request in writing. A request form is available from your clinician. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial. In certain circumstances, you may have a right to appeal the decision. If you request a copy of any portion of your protected health information, we will charge you for the copy on a per page basis. If you agree in advance, we may be able to provide you with a summary or an explanation of your records instead. There will be a charge for the preparation of the summary or explanation.
D. The Right to Receive a List of Certain Disclosures of Your Health Information That We Have Made. You have the right to get a list of certain types of disclosures that we have made of your health information. This list would not include uses or disclosures for treatment, payment or health care operations, disclosures to you or with your written authorization, or disclosures to your family for notification purposes or due to their involvement in your care. This list also would not include any disclosures made for national security purposes, disclosures to corrections or laws enforcement authorities if you were in custody at the time. You may not request an Accounting for more than a six (6) year period. To make such a request, we require that you do so in writing; a request form is available from the clinician. We will respond to you within 30 days of receiving your request. The list that you may receive will include the date of the disclosure, the person or organization that received the information (with their address if available), a brief description of the information disclosed, and a brief reason for the disclosure.
E. The Right to Ask to Correct or Update Your Health Information. If you believe that there is a mistake in your health information or that a piece of important information is missing, you have a right to ask that we make an appropriate change to your information. You must make the request in writing, with the reason for your request, on a request form that is available from your clinician. We will respond within 30 days of receiving your request. If we approve your request, we will make the change to your health information, tell you when we have done so, and will tell others that need to know about the change. We may deny your request if the protected health information: (1) is correct; (2) was not created by us; (3) is not allowed to be disclosed to you; or (4) is not part of our records. Our written denial will state the reasons that your request was denied and explain your right to file a written statement of disagreement with the denial. If you do not wish to do so, you may ask that we include a copy of your request form, and our denial form, with all future disclosures of that health information.
F. The Right to Get a Paper Copy of This Notice. You will always have a right to request a paper copy of this Notice.
III. Question: How Do I Complain or Ask Questions About This Organization’s Privacy Practices?
Answer: If you have any questions about anything discussed in this "Notice" or about any of our privacy practices, or if you have any concerns or complaints, please contact your clinician or the Administrator of The Well BH at (888)-888-8888. You also have the right to file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We may not take any retaliatory action against you if you lodge any type of complaint.
IV. Question: When Does This Notice Take Effect?
Answer: This Notice took effect on January, 1st 2021