Notice to Patients
To Protect the Privacy of Your Health Information
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.
I.Uses and Disclosures for Treatment, Payment, and Health Care Operations
FBH may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
“PHI” refers to information in your health record that could identify you.
“Treatment, Payment and Health Care Operations”
– Treatment is when FBH provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when FBH consults with another health care provider, such as your family physician or another psychologist.
– Payment is when FBH obtains reimbursement for your healthcare. Examples of payment are when FBH discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
– Health Care Operations are activities that relate to the performance and operation of FBH. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
“Use” applies only to activities within FBH, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
“Disclosure” applies to activities outside FBH, such as releasing, transferring, or providing access to information about you to other parties.
I.Uses and Disclosures Requiring Authorization
FBH may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when FBH asks for information for purposes outside of treatment, payment and health care operations, FBH will obtain an authorization from you before releasing this information. FBH will also need to obtain an authorization before releasing your psychotherapy notes.
“Psychotherapy notes” are notes FBH clinicians have made about conversations during a private, group, joint, or family counseling session, the FBH Clinician must keep these notes separate from the rest of your medical record. These notes are given a 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) FBH has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.
II.Uses and Disclosures with Neither Consent nor Authorization
FBH may use or disclose PHI without your consent or authorization in the following circumstances:
Child Abuse: If FBH has reasonable cause to believe that a child has been abused or neglected, FBH must report this and relevant information, within 24 hours, to the Division of Child and Family Services, the county agency which provides child welfare services or a law enforcement agency.
Adult and Domestic Abuse: If FBH has reasonable cause to believe that an older person has been abused, neglected, exploited or isolated, FBH must make a report to the local office of the Nevada Department of Human Resources Division of Aging Services, the police department or sheriff’s office, or other appropriate agency within 24 hours after becoming aware of this information.
Health Oversight: If FBH receives a request from the Nevada Board of Psychological Examiners with respect to an inquiry or complaint about professional conduct, FBH must make available any record relevant to such inquiry.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law, and FBH will not release this information without written authorization from you or your legally-appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.
Serious Threat to Health or Safety: FBH may disclose confidential information from your records if I believe such disclosure is necessary to protect you or another person from a clear and substantial risk of imminent, serious harm. FBH may only disclose such information and to such persons as are consistent with the standards of the mental health and substance abuse profession in addressing such problems.
Worker’s Compensation: If you file a worker’s compensation claim, and if FBH provides treatment to you relevant to that claim, then FBH must submit to your employer’s insurer or a third party administrator, a report on services rendered.
III.Patient’s Rights and Therapist’s Duties
Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, FBH is not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing an FBH clinician. Upon your request, FBH will send your bills to another address.)
Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in mental health records used to make decisions about you for as long as the PHI is maintained in the record. FBH may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. You may file an appeal with the FBH appeals process.
Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. FBH may deny your request. On your request, FBH personnel will discuss with you the details of the amendment process.
Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, FBH will discuss with you the details of the accounting process.
Right to a Paper Copy – You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.
FBH Therapist’s Duties:
FBH is required by law to maintain the privacy of PHI and to provide you with a notice of legal duties and privacy practices with respect to PHI.
FBH reserve the right to change the privacy policies and practices described in this notice. Unless FBH notifies you of such changes, however, FBH is required to abide by the terms currently in effect.
If FBH revises policies and procedures, FBH will provide you with the information.
If you are concerned that FBH have violated your privacy rights, or you disagree with a decision FBH has made about access to your records, you may contact the FBH at 775-419-6350.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed above can provide you with the appropriate address upon request.
This notice will go into effect on 1/01/18
FBH reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that FBH maintains. FBH will provide you with a revised notice before the changes take place and before you receive and treatment under the revised terms. Information will be given to you before your therapy visit for your signature of the new terms.
“Notice to Patients Regarding the Destruction of Health Care Records”
FOCUSLINK BEHAVIORAL HEALTH pursuant to the provisions of subsection 7 of NRS 629.051 (SB17):
The health care records of a person who is less than 23 years of age may not be destroyed; and
The health care records of a person who has attained the age of 23 years may be destroyed for those records which have been retained for at least 5 years or for any longer period provided by federal law; and
Except as otherwise provided in subsection 7 of the NRS 629.051 and unless a longer period is provided by federal law, the health care records of a patient who is 23 years of age or older may be destroyed after 5 years pursuant to subsection 1 of NRS 629.051.
CIVIL RIGHTS NON-DISCRIMINATION STATEMENT
Pursuant to Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Americans With Disabilities Act (ADA) of 1990, FOCUSLINK BEHAVIORAL HEALTH does not discriminate in admissions, provision of services, hiring and employment on the basis of race, color, national origin, sex, religion, age or disability (including AIDS and related conditions).
For further information or to file a complaint please contact
Focuslink Healthcare Inc.
3889 S Eastern Ave, Las Vegas, NV 89048
Voice Phone (702) 331-9561 - FAX (702) 331-6703
The Office for Civil Rights
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100 San Francisco, CA 94103
Voice Phone (415) 437-8310 · FAX (415)437-8329 · TDD (415)437-8311