This notice describes how medical information regarding your health care, including payment for health care is protected by two federal laws: The Health Insurance Portability and Accountability Act of 1966 ("HIPAA"), 42 U.S.C. & 1320d et seq., 45 C.R.F. Part 160 & 164, and the confidentiality Law, 42 U.S.C. & 290dd-2, 42 C.F.R. Part 2. Under these laws, Grey Nelei Counseling may not say to a person outside of Grey Nelei Counseling that you attend the program, nor may Grey Nelei Counseling disclose information identifying you as an alcohol or drug user, or disclose any other protected information except as permitted by federal law.
PLEASE REVIEW IT CAREFULLY
This Notice Describes Our Practices and Those of:
- Any professional allowed to enter information into your chart
- Any employee we allow to help you while you are here; and
- All employees affiliated with Grey Nelei Counseling.
All of these people follow the terms of this notice. They also share protected health information with each other for treatment and payment of health care operations as described in this notice.
Our Commitment Regarding Your Health Information:
Grey Nelei Counseling uses health information about you for treatment, to obtain payment for treatment, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Grey Nelei Counseling.
We understand that health information about you and your health is personal. We are committed to protecting health information about you. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
Grey Nelei Counseling is Required by law to:
- Make sure that medical information that identifies you is kept private.
- Give you this notice of our legal duties and privacy practices with respect to medical information about you.
- Accommodate reasonable requests you may make to communicate health information by alternative means or alternative locations.
- Follow the terms of this notice that is currently in effect.
For Treatment:
Grey Nelei Counseling may use your health information to provide you with medical treatment for services. Information may be obtained, with your written consent, from other healthcare providers. Information may be given, with your written consent, to other healthcare providers. Your record is created and obtained electronically and is compliant with all confidentiality and privacy laws.
For Payment:
Grey Nelei Counseling may use and disclose your health information to others for purposes of receiving payments for treatment and services that you receive. For example, a bill may be sent to you. The information of the bill may contain information that identifies you, your diagnosis, and treatment information.
Appointments/Health Related Products and Services:
Grey Nelei Counseling may use your information to contact you to provide appointment reminders. Grey Nelei Counseling may also contact you to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.
Others Involved In Your Care:
Grey Nelei Counseling may release relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your case or payment related to your case. Grey Nelei Counseling may also disclose health information to those assisting in emergency situations you may be involved in or in disaster relief efforts so that others can be notified about your condition, status and location.
Fundraising:
Grey Nelei Counseling does not use information for fundraising unless authorized, in writing, by you.
Required By Law:
Grey Nelei Counseling may use and disclose information about you as required by law. For example, Grey Nelei Counseling may disclose information for the following purposes:
- For judicial and administrative proceedings pursuant to a court order
- To notify emergency services or potential victims if your counselor determines you may be a risk to yourself or others
- To prevent or control disease, injury, or disability
- To notify the proper authorities if we believe a client has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree
or when required or authorized by law.
Public Health:
Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities (State Health Department, Center for Disease Control, Etc.) to prevent or control disease, injury, or disability, or for other public health activities.
Health Oversight Activities:
Grey Nelei Counseling may disclose your health information to a health oversight agency for activities authorized by law. Examples of these activities include audits, investigations, and inspections to monitor the health care system and compliance with laws and regulations.
Decedents:
Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Health and Safety:
Your health information may be disclosed to avert a serious threat to the health and safety of you and any person pursuant to applicable law.
Workers Compensation:
Your health information may be used or disclosed in order to comply with laws and regulations related to Worker's Compensation.
Other Uses:
Other uses and disclosures will be made only with your written authorization. You may revoke an authorization except to the extent Grey Nelei Counseling has taken action in reliance to it.
Your Health Information Rights
Under HIPAA you have the right to:
- Obtain a copy of this notice of information practices upon request
- Request an amendment to your health information under certain circumstance
- Request a confidential communications of your health information by alternative means or at alternative locations. Please be advised that this request for
alternative means or locations of communications applies only to this provider or location.
- Receive an accounting of disclosures made of your health information
- Request a restriction on certain uses and disclosures of your information; however, Grey Nelei Counseling is not required to agree to a requested restriction.
Change to This Notice: Grey Nelei Counseling reserves the right to change the terms of this notice and make the new terms effective for all protected health
information kept by Grey Nelei Counseling. You may also get a current copy by contacting Grey Nelei Counseling at 513-201-7749. The effective date of the notice is the date of signing and it is effective for 1 year.
Complaints:
If you believe your privacy rights have been violated, you may file a complaint with Grey Nelei Counseling or;
The Ohio Counselor, Social Worker, and Marriage and Family Therapist Board
77 S High St
24th Floor Room 2468
Columbus, OH 43215
614-466-0912
To file a complaint with Grey Nelei Counseling, submit your written complaint to grey@greyneleicounseling.com. You will not be penalized for filing a
complaint.
Contact Information for Questions or To File a Complaint:
If you have any questions about this notice, want to exercise one of your rights that are described in this notice, or want to file a complaint, please contact Grey Nelei Counseling at:
513-463-8313