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.

Understanding Your Health Record/Information

When you receive services through Dr. Backs & Associates (DBA), we create and obtain personal and health information about you that we keep in a medical record. We understand this information is private, and your record will be maintained and protected in a confidential manner, as required by law. Your records will be generated and maintained on a secure database for a minimum of five years past your last date of service.
This notice describes how DBA may use and disclose your information. It also explains your rights and the legal duties we have regarding your information as we are committed to protecting your personal information.

Your Health Information Rights

* You have the right to look at and/or get a copy of your health information, with a few exceptions. You can obtain a copy of these records for a copying fee. Please allow 14 business days to fulfill this request. If you are denied access, you will be notified of the reason.
* You have the right to ask DBA to correct any information you believe is wrong. We may add the information and make a note that the information is from you. You must explain why you believe the correction must be made. If we are unable to make the correction, you will be notified why in writing.
* You have the right to ask DBA to limit the use or disclosure of your health information. We will do our best to accommodate your request.
* You have the right to ask that DBA contact or communicate with you at the address or telephone number that you specify. We will do our best to accommodate your request.
* You have the right to revoke your written permission for DBA to disclose your health information. This needs to be done in writing and will be effective only after the date your written revocation was received.
* You have the right to a list of disclosures we have made of your health information that we are legally permitted to disclose.
* You have the right to ask for and receive a copy of this notice. If we change this notice, we will provide you with the new copy.
* You may have other rights that are granted to you by the laws of our state, and these may be the same or different from the rights described above. We will be happy to discuss these situations with you now or as they arise.
 
You must ask DBA in writing if you want to access, amend, revoke an authorization, restrict, communicate with us in a special way, or have an accounting of disclosures of your health information.

DBA’s Responsibilities

* DBA is required by law to maintain the privacy of your health information and to give you notice of our legal duties and privacy practices with respect to your information.
* We will maintain your files for five years for counseling services and seven years for forensic services.
* We are required to follow the terms of this notice or any use and/or disclosure of limits.
* We will notify you if we are unable to agree to a limitation you request.
* We may use, disclose or ask for only the information about you that is needed to accomplish a specific purpose.
We have the right to change how we protect the privacy of your health information. If our privacy policies change, we will revise this notice and make it available to you in our office and on our website.
DBA may not use or disclose your health information without your written permission, except as described in this notice. This includes the information that you receive, or have received, services from us. The information you permit us to disclose may be subject to re- information.

Examples of Use and Disclosure

DBA may use your health information to provide treatment to you, to receive payment, and for our own health care operations, as permitted by law.

DBA may use your health information for payment:

We may use your health information to be paid for providing care to you or to provide benefits to you under a health plan such as Medicaid. We may use your information to contact a third party to verify your coverage and to determine what services may be covered. We may also need to disclose your diagnosis, services received, progress, and similar items in order to bill your insurance company for care provided to you. Any information provided by you may be subject to verification through matching programs.

DBA may use your health information for regular agency operations:

We may use the information in your health record to assess the care and outcomes in your case and others like it. This information may be used to improve the care and service we provide. We may also discuss cases in case review meetings and practice groups to help assist in providing the best treatment for you. We make every effort to protect the specific identity of the case being discussed. Other professionals in the meeting or group are required by professional ethics to keep this information confidential. We may also use and disclose your health information if we are being audited by an organization that requires the use of your information to confirm that services are being delivered according to contract or other rules.

DBA may use your health information with your permission:

If you would like your information, or we need to use your information, to be used for any purpose outside those listed in our Privacy Practices, we need your authorization on an Authorization Form. If you do authorize us to disclose your information, you have the right to revoke your permission at any time, in writing.
DBA may use and disclose your health information as allowed by privacy regulations and laws. Some examples include, but are not limited to, the following:
 
Communications for treatment and health care; we may contact you to provide appointment reminders or information about types of treatment or health-related services that may interest you.

Working with Business Associates; we may disclose your health information to individuals who are hired by us in order to provide services to us, i.e. office manager. To protect your privacy, these individuals have agreed in their contract with us to protect your information.

When required by law; we may use or disclose your information as required by state or federal law. This may include disclosure to you, your legal representative, or to any other person or entity under the law to receive such information, unless such disclosure is determined to be harmful to you.

To report suspected child or elder abuse or neglect; we may disclose your information to a government authority if necessary to report child or elder abuse or neglect.

To a government authority if we believe you are a victim of abuse; we may use or disclose your information to persons legally authorized to investigate a report that you have been abused or have been denied your rights.

Workers compensation: we may disclose your information to comply with laws relating to workers compensation and similar programs.

To address a serious threat to health or safety; we may use or disclose your information to medical or law enforcement personnel if we believe you or others are in danger and the information is necessary to prevent physical harm.

In judicial and administrative proceedings; we may disclose your information in any criminal or civil proceeding if a court or administrative judge orders us to disclose it.

If you are a minor or have an appointed guardian; we may give health information about your current physical and mental condition to your parent or guardian unless a licensed professional determines such disclosure is likely to harm you or another person.

Other possible disclosures include, but are not limited to, fee disputes between DBA and a client, negligence suit by the client, filing a complaint with a licensing board, possible transmission of AIDS/HIV, or government agencies making sure we are compliant with privacy laws.

Non-Protected Health Information Services

If you are receiving Forensic Services, the records maintained are not health care records and are not subject to protection under federal privacy regulations. Forensic services include services ordered by the court, directly related to a court case, or performed with a reasonable expectation that they will be the subject of a future court case.
Examples of forensic services include, but are not limited to, child custody evaluations, court ordered services, and CPS services.