THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Counseling Solutions of Alaska is a private physician’s clinic.
Your health record contains personal information about you and your past, present, or future mental health, and related health care. It is referred to as Protected Health Information (PHI). We are required by law to maintain privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of the notice of Privacy Practices at any time. Any new notice of Privacy Practices will be effective for all PHI that we maintain currently at the time. We will provide you with a copy of the revised notice of Privacy Practices by providing it to you at your next appointment, or by sending a copy to you in the mail upon request.
We may use or disclose your protected health information (PHI) for treatment, payment, and health care operation purposes without your consent. To help clarify these terms, here are some definitions:
We may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An authorization is written permission about and beyond the general consent that permits only specific disclosures. In those instances when we are asked for information for purposes outside of treatment, payment, or health care operation, we will obtain an authorization from you before releasing your Psychotherapy Notes. Psychotherapy Notes are notes that your therapist or medical provider have made about your conversations during individual, group, couple, or family counseling sessions. These notes are given greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage. The insurer has the right to contest the claim under the policy.
We may use or disclose PHI without your consent or authorization in the following circumstances:
Although we are not required by law, whenever possible, we will inform you of our intent to disclose your PHI in the situations described above even though your consent and/or authorization is not required.
We may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
You have the following right regarding PHI that we maintain about you. To exercise any of these rights, please submit your request in writing to the clinic at 701 East Tudor Road, Suite 215, Anchorage, AK 99503.
If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the managing director at 701 East Tudor Road, Suite 215, Anchorage, AK 99503. You may also send a written complaint to the secretary of the U.S. Department of Health and Human Services. We will provide you with the appropriate address upon request. We will not retaliate against you for filing a complaint.
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Fax: (907) 644-8004
ROI/Medication Refill: (907) 770-0357