Privacy Notice

Saint Mary's College Counseling Center

THIS NOTICE DESCRIBES HOW COUNSELING, PSYCHOLOGICAL, AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AS WELL AS HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. OUR PLEDGE TO YOU:

Your health information --which means any written or oral information that we create or receive that describes your health condition and treatment -- is personal. Therefore, the Counseling Center pledges to protect your health information as required by law. We give you this Privacy Notice to tell you (1) how we will use and disclose your "protected" health information, or "PHI" and (2) how you can exercise certain individual rights related to your PHI.

II. USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS:

We may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your written authorization. To help clarify these terms, here are some definitions:

  • "PHI" refers to information in your health record that could identify you.
  • "Treatment, Payment, and Health Care Operations"
    • --Treatment is when we provide, coordinate, or manage your health care and other services related to your health care. An example of treatment might be consultation with your family physician.
    • --Payment is when we assist you to obtain reimbursement for your healthcare. Example of payment is when we disclose your PHI to your health insurer to obtain reimbursement for laboratory tests or medication that might be needed.
    • --Health Care Operations are activities that relate to the performance and operation of the Counseling Center practice. Examples of health care operations are case management and care coordination among our staff.
  • "Use" applies only to activities within the Center practice group such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. An example is our secretaries scheduling your appointments.
  • "Disclosure" applies to activities outside of the Counseling Center such as releasing, transferring, or providing access to information about you to other parties.
  • "Authorization" is your written permission to disclose confidential mental health or other health information. All authorizations to disclose must be on a specific legally required form. On rare occasions, we will discuss an authorization directly with you by phone and act on it in a pressing situation; completion of the form will take place in person as soon as it can be arranged.

III. OTHER USES AND DISCLOSURES REQUIRING AUTHORIZATION

The Counseling Center licensed mental health staff are required to maintain a record of your counseling services. While the contents of records vary from client to client, they can, and often do, include the contents of our conversations. These documents are classified as psychotherapy notes. We recommend you release only a summary of services which will be adequate for most situations where you request we talk to others. We will obtain your signature on an authorization before releasing this information. Psychotherapy notes are made from our conversations during a private, group, joint or family counseling session. These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time. You may not revoke an authorization to the extent that (1) we have relied on that authorization to act in accordance with it; or (2) if the authorization was obtained as a condition of obtaining insurance coverage where law provides the insurer the right to contest the claim under the policy.

IV. USES AND DISCLOSURES WITH NEITHER CONSENT NOR AUTHORIZATION

We may use or disclose PHI without your consent or authorization in the following circumstances:

  • Serious Threat to Health or Safety – If we have reason to believe that you present an imminent, serious risk of physical harm or death to yourself, we may need to disclose information in order to protect you. If you communicate to any Counseling Center staff an actual threat of violence to cause serious injury or death against a reasonably identifiable victim or victims or if you evidence conduct or make statements indicating an imminent danger that you will use physical violence or use other means to cause serious personal injury or death to others, we may take the appropriate steps to prevent that harm from occurring. In both cases, we will only disclose what we feel is the minimum amount of information necessary.
  • Child Abuse – If we believe that a child is a victim of child abuse or neglect, we are legally required to report this belief to the appropriate authorities.
  • Adult and Domestic Abuse – If we believe or have reason to believe that an individual is an endangered adult, we are legally required to report this belief to the appropriate authorities.
  • Health Oversight Activities – If the Indiana Attorney General's Office (who oversees complaints brought against mental health practitioners) is conducting an investigation into Counseling Center practice, then we are required to disclose PHI upon receipt of a subpoena.
  • Judicial and Administrative Court Proceedings – If a court proceeding is involved and a request made for information about the professional services we provided you and/or the records thereof, such information is privileged under state law, and we will not release information without the written authorization of you, or your legally appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
  • Worker's Compensation – We may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker's compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault. This would occur for a student only under rare circumstances.

V. PATIENT'S RIGHTS AND PSYCHOLOGIST/MENTAL HEALTH PRACTITIONER'S DUTIES

Patient's Rights:

  • Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information. However, we are not required to agree to a restriction you request. On request we will discuss the restriction process.
  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – (For example, you may not want a family member to know that you are receiving services at the Counseling Center. On your request, we will send your correspondence to a specific alternative address.) You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.
  • Right to Inspect and Copy – You have the right to inspect or obtaina copy (or both) of PHI of Counseling Center mental health records used to make decisions about you for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, we will discuss with you the details of the request and denial process.
  • Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process.
  • Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, we will discuss with you the details of the accounting process and provide the related forms.
  • Right to a Paper Copy – You have the right to obtain a paper copy of this notice from Counseling Center upon request, even if you have agreed to review the notice electronically.

Psychologist/Mental Health Practitioner's Duties:

  • We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
  • The Counseling Center reserves the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect.
  • If we revise our policies and procedures we will update the website information, inform all students of the update through the annual counseling evaluation letter, and a posted notice of the change in the Center waiting area.

VI. Effective Date, Restrictions, and Changes to Privacy Policy

This notice went into effect on April 14, 2003

We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. We will provide you with a revised notice by updating the Counseling Center website, including information in the annual counseling evaluation letter and a posted notice of the change in the Center waiting area.