Notice of Privacy Practices

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.

Origins Counseling & Wellness (“Origins,” “we,” “us”) is required by the federal Health Insurance Portability and Accountability Act (HIPAA) to maintain the privacy of your protected health information (“PHI”), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. PHI is information about you, including demographic information, that identifies you and relates to your past, present or future physical or mental health, the care you receive or payment for that care.

How we may use and disclose your PHI without your written authorization

Treatment. We may use and share your PHI to provide, coordinate or manage your care. For example, clinicians at Origins may consult with each other about your care, or we may contact another provider you are seeing, with your permission where required.

Payment. We may use and share PHI to bill for services and to get paid, such as sending information to your health plan to verify benefits, obtain authorization or process a claim.

Health care operations. We may use and share PHI for activities that keep our practice running, such as quality review, training and supervision, licensing, audits, business planning and administration.

Other permitted or required uses and disclosures. We may use or disclose PHI without your authorization in limited situations, including:

• When required by law.
• To report suspected abuse, neglect or domestic violence, as required by law, including child and vulnerable adult protection reporting.
• To prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
• For public health activities and health oversight activities authorized by law.
• In response to a court order, subpoena or other lawful process, subject to the protections that apply to mental health records.
• For certain law enforcement purposes, to coroners and medical examiners, for workers’ compensation, and for specialized government functions, as permitted by law.
• To business associates who perform services for us and have agreed in writing to protect your PHI.
• To you, and to family members or others involved in your care or payment when you agree or do not object, or in an emergency when it is in your best interest.

Uses and disclosures that require your written authorization

We will get your written authorization before using or sharing PHI in ways not described in this notice. In particular, we need your authorization for most uses and disclosures of psychotherapy notes, for marketing, and for any sale of PHI. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Substance use disorder records

If we provide substance use disorder treatment that is covered by the federal confidentiality rules at 42 CFR Part 2, those records receive additional protection, and we will follow those rules, including obtaining your consent where they require it.

Your rights regarding your PHI

• Right to access. You may ask to see and get a copy of your PHI in the records we use to make decisions about you. We may charge a reasonable cost-based fee. In limited circumstances we may deny access and will explain why.
• Right to request an amendment. If you believe information is wrong or incomplete, you may ask us to correct it. We may deny the request in certain cases and will tell you why in writing.
• Right to an accounting of disclosures. You may ask for a list of certain disclosures we made of your PHI in the past six years.
• Right to request restrictions. You may ask us to limit how we use or share your PHI for treatment, payment or operations. We are not required to agree, except that we must agree to a request not to share information with your health plan for a service you have paid for in full out of pocket, unless the law requires the disclosure.
• Right to confidential communications. You may ask us to contact you in a particular way or at a particular place, such as a specific phone number or email address. We will accommodate reasonable requests.
• Right to a paper copy of this notice. You may ask for a paper copy at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach. We will notify you if there is a breach of your unsecured PHI.

To use any of these rights, contact us using the information below. Requests to access, amend or restrict information should be made in writing.

Our responsibilities

We are required by law to keep your PHI private and secure, to give you this notice, to follow its terms, to notify you following a breach of unsecured PHI, and not to use or share your PHI other than as described here unless you give us written permission. State law may give you additional protection, and where it does we will follow the stricter rule.

Changes to this notice

We may change this notice and the changes may apply to PHI we already hold. The current notice is always available on this website and from our offices.

Questions and complaints

If you have questions about this notice, or believe your privacy rights have been violated, contact our Privacy Officer at Origins Counseling & Wellness, phone 252-220-0420 or email appointments@originscw.com. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr/privacy/hipaa/complaints or by calling 1-800-368-1019. We will not retaliate against you for filing a complaint.