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.

Our Commitment to your Privacy

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” (or “PHI” for short) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services including the payment for your health care. We are required by law to maintain the privacy of your PHI and to provide you with this notice informing you of our legal duties and privacy practices with respect to your PHI.

A. Confidentiality of Your PHI.

Your PHI is confidential. We are required to maintain the confidentiality of your PHI under Pennsylvania law.
The federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) that governs the privacy of PHI does not apply to Hostetter Counseling as we do not meet the statutory definition of a “Covered Entity”. However, we are required to comply with Pennsylvania law regarding the confidentiality of your PHI. In fact, Pennsylvania law provides greater protection for your PHI than does HIPAA. For example, HIPAA allows providers to disclose PHI upon receipt of a subpoena. However, Pennsylvania law does not permit us to disclose or release PHI in response to a Pennsylvania subpoena. All information acquired by Hostetter Counseling in the course of your treatment that is PHI is privileged under Pennsylvania law and we may not release this information without your authorization or pursuant to a court order.

B. How we use and disclose your protected health information with your consent.

We use the information we collect about you to provide treatment, accept payment for services, for scheduling purposes and for communicating and supervisory consultations within Hostetter Counseling. When you sign the Informed Consent Form you are agreeing to let us use your information in these ways. If we want to use, send, share, or release your information for other purposes, we will discuss this with you and ask you to sign an authorization form, called a consent form, to allow us to disclose your PHI.

C. Disclosing your health information without your consent.

There are times when Pennsylvania law requires us to use or share your information and your consent is not needed. All information to be disclosed will be either be dictated by state law or is necessary to meet the specific purpose of the disclosure. For example:

a. If we believe that there is a serious threat to your or another’s health and safety or to the public, I will only share only information necessary for this purpose and with persons who are able to help prevent or reduce the threat.
b. If I receive an order from the court signing by a judge mandating disclosure.
c. If there is suspected Child or Elder Abuse.
d. In case of a medical emergency.

D. Your rights regarding your health information.

a. You can ask us to communicate with you in a particular way or at a certain place that is more private for you. For example, you can ask us to call you at home, and not at work or to only call you on your cell phone, or call at certain times of the day. We will try our best to do as you ask.

b. You can ask us to limit what I tell people involved in your care or the payment for your care, such as family members and friends.

c. You have the right to look at the health information we have about you, such as your medical and billing records. You can get a copy of these records upon request and for a fee.

d. If you believe that the information in your records is incorrect or missing something important, you can ask us to make additions to your records to correct the records.

e. You have the right to a copy of this notice. If we change this notice, we will be sure to inform you of this change.

f. You have the right to file a complaint with our privacy officer if you believe your privacy rights have been violated. Our privacy officer is Joshua Hostetter and can be reached by contacting him at the address and telephone number listed above.

If you have any questions regarding this notice or our health information privacy policy, please feel free to ask at any time. Please be sure to initial at the appropriate place on the informed consent that you have received this notice.

Thank you.