THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
CARE Clinics, LLC (CARE Counseling and/or CAREfree Counseling) referred to throughout as CARE, we understand that you are sharing private and personal information with us and your privacy is very important. Your confidential and private information is called “protected heath information” (PHI) and is protected under the “Health Insurance Portability and Accountability Act” (HIPAA). Below you will find information about HIPAA and applicable Minnesota State Law. This can be complicated, so some parts of this notice are very detailed to make sure you have and understand how your information may be used and/or disclosed, and your rights related to your private health information. If you have any questions, our privacy officer will be happy to help you understand our procedures and your rights. Her name and address are at the end of this notice.
Contents of this notice
Introduction: To our clients
What we mean by your medical information
Privacy and the laws about privacy
How your protected health information can be used and shared
Uses and disclosures when you sign the Consent to Treatment Form
The basic uses and disclosures: For treatment, payment, and health care operations
Other uses and disclosures in health care
Uses and disclosures that require your authorization
Uses and disclosures that don’t require your consent or authorization
When required by law
For law enforcement purposes
For public health activities
Relating to decedents
For specific government functions
To prevent a serious threat to health or safety
Uses and disclosures where you have an opportunity to object
An accounting of disclosures we have made
Your rights concerning your health information and how to file a grievance
If you have questions or problems
Introduction: To our clients
This notice will tell you how we handle your medical information. It tells how we use this information here in this office, how we share it with other professionals and organizations, and how you can see it. We want you to know all of this so that you can make the best decisions for yourself and your family. If you have any questions or want to know more about anything in this notice, please ask our privacy officer for an explanation or more details.
What we mean by your medical information
Each time you visit us or any doctor’s office, hospital, clinic, or other health care provider, information is collected about you and your physical and mental health. It may be information about your past, present, or future health or conditions, or the tests and treatment you got from us or from others, or about payment for health care. The information we collect from you is called “PHI,” which stands for “protected health information.” This information goes into your medical or health care records in our office.
In this office, your PHI is likely to include these kinds of information:
Your history: things that happened to you; your school and work experiences; your marriage and other personal history.
Reasons you came for treatment: your problems, complaints, symptoms, and/or needs.
Diagnosis(es): these are the medical terms for your problems or symptoms.
A treatment plan: this is a list of goals and objectives, as well as the treatments and other services that we think will best help you.
Progress notes: each time you come in, we write down some things about how you are doing, what we notice about you, and what you tell us.
Records we get from others who treated you or evaluated you.
Psychological test scores, school records, and other reports.
Information about medications you took or are taking and possibly data on what our medication provider recommends.
Billing and insurance information.
There may also be other kinds of information that go into your health care records at CARE Clinics.
We use PHI for many purposes. For example, we may use it:
To plan your care and treatment.
To decide how well our treatments are working for you.
When we talk with other health care professionals who are also treating you, such as your family doctor or the professional who referred you to us.
To show that you actually received services from us, which we billed to you or to your health insurance company.
For teaching and training other health care professionals.
To consult to ensure you are receiving the best care possible.
For medical or psychological research.
For public health officials trying to improve health care in this area of the country.
To improve the way we do our job by measuring the results of our work.
When you understand what is in your record and what it is used for, you can make better decisions about who, when, and why others should have this information.
Although your health care records in our office are our physical property, the information belongs to you. You can read your records, and if you want a copy we can make one for you (but we charge you for the costs of copying and mailing, if you want it mailed to you). In some very rare situations, you cannot see all of what is in your records. If you find anything in your records that you think is incorrect or believe that something important is missing, you can ask us to amend (add information to) your records, although in some rare situations we do not have to agree to do that. To obtain a copy of your records, we need a request in writing, and you will be asked to complete an ROI for yourself to help us document this request. A summary of treatment is often enough information for most people. If you want, our privacy officer, whose name is at the end of this notice, can explain more about this.
Privacy and the laws about privacy
We are required to tell you about privacy because of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires us to keep your PHI private and to give you this notice about our legal duties and our privacy practices. We will obey the rules described in this notice. Where more stringent state or federal law governs PHI, CARE will abide by the more stringent law. CARE reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by CARE.
We keep copies of our new notice of privacy practices at each CARE location if you want a physical copy and an electronic copy can be sent to your TN portal at any time. It is also posted on our website at www.CARE-Clinics.com.
How your protected health information can be used and shared
Except in some special circumstances, when we use your PHI in this office or disclose it to others, we share only the minimum necessary PHI needed for those other people to do their jobs. The law gives you rights to know about your PHI, to know how it is used, and to have a say in how it is shared. So, we will tell you more about what we do with your information.
CARE will use and disclose your PHI for routine purposes to provide for your care, and we will explain more about these below. For other uses, we must tell you about them and ask you to sign a written authorization form. However, the law also says that there are some uses and disclosures that don’t need your consent or authorization and these are noted below.
In almost all cases we intend to use your PHI here or share it with other people or organizations to provide treatment to you, arrange for payment for our services, or some other business functions called “health care operations.” In other words, we need information about you and your condition to provide care to you. You have to agree to let us collect the information, use it, and share it to care for you properly. Therefore, you must sign the Consent to Psychotherapy Form before we begin to treat you. If you do not agree and consent, we cannot treat you.
For treatment. We use your medical information to provide you with psychological treatments or services. These might include individual, family, couples, or group therapy; psychological, educational, or vocational testing; treatment planning; medication management; or measuring the benefits of our services. We may share your PHI with others who provide treatment to you. We are likely to share your information with your personal physician, current medication provider, or providers you’ve worked with in the past two years. If you are being treated by a team, we can share some of your PHI with the team members, so that the services you receive will work best together. The other professionals treating you will also enter their findings, the actions they took, and their plans into your medical record, and so we all can decide what treatments work best for you and make up a treatment plan. We may refer you to other professionals or consultants for services we cannot provide. When we do this, we need to tell them things about you and your conditions. We will get back their findings and opinions, and those will go into your records here. If you receive treatment in the future from other professionals, we can also share your PHI with them. We also engage in case consultations and supervision as applicable which is review of both written and verbal descriptions of the case and services provided, as well as peer review processes. These are used to best support your treatment and PHI is needed to ensure best practices. These are some examples so that you can see how we use and disclose your PHI for treatment.
For payment. We use your information to bill you, your insurance, or others, so we can be paid for the treatments we provide to you. We have a business relationship with our billing team, accounting team, and EHR. Your PHI will be provided to our billing and accounting teams to bill your insurance, send you monthly statements, and/or work with collections agencies. We will likely contact your insurance company to find out exactly what your insurance covers. We (and our billing team and EHR) will likely tell your insurance company about your diagnoses, what treatments you have received, and the changes we expect in your conditions. We will need to tell them about when we met, your progress, and other similar things. If your account is delinquent, we may need to share your information with a collection’s agency, small claims court, and/or credit bureaus.
For health care operations. Using or disclosing your PHI for health care operations includes us reaching out to you and to run the business. This also goes beyond our care and your payment. For example, we may use your PHI to see where we can make improvements in the care and services we provide. We may be required to supply some information to some government health agencies, so they can study disorders and treatment and make plans for services that are needed. If we do, your name and personal information will be removed from what we send.
Other uses and disclosures in health care:
Appointment reminders. We may use and disclose your PHI to reschedule or remind you of appointments for treatment or other care. If you want us to call or write to you only at your home or your work, or you prefer some other way to reach you, we usually can arrange that. Just tell us.
Treatment alternatives. We may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of help to you.
Other benefits and services. We may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.
Research. We may use or share your PHI to do research to improve treatments-for example, comparing two treatments for the same disorder, to see which works better or faster or costs less. In all cases, your name, address, and other personal information will be removed from the information given to researchers. If they need to know who you are, we will discuss the research project with you, and we will not send any information unless you sign a release of information form.
Business associates. We hire other businesses to do some jobs for us. In the law, they are called our “business associates.” For example, we use a collections agency, billing team, have an accounting firm, use an EHR to figure out, print, and mail our bills. Business associates need to receive some of your PHI to do their jobs properly. To protect your privacy, they have agreed in their contract with us to safeguard your information.
Consultation. We have regular consultation groups to help review and improve upon the care you are receiving.
Uses and disclosures that require your authorization.
If we want to use your information for any purpose besides those described above, we need your permission on a release of information form. If you do allow us to use or disclose your PHI, you can cancel that permission in writing at any time.
Uses and disclosures that do not require your consent or authorization.
The law lets us use and disclose some of your PHI without your consent or authorization in some cases. Here are some examples of when we might do this.
When required by law. There are some federal, state, or local laws that require us to disclose PHI:
We have to report suspected abuse of a minor or vulnerable adult.
If a non-custodial parent requests information regarding their child’s treatment, they may receive information about services for their child, but not about the other parent.
If you are involved in a lawsuit or legal proceeding, and we receive a subpoena, discovery request, or other lawful process, we may have to release some of your PHI. We will only do so after trying to tell you about the request, consulting your lawyer, or trying to get a court order to protect the information they requested.
Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request (you will be charged for this)
We have to disclose some information to the government agencies that check on us to see that we are obeying the privacy laws.
For law enforcement purposes: We may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.
For public health activities: We may disclose some of your PHI to agencies that investigate diseases or injuries.
Relating to decedents: We may disclose PHI to coroners, medical examiners, or funeral directors, and to organizations relating to organ, eye, or tissue donations or transplants.
For specific government functions: We may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment. We may disclose your PHI to workers’ compensation and disability programs, to correctional facilities if you are an inmate, or to other government agencies for national security reasons.
To the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards of Privacy of Individually Identifiable Health Information.
Health Oversite: For audits, investigations, and inspections by government agencies that oversee the health care system, government programs, and other government regulatory programs, and civil rights laws.
To prevent a serious threat to health or safety: If we come to believe that there is a serious threat to your health or safety, or that of another person or the public, we can disclose some of your PHI.
Uses and disclosures where you have an opportunity to object.
We can share some information about you with your family or close others. We will only share information with those involved in your care and anyone else you choose, such as close friends or clergy. We will ask you which persons you want us to tell, and what information you want us to tell them, about your condition or treatment. You can tell us what you want, and we will honor your wishes as long as it is not against the law.
If it is an emergency, and so we cannot ask if you disagree, we can share information if we believe that it is what you would have wanted and if we believe it will help you if we do share it. If we do share information, in an emergency, we will tell you as soon as we can. If you do not approve, we will stop, as long as it is not against the law.
An accounting of disclosures we have made.
When we disclose your PHI, we may keep some records of whom we sent it to, when we sent it, and what we sent. You can get an accounting (a list) of many of these disclosures.
Your rights concerning your health information
As a consumer of mental health services offered by Mental Health Professionals and/or Practitioners working under a Mental Health Professional and/or Medication Manager licensed by the state of Minnesota, you have the right:
To expect that your therapist has met the minimal qualifications of training and experience required by state law for the license they or their supervisor are working under.
To examine public records maintained by the respective Board, which contain the credentials of the therapist.
To obtain a copy of the rules of conduct from the State Register and Public Documents Division, Department of Administration, 117 University Avenue, Saint Paul, MN 55155.
You can ask us to communicate with you about your health and related issues in a particular way or at a certain place that is more private for you.
You have the right to know the cost of services prior to receiving them.
You have the right to ask us to limit what we tell people involved in your care or with payment for your care, such as family members and friends. We don’t have to agree to your request, but if we do agree, we will honor it except when it is against the law, or in an emergency, or when the information is necessary to treat you.
You have the right to restrict certain disclosures of PHI to a health plan if services are paid out of pocket and in full.
You have the right to look at the health information we have about you, such as your medical and billing records. You can get a copy of these records, but we may charge you. Contact our privacy officer to arrange how to see your records.
If you believe that the information in your records is incorrect or missing something important, you can ask us to make additions to your records to correct the situation. You have to make this request in writing and send it to our privacy officer. You must also tell us the reasons you want to make the changes.
You have the right to a copy of this notice. If we change this notice, we will post the new one on our website, and you can always get a copy from the privacy officer.
To be free from being the object of discrimination on the basis of race, religion, gender, sexual orientation, or other unlawful category while receiving psychological services.
To be free from exploitation for the benefit or advantage of the psychologist or counselor.
All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.
You have the right to be notified if your PHI has been breached.
You may opt out of any form of communications that are related to your care, marketing, clinic updates, newsletters, etc. via email, mail, and/or calls. You may also ask the clinic to contact you in a specific way. The practice will say “yes” to all reasonable requests.
You may terminate services, unless court ordered.
You have the right to know who will get psychological assessment results, withdraw consent to release the results (unless court ordered), and to have the results provided in understandable language.
You have the right to file a complaint/grievance. You may communicate your grievance in writing, by phone, or in person. A written complaint is preferred and within one month of the incident/situation. If you would like to make a complaint or file a grievance, our procedure is to first share with the individual(s) with whom you have a grievance. If you are not comfortable with this or are dissatisfied with the resolution, please contact CARE’s privacy officer and CEO, Andrea Hutchinson at 612-223-8898. CARE will not retaliate against you for filing a complaint. If these efforts to obtain resolution through the above steps do not result in a satisfactory resolution and/or you do not want to utilize this procedure, you may reach out to one of the following:
MN Board of Social Work (https://mn.gov/boards/social-work/): 612-617-2100
MN Board of Psychology (https://mn.gov/boards/psychology/): 612-617-2230
MN Board of Marriage and Family Therapy (https://mn.gov/boards/marriage-and-family/): 612-617-2220
MN Board of Behavioral Health and Therapy (https://mn.gov/boards/behavioral-health/): 651-201-2756
Department of Health and Human Services at (651) 296-3971. Limited English Proficiency (LEP) concerns at (651) 431-4018 (voice phone) Minnesota Relay 711 or 1-800-627-3529
The office for Civil Rights at 1-877-696-6775
To exercise these rights, please submit a written request to the Practice at firstname.lastname@example.org or mail it to 7601 Wayzata Blvd, St. Louis Park, MN 55426.
If you have questions or problems
If you need more information or have questions about the privacy practices described above, please speak to the privacy officer. As stated above, you have the right to file a complaint with us and with the Secretary of the U.S. Department of Health and Human Services. We promise that we will not in any way limit your care here or take any actions against you if you complain.
If you have any questions or problems about this notice or our health information privacy policies, please contact our privacy officer, Dr. Andrea Hutchinson, who is and can be reached by phone at 612.223.8898 or by e-mail at email@example.com. The effective date of this notice is June 2014 and updated March 2022.
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