Privacy Policy

NOTICE OF PRIVACY PRACTICES

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

HOW GENESIS PSYCHIATRIC SERVICES, PLLC MAY USE OR DISCLOSE YOUR HEALTH INFORMATION.

1. State Law requires us to maintain the privacy of individual identifiable health information and to provide you with notice of our legal duties and privacy practices with respect to such information. Genesis Psychiatric Services, PLLC must abide by the terms and conditions of this privacy notice. We reserve the right to change our practices and to make the new provisions effective for all individual identifiable health information that we maintain.

2. Information contained in your health record: 

· Health History

· Examination and Test Results

· Diagnosis

· Treatment

· Plan for Future Care or Treatment

3. Uses or disclosures of health information for treatment, payment and healthcare operations.

· Treatment. Treatment could include information recorded in your record to diagnose your condition and determine the best course of treatment for you. It could also include consulting with or referring your case to another healthcare provider. Copies will be provided to your physician, other healthcare professionals, or a healthcare provider, copies of your records to assist them in treating you. Genesis Psychiatric Services, PLLC may use or disclose your individually identifiable health information for its own provision of treatment or may disclose such information for the treatment activities for another healthcare provider.

· Payment. Payment could include Genesis Psychiatric Services, PLLC efforts to obtain payment and/or reimbursement from you or a third party payor for services that Genesis Psychiatric Services, PLLC has provided to you. The bill which will be prepared for the treatment given by Genesis Psychiatric Services, PLLC may include information that identifies you, your diagnosis, treatment received and supplies used. Genesis Psychiatric Services, PLLC, may use or disclose your individually identifiable information for its own payment or for the payment activities of another healthcare provider, health plan or health insurer. Healthcare operations could include activities such as quality assessment, risk management, audits of the process of billing you or a third party payor for healthcare services which Genesis Psychiatric Services, PLLC provides to you. As part of Genesis Psychiatric Services, PLLC treatment of you and operation of a healthcare organization, Genesis Psychiatric Services, PLLC may contact you by phone; by mail or e-mail to provide appointment reminders or to provide information about treatment alternatives or other health related services that may be of interest to you. Genesis Psychiatric Services, PLLC may use or disclose your individually identifiable health information for its own healthcare operations or for the healthcare operations of a health plan, or healthcare provider that is subject to certain federal health information privacy laws. The entity, which receives this information, must have or have had a treatment relationship with you and the information we disclose must pertain to that relationship.

· Communication with Family. Unless you object, health professionals using their best judgment may disclose to a family member, another relative, a close, personal friend or any other person you identify, health information relative to that person’s involvement in your care for payment related to your care. If you are unable to object, we may exercise our professional judgment to determine if the disclosure is in your best interest and disclose only information that is directly related to the person’s involvement with your healthcare.

· Notification. May use or disclose information to notify or assist in notifying a family member, personal representative, or any other person responsible for your care and general condition.

· Business Associates. There are some services provided in Genesis Psychiatric Services, PLLC through contracts with business associates, which may include but are not limited to third party billing entity, a practice management company, laboratory testing. When these services are contracted, we may disclose your health information to our business associate so they can perform the job we have asked them to do and bill you or your third party payor for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information and to comply with the same federal privacy rules as we do.

· Food and Drug Administration. We may disclose to the Food and Drug Administration health information relative to adverse effects, events with respect to drugs supplements, product or product defects or post-marketing information to enable product recalls, repairs or replacement.

· Incidental Uses and Disclosures. We are permitted to use and disclose information incident to another use or disclosure of your protected health information permitted or required under law.

YOUR RIGHTS UNDER THE FEDERAL PRIVACY STANDARDS

Federal and State Laws protect your right to keep your individual identifiable health information private. You have the following rights with regard to the information contained therein;

· You generally have the right to inspect and obtain a copy of any protected health information in your medical record, with the exception of psychotherapy notes, information compiled in anticipation of use in a civil, criminal, or administrative proceeding and certain other health information in which the law restricts Genesis Psychiatric Services, PLLC from disseminating. Psychotherapy notes include notes that are recorded in any medium by a healthcare provider who is a mental health professional documenting or analyzing a conversation during a private, group, joint, or family counseling session and they are separated from the rest of your medical records. You do not have a right of access to information that was obtained from someone other than a healthcare provider under a promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information. In other situations we may deny you access to certain healthcare information. If access is denied, we must provide you a review of our decision denying the access. The grounds for reviewing a denial include the following: a licensed healthcare professional has determined in the exercised professional judgment, that the access is reasonably likely to endanger the life or physical safety of yourself or another person. If the request is made by your personal representative and a licensed healthcare professional has determined, in its exercised professional judgment, that giving access to such personal representative is reasonably likely to cause substantial harm to you or another person. For these reviewable grounds, another licensed healthcare professional must review the decision of the provider denying access within sixty (60) days. If we deny you access, we will explain why and what your rights are, including how to seek review. If we grant access, we will tell you what actions you have to take to obtain access. We reserve the right to charge a reasonable, cost-based fee for making copies.

· If you feel the health information about you is incorrect or incomplete, you may ask us to amend or correct the information. We do not have to grant the request if the following conditions exist:

a. We did not create the record, therefore we do not know if the information is correct or accurate. In those cases, you must seek an amendment or correction from the party creating the record. 

b. Does not include a reason to support a request. 

c. That the information is accurate and complete. If we deny your request for an amendment or correction, we will notify you why, how you can attach a statement of disagreement to your records and how you can complain. If we grant the request, we will make the correction and distribute the correction to those who need it and those that you identified to us that you want to receive the corrected information.

· You have the right to obtain an accounting upon request for uses and disclosures for treatment, payment and healthcare operations. However, we are not required to provide an accounting for the following disclosures:

a. Disclosures are protected health information to you. 

b. For the facility director or to persons involved in your care or for other notification purposes as required in Section 164.510 of the Federal Privacy Regulations. 

c. For national security or intelligence purposes under Section 164.512 (k) (2) of the Federal Privacy Regulations. 

d. To law enforcement officials or correctional institutions under Section 164.512 (k) (5) of the Federal Privacy Regulations.

We will provide the accounting within sixty (60) days and it will include the date of each disclosure, name and address of the organization or person who received the protected health information, a brief description of the information disclosed and a brief statement of the purpose of the disclosure that reasonably informs you of the basis for disclosure or, in lieu of such statement, a copy of your written authorization or copy of the written request for disclosure. We will provide the first accounting in any twelve (12) month period at no cost. Thereafter, we reserve the right to charge a reasonable cost-based fee.

· You may revoke your consent or authorization to use or disclose health information except to the extent that we have taken action and reliance on the consent or authorization. THE RESPONSIBILITIES OF GENESIS PSYCHIATRIC SERVICES, PLLC UNDER THE FEDERAL PRIVACY STANDARD:

· Provide you this notice as to our legal duties and privacy practice with respect to individually identifiable information that we collect and maintain about you.

· Abide by the terms of this notice.

· Train our personnel concerning privacy and confidentiality.

· Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information.

· Implement a policy to discipline those who breach privacy or confidentiality or our policies of providing healthcare information.

· Request of confidential information. We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law. You have the right to request that we communicate with you about matters in a certain way or at a certain location, such as contacting you only on certain telephone numbers. To request confidential information, the request must be in writing to Genesis Psychiatric Services, PLLC, 237 Castlewood Dr, #A, Murfreesboro, TN 37129.

· Right to a paper copy of this notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy. You may obtain a copy at www.genesispsychiatricservices.com or contact Genesis Psychiatric Services, PLLC at (615) 494-4804.

· Changes to this notice. We reserve the right to change this notice effective for information we already have about you as well as any information we receive in the future. We will display a copy of the current notice and display in the common area of Genesis Psychiatric Services, PLLC. Additionally, you may have a copy of the current notice in effect. You may obtain a current copy at www.genesispsychiatricservices.com or contact Genesis Psychiatric Services, PLLC at (615) 494-4804.

· How to report a problem. If you believe your privacy rights have been violated, you may file a complaint with Genesis Psychiatric Services, PLLC or the Office for Civil Rights, U. S. Department of Health and Human Services. To file a complaint with Genesis Psychiatric Services, PLLC, please call (615) 494-4804. To file a complaint with the U.S. Department of Health and Human Services, write to: Region 4, Office for Civil Rights, U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3, V70, 61 Forsyth Street Southwest, Atlanta, GA 37303, (404) 562-7886, Fax (404) 562-7881. There will be no retaliatory actions towards you for filing a complaint to either party.

· Amendments. Genesis Psychiatric Services, PLLC reserves the right to amend the terms of this Privacy Notice at any time and to apply the revised Privacy Notice to all individually identifiable information that it maintains.

This Privacy Notice is effective on May 31, 2012.