Notice of Privacy Practices

ADOPTED August 6, 2013

THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS CAREFULLY.

MY COMMITMENT TO YOUR PRIVACY:

  • I, Sheri Cobarruvias, MS, LPC-S, NCC, understand the importance of keeping your personal and health information secure and private. This Notice informs you of your rights about the privacy of your protected health information and how I may use and share it. I am required by law to protect the privacy of your health information, to provide you with a Notice of Privacy Practices for your review, and to get a signed statement from you indicating that you have been provided the opportunity to review the Notice. You may request that I provide you with a copy to take home.
  • As of April 14, 2003, I am required and will comply with the health information privacy standards issued under the federal Health Information Portability and Accountability Act (HIPAA). Federal and state laws allow me to use and disclose your personal health information for purposes of treatment, payment, and health care operations.
  • Each time you visit my office a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This notice applies to all of the records of your care generated or retained by your practitioner, whether made by your independent practitioner, staff, or business associates. I will post a copy of my current Notice in my offices in a visible location at all times. I reserve the right to amend this Notice of Privacy Practices

HOW I PROTECT PERSONAL INFORMATION:

  • I use strict safeguards to protect the personal information of my clients. These safeguards include how I store personal information in workspaces and computers and how I transfer that information within the facility and to my business partners. I only allow people to work with me or my business partners to see personal information when it is part of their job to provide products or services to my clients. These people are informed about the safeguards I have in place, my privacy policies, and the law that protects your privacy.

IF YOU HAVE ANY QUESTIONS:

  • If you have any questions about this notice, please contact the following: 1001 Pat Booker, Suite 208, Universal City, Texas 78154 210.849.7199. For complaints see the information at the conclusion of this Notice.

USE AND DISCLOSURE FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS:

The following categories describe examples of the ways I may use and disclose your protected health information. In these situations, I will ask for your written authorization before using or disclosing any identifiable or protected health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization, in writing, to stop future uses and disclosures. However, any revocation will not apply to disclosures or uses already made or that rely on that authorization.

  • For Treatment: I may use your protected health information to provide, coordinate, or manage your care and any related services. This includes the coordination or management of your health care with a third party for treatment purposes or for the provision of services. For example, I may disclose your provided health information to a pharmacy to fill a prescription, or to a subcontracted provider who is providing services to you. I may also disclose protected health information to physicians or other health care providers who may be treating you or consulting with your practitioner with respect to your care. In some cases, I may also disclose your protected health information to an outside provider for purposes of the treatment activities of the other provider. Finally, unless you object, I may also disclose your personal health information to others who may assist in your care, such as your spouse, children, or parents.
  • For Payment: I may use and disclose protected health information about your treatment and services to bill and collect payment from you, your insurance company, or a third party payer. For example, I may need to give your insurance company information about your surgery so they will pay me or reimburse you for the treatment. I may also tell your health plan about a treatment you are going to receive such as: for making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
  • For Health Care Operations: I may use and disclose your protected health information, as necessary, for my own operations in order to facilitate the function of your independent practitioner’s office and to provide quality care to all clients. Health care operations include such activities as: quality assessment and improvement activities; employee review activities; training programs including those in which students, trainees or practitioners in health care learn under supervision; accreditation; certification; licensing or credentialing activities; review and auditing, including compliance reviews, medical reviews, legal services, maintaining compliance programs; business management and general administrative activities; activities related to protocol development; case management and care coordination; activities designed to improve health or reduce health care costs; business planning and development including cost management and/ or planning related analysis.
  • For Business Associates: I may share your protected information with third party “business associates” that perform various activities (for example, billing or transcription services) for your practitioner. Whenever an arrangement with a business associate involves the use or disclosure of your protected health information, I require the business associate to appropriately safeguard your information.
  • For Appointment Reminders: I may use and disclose your protected health information to contact you as a reminder that you have an appointment. This may include the use of postcards, messages left on your answering machine or cell phone, and/or text reminders.
  • For Treatment Alternatives: I may use and disclose your protected health information to tell you about or recommend possible service options or treatment alternatives that may be of interest to you.
  • For Communication Barriers: I may share your protected information in case a translator is needed in order to facilitate the carrying out of your treatment.
  • For Emergencies: I may use or disclose your protected health information in an emergency treatment situation. It may be necessary for your provider to notify you and obtain your consent as soon as reasonably practicable after the delivery of treatment. Also, in the event of a disaster or emergency, I may disclose information about you to an entity assisting in disaster relief so that your family can be notified about your condition, status, and location.
  • To Discuss Your Care with Individuals Involved in Your Care or Payment for Your Care: I may release protected health information about you to one of your family members, to a relative, to a close personal friend, or to any other person identified by you who is directly involved with your care or payment related to your care.

DISCLOSURES THAT CAN BE MADE WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT:

The HIPAA Privacy Rule also allows me to use or disclose your protected health information without your written authorization or opportunity to object for a number of reasons including the following:

  • When Required by Law: I will disclose protected health information about you when required to do so by federal, state, or local law and I am limited to the relevant requirements of such law.
  • To Avert a Serious Threat to Health or Safety: I am allowed, consistent with applicable law and ethical standards of conduct, to use or disclose your protected health information if I believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public or to another person. Under these circumstances, I will only make disclosures to a person or organization able to help prevent the threat.
  • When There Are Risks to Public Health: I may disclose your protected health information, if authorized by law, to a public health authority that is permitted by law to collect or receive the information under federal, state, or local government. This disclosure will be made for public health activities for the purpose of controlling or reporting disease, injury or disability, vital statistics (like birth or death), to report injury by a public health authority, or to notify a person who has been exposed to a communicable disease or who may be a risk of contracting or spreading a disease. I may disclose your medical information under the Federal Drug Administration’s jurisdiction to report reactions to medication, problems with products, or to notify people of recalls or products they may be using.
  • To Conduct Health Oversight Activities: I may disclose your protected health information to a health oversight agency for those activities authorized by law. Examples of these activities are audits, investigations, licensure, disciplinary actions, applications, and inspections; which are all activities undertaken to monitor the health care delivery system and compliance with other laws, such as Civil Rights laws. I may disclose your protected health information to report to an employer about an individual who is a member of the workforce as legally required or authorized by law, or when you agree to the disclosure. I may not; however, disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.
  • When Lawsuits and Disputes Arise: If you are involved in a lawsuit or dispute, I may disclose protected health information about you in response to a court or administrative order, or a subpoena to testify in court. I may also disclose protected health information about you in response to a discovery request, or other lawful processes by someone else involved in the dispute, but only after reasonable efforts have been made to tell you about the request, or to obtain a court order requiring the release of the information, or to obtain a court order protecting the information requested.
  • For Workers’ Compensation: I may disclose your information required by Workers’ Compensation Laws or similar programs established by law that provide benefits for work-related injuries or illnesses without regard to fault.
  • For Military, National Security, and Intelligence Activities, or for Protection of the President: If you are a member of the U.S. or foreign military forces (including veteran) I may disclose your protected health information to the military upon proper request and if required by the appropriate authorities. I may also disclose your information to federal officials conducting authorized national security, intelligence and counterintelligence, and other national security activities and investigations authorized by law, as well as authorized activities for the provision of protective services for the President of the United States, or other officials or foreign heads of state.
  • To Disclose Abuse, Neglect, or Domestic Violence: I may disclose your protected health information to law enforcement, social services, or other government agencies authorized to receive the report if I believe that you are the victim of abuse, neglect, or domestic violence. I will make this disclosure only when specifically required, or authorized by law, or when you agree to the disclosure. Because Texas law requires practitioners to report child abuse or neglect, I may disclose medical information to a public agency authorized to receive reports of child abuse or neglect. Texas Law also requires a person having cause to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation to report the information to the State, and HIPAA privacy regulations permit the disclosure of information to report abuse or neglect of elders or the disabled.
  • For Law Enforcement Purposes: If asked by a law enforcement official, I may disclose your medical information under limited circumstances provided:
    • The information is released pursuant to a legal process, such as a warrant or subpoena;
    • The information pertains to a victim of a crime and you are incapacitated;
    • The information pertains to a person who has died under circumstances that may be related to criminal conduct;
    • The information is about a victim of a crime and I am unable to obtain the person’s agreement;
    • The information is released because a crime that has occurred on these premises; or
    • The information is released to locate a fugitive, missing person, or suspect.
  • Research, Organ Donation, Coroners, Medical Examiners, and Funeral Directors: When a research project and its privacy protections have been approved by an institutional review board or privacy board, I may release medical information to researchers for research purposes provided that the researcher represents that the protected health information is necessary for the research. I may release medical information to organ procurement organizations for the purpose of facilitating organ, eye, or tissue donation if you are a donor. Also, I may release your medical information to a coroner or medical examiner to identify a deceased person or a cause of death. Further, I may release your medical information to a funeral director, consistent with applicable law, when such disclosure is necessary for the director to carry out his duties.
  • Inmates: If you are an inmate or under the custody of law enforcement, I may release your medical information to the correctional institution or law enforcement official. This release is permitted to allow the institution to provide you with medical care, to protect your health, or the health and safety of others, or for the safety and security of the institution.

USES AND DISCLOSURES REQUIRING AUTHORIZATION

  • Any other use or disclosure of your protected health information than those listed above will only be made with your written authorization. This authorization must specifically identify the information I seek to use or disclose, as well as when and how I seek to use or disclose it. Information requested by schools, other healthcare professionals, organizations, and institutions not listed above must be approved by you. I will provide this information within 30 days of the request.

YOUR RIGHTS UNDER FEDERAL LAW

The U.S. Department of Health and Human Services created regulations to protect client privacy as required by the Health Insurance Portability and Accountability Act (HIPAA). Those regulations create several privileges that clients may exercise. I will not retaliate against clients who exercise their HIPPA rights.

  • Requested Restrictions: You may request that I restrict or limit how your protected health information is used or disclosed for treatment, payment, or health care operations. I do NOT have to agree to this restriction, but if I do agree, I will comply with your request except under emergency circumstances.
  • The Right to Obtain, Copy, or Inspect Your Protected Health Information: You may visit my office at 1001 Pat Booker, Suite 208, inspect and copy most of the medical information about you that I maintain. I will provide you with access to this information within 30 days of your request. I may charge you for the cost to copy any medical information that you have the right to access.
  • The Right to Amend Your Protected Health Information: You have the right to ask your provider to amend written medical and clinical information about you. If I agree to amend your information I will generally amend your information within 60 days of your request and will notify you when I have amended the information. Your provider is permitted by law to deny your request to amend your medical and clinical information only in certain circumstances, like when your provider believes the information you have asked to be amended is correct. If you wish to request that I amend the medical information that I have about you, you should contact the privacy officer listed at the end of this Notice.
  • The Right to Request an Accounting of My Use and Disclosure of Your Protected Health Information: You may request an accounting of certain disclosures of your protected health information that I have made in the last six years prior to the date of your request. Please contact the privacy officer at the end of this notice. I am not required to give you an accounting of information I have used or disclosed for purposes of treatment, payment, healthcare operations, or when I share your information with my business associates, like my billing company or a medical facility from/ to which I have transported you, or of my use of protected health information for which you have already given me written authorization.
  • The Right to Request That I Restrict the Uses and Disclosures of Your Protected Health Information: You have the right to request how I use and disclose your protected health information that I have about you for treatment, payment, or healthcare operations; or to restrict the information that is provided to family, friends, and other individuals involved in your health care. But if you request a restriction and the information you asked me to restrict is needed to provide you with emergency treatment, then I may use the protected health information to disclose it to a health care provider to provide you with emergency treatment. Your provider is not required to agree with any restrictions you request, but any restrictions agreed to by your provider are binding.
  • The Right to Obtain a Copy of Paper Notice on Request: Upon request, I will provide you with a copy of this Notice at any time.
  • Revisions to the Notice: I reserve the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected health information that I maintain. Any material changes to the Notice will be promptly posted in the facility. You can get a copy of the latest version of this Notice by contacting the Privacy Officer identified below.
  • Patients’ Legal Rights and Complaints: You also have the right to complain to the Privacy Officer listed at the end of this notice or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with me or to the government.
  • Marketing/ Fundraising: I will not use any protected health information for marketing or fundraising purposes.
  • Research: If I engage in any research projects where protected health information identifies individual clients, I will obtain the client’s authorization to disclose the client’s protected health information.

If you have any questions about this Notice or if you wish to file a complaint or exercise any rights listed in this Notice please contact:

Sheri Cobarruvias, MS, LPC-S, NCC – Therapist/ Owner

1001 Pat Booker, Suite 208

Universal City, Texas 78148

210.849.7199

Texas State Board of Examiners of Professional Counselors

Complaints Management and Investigative Section

P.O. Box 141369

Austin, Texas 78714-1369

1.800.942.5540

“The Lord is a refuge for the oppressed, a stronghold in times of trouble.” – Psalm 9:9