Privacy Policy
Carla Van Hoose, LCSW
dba Van Hoose & Associates
501 Darby Creek Road, Suite 3
Lexington KY 40509
859-263-2377
dba Van Hoose & Associates
501 Darby Creek Road, Suite 3
Lexington KY 40509
859-263-2377
Notice of Privacy Practices (NPP)– Short Version
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
Our practice is dedicated to maintaining the privacy of your personal health information. We are required also by law to do this. These laws are complicated, but we must provide you with important information. This pamphlet is a shorter version of the full, legally required Notice of Privacy Practices (NPP) which you received along with this, so refer to it for more information. However, we can’t cover all possible situations so please talk to Carla Van Hoose about any questions or problems.
We will use the information about your health which we get from you or from others mainly to provide you with treatment, to arrange payment for our services, and for some other business activities which are called, in the law, health care operations. After you have read this NPP we may ask you to sign a Consent Form to let us use and share your information. This information can be shared without your consent.
If we or you want to use or disclose (send, share, release) your information for any other purposes we will discuss this with you and ask you to sign an Authorization to allow this.
Of course we will keep your health information private but there are some times when the laws require us to use or share it such as:
1. When there is a serious threat to your health and safety or the health and safety of another individual or the public, including specific threats of suicide, homicide, child abuse, adult abuse, domestic violence, public health threats and national security. We will only share information with a person or organization who is able to help prevent or reduce the threat.
2. Some lawsuits and legal or court proceedings, certain judicial and administrative proceedings.
3. If a law enforcement official requires to do so.
4. For Workers Compensation and similar benefit programs.
There are some other situations like these but which don’t happen very often. They are described in the longer version of the NPP.
Your rights regarding your health information
1. You can ask us to communicate with you about your health and related issues in a particular way or at a certain place. For example, you can ask us to call you at home and not at work to schedule or cancel an appointment. We will try our best to do as you ask.
2. You have the right to ask us to limit what we tell certain individuals involved in your care or the payment for your care, such as family members and friends. While we don’t have to agree to your request, if we do agree, we will keep our agreement except if it is against the law, or in an emergency, or when the information is necessary to treat you.
3. You have the right to look at the health information we have about you such as your medical and billing records. You can even get a copy of these records but we may charge you. Contact your therapist to arrange how to see your records. Psychotherapy notes, if they are kept, are the property of the therapist. Requests for these psychotherapy notes may be granted or denied at the therapists discretion and are not part of the mental health medical record.
4. If you believe the information in your records is incorrect or incomplete, you can ask us to make some kinds of changes (called amending) to your health information. You have to make this request in writing and send it to your therapist. You must tell us the reasons you want to make the changes. A form is available upon request.
5. You have the right to a copy of this notice. If we change this NPP we will post it in our waiting room and you can always get a copy of the NPP from your therapist.
6.You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with your therapist and with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.
If you have any questions regarding this notice or our health information privacy policies, please contact your therapist, Carla Van Hoose, LCSW, who can be reached by phone at 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
__________________________________ ____________________________________
Patient/Client Witness
Date: ____________________________
Please initial your choices below:
_____ Accepted a copy of short NPP form
_____ Refused a copy of short NPP form
CV NOTICE OF PRIVACY SHORT VERSION 04-08-03
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
Our practice is dedicated to maintaining the privacy of your personal health information. We are required also by law to do this. These laws are complicated, but we must provide you with important information. This pamphlet is a shorter version of the full, legally required Notice of Privacy Practices (NPP) which you received along with this, so refer to it for more information. However, we can’t cover all possible situations so please talk to Carla Van Hoose about any questions or problems.
We will use the information about your health which we get from you or from others mainly to provide you with treatment, to arrange payment for our services, and for some other business activities which are called, in the law, health care operations. After you have read this NPP we may ask you to sign a Consent Form to let us use and share your information. This information can be shared without your consent.
If we or you want to use or disclose (send, share, release) your information for any other purposes we will discuss this with you and ask you to sign an Authorization to allow this.
Of course we will keep your health information private but there are some times when the laws require us to use or share it such as:
1. When there is a serious threat to your health and safety or the health and safety of another individual or the public, including specific threats of suicide, homicide, child abuse, adult abuse, domestic violence, public health threats and national security. We will only share information with a person or organization who is able to help prevent or reduce the threat.
2. Some lawsuits and legal or court proceedings, certain judicial and administrative proceedings.
3. If a law enforcement official requires to do so.
4. For Workers Compensation and similar benefit programs.
There are some other situations like these but which don’t happen very often. They are described in the longer version of the NPP.
Your rights regarding your health information
1. You can ask us to communicate with you about your health and related issues in a particular way or at a certain place. For example, you can ask us to call you at home and not at work to schedule or cancel an appointment. We will try our best to do as you ask.
2. You have the right to ask us to limit what we tell certain individuals involved in your care or the payment for your care, such as family members and friends. While we don’t have to agree to your request, if we do agree, we will keep our agreement except if it is against the law, or in an emergency, or when the information is necessary to treat you.
3. You have the right to look at the health information we have about you such as your medical and billing records. You can even get a copy of these records but we may charge you. Contact your therapist to arrange how to see your records. Psychotherapy notes, if they are kept, are the property of the therapist. Requests for these psychotherapy notes may be granted or denied at the therapists discretion and are not part of the mental health medical record.
4. If you believe the information in your records is incorrect or incomplete, you can ask us to make some kinds of changes (called amending) to your health information. You have to make this request in writing and send it to your therapist. You must tell us the reasons you want to make the changes. A form is available upon request.
5. You have the right to a copy of this notice. If we change this NPP we will post it in our waiting room and you can always get a copy of the NPP from your therapist.
6.You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with your therapist and with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.
If you have any questions regarding this notice or our health information privacy policies, please contact your therapist, Carla Van Hoose, LCSW, who can be reached by phone at 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
__________________________________ ____________________________________
Patient/Client Witness
Date: ____________________________
Please initial your choices below:
_____ Accepted a copy of short NPP form
_____ Refused a copy of short NPP form
CV NOTICE OF PRIVACY SHORT VERSION 04-08-03