Carla Van Hoose, LCSW
dba Van Hoose & Associates
501 Darby Creek Road, Suite 3
Lexington KY 40509
859-263-2377

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.
Notice of Privacy Practices
Privacy is a very important concern for all those who come to this office. It is also complicated because of federal and state laws and our professional laws and regulations. Because the rules are so complicated some parts of this Notice are quite detailed and you probably will have to read them several times to understand them. If you have any questions Carla Van Hoose, LCSW will be happy to help you.
Contents of this Notice
A. Introduction - To Our Clients
B. What we mean by your medical information
C. Privacy and the laws about privacy
D. How your protected health information can be used and shared
1. Uses and disclosures with your consent
a. The basic uses and disclosures - For treatment, payment, and health care
operations (TPO)
b. Other uses and disclosures in health care
2. Uses and disclosures requiring your Authorization
3. Uses and disclosures not requiring your Consent or Authorization
4. Uses and disclosures requiring you to have an opportunity to object
5. An Accounting of disclosures we have made
E. If you have questions or problems

A. Introduction - To our clients
This notice will tell you about how we handle information about you. It tells how we use this information here in this office, how we share it with other professionals and organizations, and how you can see it. We want you to know all of this so that you can make the best decisions for yourself and your family. We are also required to tell you about this because of the privacy regulations of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Because this law and the laws of this state are very complicated and we don’t want to make you read a lot that may not apply to you, we have simplified some parts. If you have any questions or want to know more about anything in this Notice, please ask your therapist for more explanation or more details.

B. What we mean by your medical information
Each time you visit us or any doctor’s office, hospital, clinic, or any other “healthcare provider” information is collected about you and your physical and mental health. It may be information about your past, present or future health or conditions, or the treatment or other services you got from us or from others, or about payment for healthcare. The information we collect from you is called, in the law, PHI which stands for Protected Health Information. This information goes into your medical or healthcare record or file at office. In this office this PHI is likely to include these kinds of information:
? Your history. As a child, in school and at work, and marital and personal history.
? Reasons you came for treatment. Your problems, complaints, symptoms, needs, goals.
? Diagnoses. Diagnoses are the medical terms for your problems or symptoms.
? A treatment plan. These are the treatments and other services which we think will best help you.
? Progress notes. Each time you come in we write down some things about how you are doing, what we observe about you, and what you tell us.
? Records we get from others who treated you or evaluated you.
? Psychological test scores, school records, etc.
? Information about medications you took or are taking.
? Legal matters
? Billing and insurance information

We are required to protect the privacy of health information about you and that can be identified with you, which we call “protected health information,” or “PHI” for short. We must give you notice of our legal duties and privacy practices concerning PHI:

• We must protect PHI that we have created or received about your past, present, or future health condition, health care we provide to you, or payment for your health care.
• We must notify you about how we protect PHI about you.
• We must explain how, when and why we use and/or disclose PHI about you.
• We may only use and/or disclose PHI as we have described in this Notice.

This Notice describes the types of uses and disclosures that we may make and gives you some examples. In addition, we may make other uses and disclosures which occur as a byproduct of the permitted uses and disclosures described in this Notice.

We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all PHI that we maintain by first:

• Posting the revised notice in our offices;
• Making copies of the revised notice available upon request (either at our offices or through the contact person listed in this Notice); and
• Posting the revised notice on our website.

This list is just to give you an idea and there may be other kinds of information that go into your healthcare record here.
We use this information for many purposes. For example, we may use it:
? To plan your care and treatment.
? To decide how well our treatments are working for you.
? When we talk with other healthcare professionals who are also treating you such as your family doctor or the professional who referred you to us.
? To show that you actually received the services from us which we billed to you or to your health insurance company.
? For teaching and training other healthcare professionals.
? For medical or psychological research.
? For public health officials trying to improve health care in this country.
? To improve the way we do our job by measuring the results of our work.

When you understand what is in your record and what it is used for you can make better decisions about who, when, and why others should have this information. Although your health record is the physical property of the healthcare practitioner or facility that collected it, the information belongs to you. You can inspect, read, or review it. If you want a copy we can make one for you but may charge you for the costs of copying (and mailing if you want it mailed to you). In some very unusual situations you cannot see all of what is in your records. If you find anything in your records that you think is incorrect or something important is missing you can ask us to amend (add information to) your record although in some rare situations we don’t have to agree to do that. Your therapist can explain more about this.

C. Privacy and the laws
The HIPAA law requires us to keep your PHI private and to give you this notice of our legal duties and our privacy practices which is called the Notice of Privacy Practices or NPP. We will obey the rules of this notice as long as it is in effect but if we change it the rules of the new NPP will apply to all of the PHI we keep. If we change the NPP we will post the new Notice in our office where everyone can see. You or anyone else can also get a copy from your therapist at any time and it will be posted on our website.

D. How your protected health information can be used and shared. When your information is read by me or others in this office that is called, in the law, “use.” If the information is shared with or sent to others outside this office, that is called, in the law, “disclosure.” Except in some special circumstances, when we use your PHI here or disclose it to others we share only the minimum necessary PHI needed for the purpose. The law gives you rights to know about your PHI, how it is used and to have a say in how it is disclosed and so we will tell you more about what we do with your information. We use and disclose PHI for several reasons. Mainly, we will use and disclose (share) it for routine purposes and we will explain more about these below. For other uses we must tell you about them and have a written Authorization from unless the law lets or requires us to make the use or disclosure without your authorization. However, the law also says that we are allowed to make some uses and disclosures without your consent or authorization.
1. Uses and disclosures of PHI in healthcare with your consent After you have read this Notice you may be asked to sign a separate Consent form to allow us to use and share your PHI. In almost all cases we intend to use your PHI here or share your PHI with other people or organizations to provide treatment to you, arrange for payment for our services, or some other business functions called health care operations. Together these routine purposes are called TPO and the law allows us to use and disclose your PHI for TPO.

1a. For treatment, payment, or health care operations. We need information about you and your condition to provide care to you. You have to agree to let us collect the information and to use it and share it as necessary to care for you properly. When you come to see us, several people in our office may collect information about you and all of it may go into your healthcare records here. Generally, we may use or disclose your PHI for three purposes: treatment, obtaining payment, and what are called healthcare operations. Let’s see what these are about.
For treatment
We use your medical information to provide you with psychological treatment or services. These might include individual, family, or group therapy, psychological, educational, or vocational testing, treatment planning, or measuring the effects of our services. We may share or disclose your PHI to others who provide treatment to you. We are likely to share your information with your personal physician. If you are being treated by a team we can share some of your PHI with them so that the services you receive will be coordinated. They will also enter their findings, the actions they took, and their plans into your record and so we all can decide what treatments work best for you and make up a Treatment Plan. We may refer you to other professionals or consultants for services we cannot offer such as special testing or treatments. When we do this we need to tell them some things about you and your conditions. We will get back their findings and opinions and those will go into your records here. If you receive treatment in the future from other professionals we can also share your PHI with them. These are some examples so that you can see how we use and disclose your PHI for treatment.

For payment
We may use your information to bill you, your insurance, or others to be paid for the treatment we provide to you. We may contact your insurance company to check on exactly what your insurance covers. We may have to tell them about your diagnoses, what treatments you have received, and what we expect as we treat you. We will need to tell them about when we met, your progress, and other similar things.

Generally, we may use and give your medical information to others to bill and collect payment for the treatment and services provided to you. Before you receive scheduled services, we may share information about these services with your health plan(s). Sharing information allows us to ask for coverage under your plan or policy and for approval of payment before we provide the services. We may also share portions of your medical information with the following:

• Billing departments;
• Collection departments or agencies;
• Insurance companies, health plans and their agents which provide you coverage;
• Hospital departments that review the care you received to check that it and the costs associated with it were appropriate for your illness or injury; and
• Consumer reporting agencies (e.g., credit bureaus).


For healthcare operations
There are some other ways we may use or disclose your PHI which are called healthcare operations. For example, we may use your PHI to see where we can make improvements in the care and services we provide. We may be required to supply some information to some government health agencies so they can study disorders and treatment and make plans for services that are needed. If we do, your name and identity will be removed from what we send.
? Reviewing and improving the quality, efficiency, and cost of care that we provide to you and our other patients.
? Improving health care and lowering costs
? Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
? Providing training programs for students, trainees, healthcare providers or non-health care professional (for example, billing clerks or assistants, etc.) to help them practice or improve their skills.
? Cooperating with outside organizations that asses the quality of the care we and others provide. These organizations might include government agencies or accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations.

• Cooperating with outside organizations that evaluate, certify or license health care providers, staff or facilities in a particular field or specialty. For example, we may use or disclose PHI so that certification of expertise in a specific field may be obtained.
• Assisting various people who review our activities. For example, PHI may be seen by doctors reviewing the services provided to you, and by accountants, lawyers, and others who assist us in complying with applicable laws.
• Planning for our organization’s future operations, and fundraising for the benefit of our organization.
• Conducting business management and general administrative activities related to our organization and the services it provides, including providing info.
• Resolving grievances within our organization.
• Complying with this Notice and with applicable laws.


1b. Other uses in healthcare Appointment Reminders. We may use and disclose medical information to reschedule or remind you of appointments for treatment or other care. If you want us to call or write to you only at your home or your work or prefer some other way to reach you, we usually can arrange that. Just tell us.
Treatment Alternatives. We may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of interest to you. Other Benefits and Services. We may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you. Research. We may use or share your information to do research to improve treatments. For example, comparing two treatments for the same disorder to see which works better or faster or costs less. In all cases your name, address and other information that reveals who you are will be removed from the information given to researchers. If they need to know who you are we will discuss the research project with you and you will have to sign a special Authorization form before any information is shared.
Business Associates. There are some jobs we hire other businesses to do for us. They are called our Business Associates in the law. Examples include a copy service we use to make copies of your health record and a billing service who figures out, prints, and mails our bills. These business associates need to receive some of your PHI to do their jobs properly. To protect your privacy they have agreed in their contract with us to safeguard your information.

2. Uses and disclosures requiring your Authorization
If we want to use your information for any purpose besides the TPO or those we described above we need your permission on an Authorization form. We don’t expect to need this very often. If you do authorize us to use or disclose your PHI, you can revoke (cancel) that permission, in writing, at any time. After that time we will not use or disclose your information for the purposes that we agreed to. Of course, we cannot take back any information we had already disclosed with your permission or that we had used in our office.
3. Uses and disclosures of PHI from mental health records Not requiring Consent or Authorization ? The laws let us use and disclose some of your PHI without your consent or authorization in some cases. We may use and/or disclose PHI about you for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object. Those circumstances include:

• When the use and/or disclosure is required by law. For example, when a disclosure is required by federal, state or local law or other judicial or administrative proceeding.
• When the use and/or disclosure is necessary for public health activities. For example, we may disclose PHI about you if you have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
• When the disclosure relates to victims of abuse, neglect, domestic violence or threats of suicide with intent and means.
• When the use and/or disclosure is for health oversight activities. For example, we may disclose PHI about you to a state or federal health oversight agency which is authorized by law to oversee our operations.
• When the disclosure is for judicial and administrative proceedings. For example, we may disclose PHI about you in response to an order of a court or administrative tribunal.
• When the disclosure is for law enforcement purposes. For example, we may disclose PHI about you in order to comply with laws that require the reporting of certain types of wounds or other physical injuries.
Li> When the use and/or disclosure relates to decedents. For example, we may disclose PHI about you to a coroner or medical examiner for the purposes of identifying you should you die.
• When the use and/or disclosure relates to cadaveric organ, eye or tissue donation purposes.
• When the use and/or disclosure relates to medical research. Under certain circumstances, we may disclose PHI about you for medical research.
• When the use and/or disclosure is to avert a serious threat to health or safety. For example, we may disclose PHI about you to prevent or lessen a serious and eminent threat to the health or safety of a person or the public.
• When the use and/or disclosure relates to specialized government functions. For example, we may disclose PHI about you if it relates to military and veterans’ activities, national security and intelligence activities, protective services for the President, and medical suitability or determinations of the Department of State.
• When the use and/or disclosure relates to correctional institutions and in other law enforcement custodial situations. For example, in certain circumstances, we may disclose PHI about you to a correctional institution having lawful custody of you.


We can share some information about you with your family or close others. We will only share information with those involved in your care and anyone else you choose such as close friends or clergy. We will ask you about who you want us to tell what information about your condition or treatment. You can tell us what you want and we will honor your wishes as long as it is not against the law.

We may share with a public or private agency (for example, American Red Cross) PHI about you for disaster relief purposes. Even if you object, we may still share the PHI about you, if necessary for the emergency circumstances.

If it is an emergency - so we cannot ask if you disagree - we can share information if we believe that it is what you would have wanted and if we believe it will help you if we do share it. If we do share information, in an emergency, we will tell you as soon as we can. If you don’t approve we will stop, as long as it is not against the law.

5. An accounting of disclosures When we disclose your PHI we keeps some records of whom we sent it to, when we sent it, and what we sent. You can get an accounting (a list) of many of these disclosures.

E. If you have questions or problems If you need more information or have questions about the privacy practices described above please speak to your therapist, whose name and telephone number are listed below. If you have a problem with how your PHI has been handled or if you believe your privacy rights have been violated, contact your therapist. You have the right to file a complaint with us and with the Secretary of the Federal Department of Health and Human Services. We promise that we will not in any way limit your care here or take any actions against you if you complain.

If you have any questions regarding this notice or our health information privacy policies, please contact Carla Van Hoose, LCSW, by phone 859-263-2377 or in writing at Van Hoose & Associates, 501 Darby Creek Road, Suite 3, Lexington KY 40509.

The effective date of this notice is April 14, 2003

HIPPA\CV NOTICE OF PRIVACY LONG VERSION 04-08-03