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.
you have any questions about this Notice please contact: our Privacy
Contact who is Pat Luna.
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” 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.
are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice at any time. The new notice
will be effective for all protected health information that we maintain
at that time. Upon your request, we will provide you with any revised
Notice of Privacy Practices by accessing our website: www.comptherapy.com,
calling the office and requesting that a revised copy be sent to
you in the mail or asking for one at the time of your next appointment.
Uses and Disclosures of Protected Health Information
and Disclosures of Protected Health Information: We use
and disclose health information about you for treatment, payment
and health care operations. Following are examples of the types
of uses and disclosures of your protected health care information
that our office is permitted to make once you have signed our consent
form. These examples are not meant to be exhaustive, but to describe
types of uses and disclosures that may be made by our office once
you have provided consent.
We will disclose protected health information to therapists who
may be treating you or your child.
Your protected health information will be used, as needed, to obtain
payment for your health care services. This may include certain
activities that your health insurance plan may undertake before
it approves or pays for the health care services we recommend for
you such as: making a determination of eligibility or coverage for
insurance benefits, reviewing services provided to you for medical
necessity, and undertaking utilization review activities.
Operations: We may use or disclose, as needed, your protected
health information in order to support the business activities of
the practice. These activities include, but are not limited to,
quality assessment activities, employee/therapists review activities,
training of students, licensing, accreditation, certification and
example, we may disclose your protected health information to students
that see patients at our office. In addition, we may use a sign-in
sheet at the registration desk where you will be asked to sign your
name. We may also call you by name in the waiting room when your
therapist is ready to see you. We may use or disclose your protected
health information, as necessary, to contact you
to remind you of your appointment.
may use or disclose your protected health information, as
necessary, to provide you with information about treatment
alternatives or other health-related benefits and services that
may be of interest to you. We may also use and disclose your protected
health information for other marketing activities. For example,
your name and address may be used to send you a newsletter about
our practice and the services we offer. We may also send you information
about products or services that we believe may be beneficial to
you. You may contact our Privacy Contact to request that these materials
not be sent to you.
and Disclosures of Protected Health Information Based Upon Your
Written Authorization: Other uses and disclosures of your
protected health information will be made only with your written
authorization, unless otherwise permitted or required by law as
described below. You may revoke this authorization at any time,
in writing. Your revocation will not affect any use of disclosures
permitted while it was in effect.
Permitted and Required Uses and Disclosures That May Be Made With
Your Consent, Authorization or Opportunity to Object
Involved in Your Health Care: Unless you object, we may
disclose to a member of your family, a relative, a close friend
or any other person you identify, your protected health information
that directly relates to that person’s involvement in your,
or your child’s, treatment.
Permitted and Required Uses and Disclosures That May Be Made Without
Your Consent, Authorization or Opportunity to Object
may use or disclose your protected health information in the following
situations without your consent or authorization. These situations
include, but are not limited to:
By Law: We may use or disclose your protected health information
to the extent that the use or disclosure is required by law. The
use or disclosure will be made in compliance with the law and will
be limited to the relevant requirements of the law. You will be
notified, as required by law, of any such uses or disclosures.
or Neglect: We may disclose your protected health information
to a public health authority that is authorized by law to receive
reports of child abuse or neglect. In addition, we may disclose
your protected health information if we believe that you have been
a victim of abuse, neglect or domestic violence to the governmental
entity or agency authorized to receive such information. In this
case, the disclosure will be made consistent with the requirements
of applicable federal and state laws.
Proceedings: We may disclose protected health information
in the course of any judicial or administrative proceeding. In response
to an order of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), in certain conditions
in response to a subpoena, discovery request or other lawful process.
Enforcement: We may also disclose protected health information,
so long as applicable legal requirements are met, for law enforcement
purposes. These law enforcement purposes include (1) legal processes
and otherwise required by law, (2) limited information requests
for identification and location purposes, (3) pertaining to victims
of a crime, (4) suspicion that death has occurred as a result of
criminal conduct, (5) in the event that a crime occurs on the premises
of the practice, and (8) medical emergency (not on the Practice’s
premises) and it is likely that a crime has occurred.
Compensation: Your protected health information may be
disclosed by us as authorized to comply with workers’ compensation
laws and other similar legally-established programs.
is a statement of your rights with respect to your protected health
information and a brief description of how you may exercise these
have the right to request that CTS communicate with you about your
health and related issues in a particular manner or at a certain
location. For instance, you may ask that we contact you
at home, rather than work. We will accommodate reasonable requests.
have the right to inspect and copy your protected health information:
This means you may inspect and obtain a copy of protected
health information about you including patient medical records and
billing records. You must submit your request in writing to our
office. Under federal law, however, you may not inspect or copy
the following records: psychotherapy notes; information compiled
in reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding, and protected health information
that is subject to law that prohibits access to protected health
information. Depending on the circumstances, a decision to deny
access may be reviewable. In some circumstances, you may have a
right to have this decision reviewed. Please contact our Privacy
Contact if you have questions about access to your medical records.
have the right to request a restriction of your protected health
information: This means you may ask us not to use or disclose
any part of your protected health information for the purposes of
treatment, payment or healthcare operations. You may also request
that any part of your protected health information not be disclosed
to family member or friends who may be involved in your care or
for notification purposes as described in this Notice of Privacy
Practices. Your request must state the specific restriction requested
and to whom you want the restriction to apply.
may have the right to have your therapist amend your protected health
information: This means you may request an amendment of
protected health information about you in your medical record for
as long as we maintain this information.
have the right to provide an authorization for other uses and disclosures.
CTS will obtain your written authorization for uses and
disclosures that are not identified by this notice or permitted
by applicable law.
have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice electronically.
may complain to us or to the Secretary of Health and Human Services
if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our privacy contact of
your complaint. We will not retaliate against you for filing a complaint.
may contact our Privacy Contact, Pat Luna, at 214-265-1819, for
further information about the complaint process.
notice was becomes effective on April 14, 2003.