SUMMARY OF NOTICE OF PRIVACY PRACTICES FOR WESTPORT FAMILY COUNSELING LLC

 

The following statement reflects the WFC’s commitment to maintaining the Web site visitor’s rights to privacy and the confidentiality of personal information.

WFC believes that the tracking of personal medical and health information is a breach of an individual’s personal privacy, and as such, has taken extensive measures to ensure the safety and security of its Web site servers to guard against the dissemination of private information. Our Web site does not track, collect or distribute personal information about visitors.

This site will not collect names, e-mail addresses, or any other personal information unless voluntarily provided by the visitor after the visitor is informed about the potential use of such information. Names and e-mail addresses of site visitors will not be provided or released to a third party without the site visitor’s express permission.

E-mail information, personal information about specific visitor’s access and navigation, and information volunteered by site visitors, such as survey information and site registration information, may be used by the site owner to improve the site but will not be shared with or sold to other organizations for commercial purposes without the site visitor’s express permission.

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.

Your health record contains personal information about you and your health. Information that identifies you and relates to your past, present, or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”). It also describes your rights regarding how you may gain access to and control your PHI.

We are required by law to maintain the 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 this Notice of Privacy Practices. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website: https://westportfamilycounseling.org/privacy-policy/, sending a copy to you in the mail upon request, or providing one to you at your next appointment.

Use and disclosure of your personal health information (PHI) in certain special circumstances: 

 

The following circumstances may require us to use or disclose your personal health information (PHI), and we are permitted to do so by law:  

• To consult with a professional supervisor or peer supervision group about your case. In this situation, the consultation/discussion does not include confidential information that could identify you. Information may be shared only to the extent necessary to achieve the purposes of the consultation. This is to help your counselor maintain and improve their skills and the services they provide.
• To public health authorities and health oversight agencies that are authorized by law to collect information (i.e., the Department of Public Health).  
• Legal and similar proceedings in response to a court or administrative order.
• If required to do so by law enforcement.
• When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat. 
• In the event that your clinician believes you are going to harm someone, they have a duty to warn that person and possibly notify law enforcement.
• In the event that your clinician believes you are suicidal, exhibiting risky behavior, or might harm yourself.
• In the event that your clinician believes you are homicidal, exhibiting threatening behavior, or might harm someone else.
• In the case of child abuse or neglect or elder abuse or neglect.
• If you are a member of the United States or foreign military forces, including veterans, and if required by the appropriate authorities. 
• To federal officials for intelligence and national security activities authorized by law. 
• To correctional facilities or law enforcement officials if you are an inmate or under the custody of law enforcement. 
• For Workers’ Compensation and similar programs.
• For operational use, including but not limited to copy and transcription services and contractual agreements for business operations, including but not limited to legal, secretarial, actuarial, consulting, accounting, administrative accreditation, data aggregation, and billing and financial services. 
• Health Information Exchange As permitted by the Health Insurance Portability and Accountability Act (HIPAA), we may participate in one or more health information exchanges (HIEs) and may securely share your health information for treatment, payment, and healthcare operations purposes electronically with other participants in the HIEs. HIEs allow your healthcare providers to have faster, more efficient access and use your pertinent health information to make more informed decisions and enable them to best coordinate your care. Our participation with the Connecticut statewide health information exchange “Connie” is mandated by the State of Connecticut. You may opt out and disable access to your health information available through Connie by calling, completing, and submitting an Opt-Out form to Connie by mail, fax, or through their website at www.conniect.org. Public health reporting and controlled dangerous substances information, as part of the Connecticut Prescription Monitoring and Reporting System (PMP), will still be available to providers. If you do not opt out of this exchange of information, we may provide your health information to the HIEs in which we participate in accordance with applicable law.

Your rights regarding your personal health information 

 

1. Communications: WFC and its staff will communicate with patients using their selected preferred method and any other instructions given by the patient on the intake form. We will adapt to any verbal permission or retraction that you convey in treatment on your respective clinician’s voicemail box or the general voicemail box. We are not accountable for any error made due to a patient’s change of preferences if this change has not been communicated (or the communication has not been received) before the time of the error. 

2. Risks of Communication: I am aware that WFC and its staff transmit and share protected data and information in strict accordance with HIPAA guidelines and that WFC digital transmissions use a secure network that is not accessible to the public and is protected by additional security measures such as the use of a VPN and software that monitors the network and network traffic. I have been made aware that, in spite of WFC’s best efforts and measures that are taken to mitigate risk, there are still risks associated with sharing protected information. Risks include but are not limited to the possibility that the transmission of medical information can be affected by a technical malfunction or can be pirated, corrupted, recorded, misdirected, or redirected. WFC and its staff follow strict protocols and guidelines, safeguarding the communication and transmission of all information to the best of their abilities. 

3. Restrictions: You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment for your care, such as family members and friends. Please note: We are not required to abide by your request (especially if there is a lawful, ethical, or compelling reason that warrants the disclosure of information). If we do agree to your request, we are bound by our agreement, except when otherwise required by law, in emergencies, or when the information is necessary to treat you. 

4. Inspection: You have the right to inspect and obtain a copy of your health information that may be used to make decisions about you, including patient medical records and billing records. But not including psychotherapy notes. You must submit your request in writing to your clinician/therapist or the Director. 

5. Amendment: You may ask us to amend your health information if you believe it is incorrect or incomplete and as long as the information is kept by or for our practice. Your request for amendment must be made in writing and submitted to your clinician/therapist or the Director of WFC. You must provide us with a reason that supports your request. We are not required to agree with your request, but we must consider it. 

6. Copy of Notice: You are entitled to retain a copy of this summary. You are also entitled to request and obtain a full Notice of Privacy Practices. To obtain a copy of this Summary and/or the full Notice, please contact your clinician/therapist or the Director of WFC. 

7. Complaints: All complaints must be submitted in writing. You have the right to file a complaint if you believe that your privacy rights have been violated. You will not be penalized for filing a complaint. You may file a complaint with our practice or with the Secretary of Health and Human Services. To file a complaint with our practice, contact the Director at (203) 227-4555, Extension 1. The email address is n.strouse@wfcmail.org. The mailing address is 250 Post Road East, Westport, CT 06880. The address for the Department of Health and Human Services is The Office for Civil Rights, U.S. Dept of Health & Human Service, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201. Or, call (202) 619-0257.

8. Authorization: You have the right to provide authorizations for other uses and disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. 

9. Business Associates: There are some services provided in our organization through contracts with business associates. Examples include transcription services and bookkeeping services, which we use when making copies of your health records or when reviewing billing and financial matters. When these services are used, we may give your health information to our business associates so they can perform the job we’ve asked them to do. To protect your health information, however, we require business associates to keep your information confidential. 

10. Healthcare Providers: With your authorization, we may disclose your information to other healthcare providers with whom you are working or to those we refer you for treatment. We may also communicate your protected information to other healthcare providers in an emergency or if/when the law mandates us to report.

Changes to the Notice:  We reserve the right to change the Notice. If we do so, we will post it on our website https://westportfamilycounseling.org/privacy-policy/ and provide a copy upon request. 

I hereby acknowledge that I have read Westport Family Counseling’s Summary of Privacy Practices and that I may request a copy of the Summary or the entire Notice at any time. I understand that this Summary is for convenience only, is not a substitute for reading the entire Notice, and does not modify the terms of the Notice.