NOTICE OF PRIVACY POLICIES

Terms to Understand:

• Protected Health Information/PHI: Information in your health record that can identify you, including your name, date of birth, and address

• Evaluation/Treatment: Providing, coordinating, and managing your mental health care, including consultation with your other health care providers

• Payment: When we obtain payment for services rendered, which can include credit card charges and working with collection agencies, as needed

• Health Care Operations: Activities that involve the performance and operation of Stratus Psychological Services (“Stratus”), including quality improvement activities, administrative services, and case management

• Use: Refers to practices within Stratus that use information about you

• Disclosure: Refers to practices outside of Stratus, including providing information about you to other parties

• Mental Health Provider: The professional who is providing services for you within Stratus

• Consent: Permission

• Revoke: End, take back

• Amendment: Change

 

Policies:

1. We may use or disclose your PHI for treatment, payment, and health care operations.

2. We may use or disclose your PHI for purposes other than treatment, payment, and health care operations, with additional written permission from you. This typically requires you to sign a form to consent to such sharing. You can revoke prior authorization, but this must occur in writing.

3. We can use and disclose your PHI without your consent or authorization in a few circumstances:

   1. Immediate risk of suicide

   2. Immediate risk of severe harm to an identified party

   3. Ongoing abuse of someone who cannot protect themselves, including a child or vulnerable adult

   4. If required by court order, subpoena, or lawful request, including by a court, the Department of Health, or the Michigan Board of Psychology

4. You have the right to request restrictions on some uses and disclosures of your PHI, although your mental health provider may not be able to meet this request.

5. You have the right to receive confidential communication via the approach that you prefer, including using the phone number, email, and address that you wish.

6. You have the right to inspect or obtain a copy of any PHI in your medical record.

7. You have the right to request an amendment to your PHI, although your mental health provider may deny this request.

8. You have the right to receive a list of the disclosures of your PHI.

9. You have the right to a paper copy of this notice.

10. We use the electronic health record program IntakeQ to maintain records, billing, and communication. This program is compliant with federal privacy laws.

11. We are required by law to maintain the privacy and security of your PHI. We must follow the duties and privacy practices described in this Notice and give you a copy of it.

12. We can change the privacy practices described in this Notice, but you are not bound by these changes unless you are notified of them. You will be notified via email or text message if these policies are changed while you are an active patient.

13. If you are concerned that anyone at Stratus has violated your privacy, you may contact the owner via email or phone. This is most easily done by emailing info@stratuspsychological.com. You can also send a written complaint to the U.S. Department of Health and Human Services Office for Civil Rights, by sending a letter to 200 Independent Avenue, S.W., Washington, D.C., 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. You will not be penalized for filing a complaint.

14. This notice will go into effect on January 1, 2023.