Life Transition Therapy Inc.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW CAREFULLY.
Life Transition Therapy Inc. is committed to protecting the privacy and confidentiality of your personal and mental health information (PMHI). We are also mandated by federal and state law to assure that this protection occurs. The following notice outlines our privacy practices, legal duties and your rights concerning your PMHI. We are required by law to provide you with a copy of this notice. Life Transition Therapy Inc. must follow the terms of this notice which takes effect on April 14, 2003. Amendments to this notice may be made in writing by Life Transition Therapy Inc. as laws and or policies change.
Life Transition Therapy Inc. keeps Medical Records for each client that admits to our facility regardless of length of stay for a period of seven (7) years after discharge. Medical Records consist of a client’s PMHI and may include but are not limited to name, demographic information, referral information, admission notes, admission paperwork, assessments, evaluations, progress notes, treatment plan, medical and medication protocols, continuing care plan, discharge summary and financial/payment information. These records are necessary to provide you with the best interdisciplinary care, continuing care and to receive payment for treatment services from third party payers and are required by state licensing mandates.
HOW WE MAY USE AND DISCLOSE YOUR MENTAL HEALTH INFORMATION
Treatment: Your personal and mental health information (PMHI) may be disclosed to any Life Transition Therapy Inc. staff member as needed to provide you with the best possible care, the most comprehensive treatment and to assure your physical health and safety.
Any and all personal or mental health information will only be disclosed to non Life Transition Therapy Inc. related staff when Life Transition Therapy Inc. has obtained the express written consent of The Life Transition Therapy Inc. client, except when required by law.
Payment: There may be instances when payment for treatment services will require disclosure of your PMHI. This is most common when payment is made by a third party such as an insurance company, workman’s compensation, another family member or your personal financial officer. Your PMHI will only be disclosed with your express written permission. It is important to know however that your refusal to give such permission may lead to non payment by that third party as without your written consent/ authorization, we will be unable to discuss payment for your treatment services with any third party.
Healthcare Operations: Life Transition Therapy Inc. may use and/or disclose your PMHI for healthcare operations such as audits by The New Mexico Department of Mental Health, licensing issues, quality assurance, trainings, accreditation, certification and credentialing activities.
Teaching/Training/Supervision: We may disclose personal information regarding Life Transition Therapy Inc. clients in the context of teaching, trainings and the supervision of other members in the mental health field. Information will be disclosed only when the anonymity of the client can be guaranteed.
Business Associates and Ancillary Service Personnel: Some services may be provided to Life Transition Therapy Inc. through business associates and ancillary personnel such as auditors, lab technicians, medical providers, pharmacists, transcriptionists, psychiatrists and state licensing representatives. Your PMHI may be disclosed as needed to assure that such providers can perform the job we have asked them to do. Life Transition Therapy Inc. has a policy to disclose only that information necessary to assure that job is completed. We further require such business associates to sign a contract that states that they will appropriately safeguard your PMHI in compliance with The Life Transition Therapy Inc. policies and legal mandates.
Your Authorization: Although your medical record is the physical property of Life Transition Therapy Inc., you have the right to review and receive a copy of your medical record. Life Transition Therapy Inc. policy requires that any client who wishes to review their medical record do so in the presence of their Primary Therapist other staff member. A written consent/ authorization signed by Life Transition Therapy Inc. client for such medical records must be obtained prior to the copying and or delivery of those records to that client.
You may also request that your PMHI be disclosed to any person or agency that you choose for any purpose. You must provide a written consent/authorization for that information to be disclosed even when such a request is made by you. Such consent is valid for one year from the date originally signed.
You have the right to revoke any consent/authorization at any time.
Disclosure to Family and Friends: Only the PMHI that you have specified will be disclosed and only to those that you have provided written consent/authorization for. Life Transition Therapy Inc.will not confirm or deny your presence at Life Transition Therapy Inc. to any individual that you have not signed a consent/authorization for except in the case of an emergency or as required by law. In the event of your incapacity or under emergency circumstances, we will disclose your PMHI to that person you had previously designated as your “Emergency Contact Person(s)”. We will use our professional judgment to disclose reasonable information on an “as needed” basis.
As required by Law: We may use or disclose your PMHI when we are required by law. Life Transition Therapy Inc. staff who are mental health workers are Mandate Reporters. This law requires us to report to the appropriate authorities if we reasonably believe that you or another human being may be the victim or offender of abuse, neglect, exploitation, domestic violence or other violent crimes. We may disclose your PMHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
The State of New Mexico defines the following terms as:
Abuse: Any act or failure to act performed intentionally, knowingly or recklessly that causes or is likely to cause harm to a resident, including but not limited to:
-Physical contact that harms or is likely to harm a client of Life Transition Therapy Inc.
-Inappropriate use of a physical restraint, isolation or medication that harms or is likely to harm a client.
-Inappropriate use of a physical or chemical restraint, medication, or isolation as punishment or in conflict with a physicians order.
-Medically inappropriate conduct that causes or is likely to cause physical harm to a client.
-Medically inappropriate conduct that causes or is likely to cause great psychological harm to a client.
-An unlawful act, a threat or menacing conduct directed toward a client that results or might reasonably be expected to result in fear or emotional or mental distress to a client.
Neglect: Subject to the client’s right to refuse treatment and subject to the caregiver’s right to exercise sound medical discretion, the grossly negligent failure:
-To provide any treatment, service, care, medication or item that is necessary to maintain the health or safety of a client.
-To take any reasonable precaution that is necessary to prevent damage to the health or safety of a client.
-To carry out a duty to supervise properly or control the provision of any treatment, care, goods, service or medication necessary to maintain the health or safety of a client.
Exploitation: An act or process, performed intentionally, knowingly, or recklessly, of using a client’s money or property for another person’s profit, advantage or benefit. Exploitation includes but is not limited to:
-Manipulating the client by whatever mechanism to give money or property to any program staff or management member.
-Misappropriation or misuse of monies belonging to a client or the unauthorized sale, transfer or use of a client’s property.
-Loans of any kind from a client to a program staff, operator, or families of staff or operator.
-Accepting monetary or other gifts from a client or their family with a value in Excess of $25.00 or gifts which exceed a total value of $300.00 in one year. All gifts received by Life Transition Therapy Inc. operators, theirfamilies or staff of Life Transition Therapy Inc. must be documented and acknowledged by the person giving the gift and the recipient. Exception: Testamentary gifts such as wills, are not, per se, considered financial exploitation.
New Mexico State law requires Life Transition Therapy Inc. to report any incident, or unusual occurrence which has or could threaten the health, safety or welfare of its residents and staff to the Licensing Authority and Adult Protective Services by the next business day. In no instance may Life Transition Therapy Inc. delay a report to Adult Protective Services or to the Licensing Authority, while an internal investigation is being conducted.
Appointments, Reminders and Alumni contact: We may use and disclose your PMHI to contact you (ie: telephone calls, voicemails, e-mails, letters) as a reminder of an appointment at Life Transition Therapy Inc., to check on you and your mental health status and regarding alumni events and associations. You have the right to request not to be contacted for such purposes.
YOUR RIGHTS UNDER THE FEDERAL PRIVACY STANDARD
To request that LHC place additional restrictions on certain uses and disclosures of your information: We are not required by law to agree with your request however, whenever possible as to not cause undue hardship to the flow of business of Life Transition Therapy Inc., we will honor such requests.
For instance: You may request that your medical record not be made available to a state licensing representative from the Department of Health during their yearly audit of Life Transition Therapy Inc. These audits do require that the DOH have access to any client record and that we do not impede in any way random audits of our medical record keeping. Under theses circumstances, your request could not be honored. Life Transition Therapy Inc.does require that such Business Associates sign a written consent to adhere to Life Transition Therapy Inc. standards regarding your privacy and confidentiality so that none of your PMHI will be disclosed.
To obtain a copy of this notice of Life Transition Therapy Inc. Practices upon request. All Life Transition Therapy Inc. clients are given a copy of this notice upon admission and asked to sign that copy to acknowledge they have seen it. Further, clients are given their own copy to keep so that they may review it at any time.
To Request a copy of your medical record: This right is not absolute if Life Transition Therapy Inc. believes that such access would cause harm, we can deny such a request. You do not have the right of access in the following instances:
When information was compiled in reasonable anticipation of or for use in civil, criminal or administrative actions or proceedings.
When information was obtained from someone other than a healthcare provider under a
promise of confidentiality and the access required would be reasonably likely to reveal the source of the information.
When the records were created by a treatment facility or mental health professional that
is not a Life Transition Therapy Inc. employee or Business Associate. It is Life
Transition Therapy Inc. policy not to make copies of medical records created by
any non Life Transition Therapy Inc. employee or Business Associate. In this
situation, you must request such records directly from that person or facility that
created those records originally.
There are other situations in Life Transition Therapy Inc. may deny you access to your medical record. If so, Life Transition Therapy Inc. is required to provide you with a review if the decision denying such access. Reviewable grounds for denial include but are not limited to:
When a licensed Life Transition Therapy Inc. employee has determined, in their professional judgment that access is likely to endanger the life or physical safety of the client or another person.
When the medical record makes reference to another Life Transition Therapy Inc. client or person other than a mental healthcare provider, and a licensed Life Transition Therapy Inc. employee has determined that such access is likely to cause substantial harm to the client or another person.
When the request is made by the client’s personal representative and a licensed Life Transition Therapy Inc. employee has determined that such access is likely to cause substantial harm to the client or another person.
When the proper written consents/authorization have not been obtained.
For these reviewable grounds, another licensed professional must review the decision within 60 days. Their decision will be upheld.
To request an amendment or correction to your Medical Record:
If Life Transition Therapy Inc. denies your request for amendment/ correction, wewill notify you of why and how you can attach a statement of disagreement to your record (which we may argue) and how you can register a written complaint to our Privacy Officer or the Department of Health and Human Services.
If we grant the request, we will make the correction and distribute it to those you identify in writing that you want notified. We do not have to grant the request if Life Transition Therapy Inc. did not create the record. In this case you must seek the amendment/ correction from the party who originally created the record. For instance: If Life Transition Therapy Inc. has obtained your written PMHI from another treatment facility or professional, and there is information contained in those records that you disagree with, Life Transition Therapy Inc. may not legally amend those records in any way.
To request alternative communication:
You have the right to request that we communicate with you by alternative means or to alternative locations. Requests must be made in writing and state the purpose of the request, and must specify the alternative means and location. A fee may be charged for such requests.
For instance: You may request that all correspondence between you and Life Transition
Therapy Inc. be through e-mail only and that you not be contacted by US mail or telephone.
LIFE TRANSITION THERAPY INC. RESPONSIBILITIES
UNDER THE FEDERAL PRIVACY STANDARD
In addition to providing you your rights as detailed above, Life Transition Therapy Inc. is required to:
Maintain the privacy of your PMHI: Life Transition Therapy Inc. will do this by the implementation of reasonable and appropriate physical, administrative and technical safeguards.
Provide you with this notice: As to our legal duties and privacy practices with respect to the personal and private information we obtain about you during the course of your treatment at Life Transition Therapy Inc.
Abide by the terms of this notice.
Train Life Transition Therapy Inc. employees on our privacy and confidentiality policies.
Implement a disciplinary plan: Life Transition Therapy Inc. has a course if disciplinary action for those Life Transition Therapy Inc. Employees, Business Associates and Ancillary Service Providers who breach our privacy/confidentiality policies. And if such a breach occurs, to lessen any resulting harm this breach may have caused.
Life Transition Therapy Inc. will not use or disclose your personal and mental health information without your written consent/ authorization.
Maintain an account of any non-routine disclosures and uses of your medical records over the past 6 years beginning on April 14, 2003 within 60 days of such disclosures. Information provided will include name and address of who received your PMHI, a description of the information disclosed, and a statement of the purpose of such disclosure. Life Transition Therapy Inc. reserves the right to charge a reasonable fee for this service.
Life Transition Therapy Inc. does not need to provide an account for:
Disclosures to you.
Disclosures authorized by you.
Partially de-identified data used for research, education, public health or health care operations.
For the facility directory or to persons involved in your care such as outpatient therapists, psychiatrists or medical doctors.
For national security or intelligence purposes, to correctional institutions or law enforcement officials under 164.512(K)(2) and (5) Disclosures that occurred before April 14, 2003.
Allow you to revoke your consent to use or disclose your PMHI at any time except to the extent that we have previously taken action.
If you have questions, would like further information or believe your privacy rights have been violated you may contact Life Transition Therapy Inc.’s Privacy Officer: Amy Lashway-Cisneros, MA, LPCC, NCC, at PO Box 29075, Santa Fe, NM 87508.
Grievances should be made in writing and be addressed to the attention Life Transition Therapy Inc. Privacy Officer. You also have the right to file a grievance with The U.S. Department of Health and Human Services at Region IV Office for Civil Rights, 1301 Young St. Suite 1169, Dallas, TX 75202, 214-767-4056. Life Transition Therapy Inc.will not retaliate in any way if you choose to file a grievance with us or The USDHHS.
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