NOTICE OF PRIVACY POLICIES

This form details the confidentiality of your medical records, how the information is used, your rights and how you may obtain this information. 

 Our Legal Duties State and Federal laws require that we keep your medical records private. Such laws require that we provide you with this notice informing you of our privacy of information policies, your rights and our duties. Inspire Communication, Inc.has the right to revise our privacy policies for all medical records, including reports kept before policy changes were made. Any changes in this notice will be made available upon request before changes take place. The contents of material disclosed during evaluations, intake or counseling sessions are covered by law as private information. Inspire Communication, Inc.respects the privacy of the information that you provide and abide by the ethical and legal requirements of confidentiality and privacy records. 

 Use of Information Information about you may be used by the personnel associated with Inspire Communication, Inc. for diagnosis, treatment planning and continuity of care. Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client’s legal guardian or personal representative. It is the policy of Inspire Communication, Inc. not to release any information about a client without a signed release of information except in certain emergencies or exceptions in which client information can be disclosed to others without written consent. Some of these situations are noted below, and there may be other provisions provided by legal requirements. 

 Duty to Warn and Protect When a client discloses intentions or a plan to harm another person or persons, the healthcare professional is required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a plan for suicide, the health care professional is required to notify legal authorities and make reasonable attempts to notify the family of the client. 

 Public Safety Health care records may be released for the public interest and safety for public health activities, judicial and administrative proceedings, law enforcement purposes, serious threats to public safety, essential government functions, military and when complying with worker’s compensation laws. 

 Abuse If a client states or suggests that he or she is abusing a child or vulnerable adult, or has recently abused a child or vulnerable adult, or a child (or vulnerable adult) is in danger of abuse, the healthcare professional is required to report this information to the appropriate social services and/or legal authorities. If a client is the victim of abuse, neglect, violence, or a crime victim, and their safety appears to be at risk, we may share this information with law enforcement officials to help prevent future occurrences and capture the predator.
 
  Prenatal Exposure to Controlled Substances Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful. 

 In the Event of a Client’s Death In the event of a client’s death, the spouse or parents of a deceased child have a right to access their child or spouse’s medical records. 

 Professional Conduct Professional conduct by a health care professional must be reported by other health care professionals. In cases in which a professional or legal disciplinary meeting is being held regarding the health care professional’s actions, related records may be released in order to substantiate disciplinary concerns. 

 Judicial or Administrative Proceedings Health care professionals are required to release records of clients when a court order has been placed. In the event of a court order, only the minimally acceptable amount of information will be revealed. Additionally if a client files a complaint or lawsuit against anyone affiliated with Inspire Communication, Inc.; relevant information regarding the client may be disclosed for the purpose of formulating an appropriate defense. 

 Minors/Guardianship Parents or legal guardians of non-emancipated minor clients have the right to access the client’s records unless it is determined that access would have a detrimental effect on the therapeutic relationships, or on the client’s physical safety or psychological well-being. 

 Other Provisions When payment for services is the responsibility of the client, or a person who has agreed to providing payment, and payment has not been made in a timely manner, collection agencies may be utilized in collecting unpaid debts. The specific content of the services (e.g., diagnosis, treatment plan, progress notes, testing) is not disclosed. If a debt remains unpaid it may be reported to credit agencies and the client’s credit report may state the amount owed, the time-frame, and the name of the clinic or collection source. 

 Insurance companies and managed care payers are given information that they request regarding services to the client. Information that may be released includes the type of services, dates/times of services, diagnosis, treatment plan, description of impairment, progress of therapy, and/or summaries or copies of the entire medical record. Only the minimally acceptable amount of information will be released to accommodate such requests. 

 Information about clients may be disclosed in consultations with other professionals in order to provide the best possible treatment. In such cases the name of the client, or any identifying information is not disclosed. Clinical information about the client is discussed. Some progress notes and reports are dictated/typed within the practice or by outside sources specializing in (and held accountable for) such procedures. 

 Communications with the client outside the clinic setting will only occur as authorized by the client. When it is necessary to contact the client via telephone, messages will not be left on voicemails (or with persons other than the client or the client’s legal guardian) unless Inspire Communication, Inc. has received written authorization to do so.

 Your Privacy Rights 

 You have the right to request to review or receive your medical files. If you request is denied, you will receive a written explanation of the denial. Records for non-emancipated minors must be requested by their custodial parents or legal guardians.    
 

  You have the right to cancel a release of information by providing Inspire Communication, Inc. a written notice.  

 You have the right to restrict which information might be disclosed to others. However, if we do not agree with these restrictions, we are not bound to abide by them.  

 You have the right to request that information about you be communicated by other means or to another location.  

 You have the right to disagree with the medical records in our files. You may request that this information be changed. Although we may deny changing the record, you have the right to make a statement of disagreement, which will be placed in your file. 

 You have the right to know what information in your record has been provided to whom.  

 You have the right to request a copy of this notice.  

 Complaints
 In order to maintain a harmonious and cooperative relationship between clients, their families and their health care professional it is the policy of Inspire Communication, Inc. to provide for the settlement of problems and differences through an orderly grievance procedure. All clients, their families, and their health care professional have the right to present his/her problem or grievance in accordance with this established procedure free from interference, coercion, restraint, discrimination or reprisal. 

 1. The client consults first with their direct service provider regarding any action, occurrence or attitude either expressed or implied which is perceived as unfair or inequitable with Inspire Communication, Inc.’s delivery of services. If a satisfactory agreement for resolution cannot be made through this consultation, the consumer may appeal in writing to the Director.  
 

  2. The Director must arrange a meeting with the consumer and the direct services provider within ten (10) working days after the grievance is received. If no resolution can be reached at this level, the consumer may appeal in writing to: Office of Civil Rights, U. S., Department of Health and Human Services, 200, Independence Avenue, S.W., Room 509F, HHH Building, Washington, DC 20201. There will be no retaliation for filing a complaint with either Inspire Communication, Inc. or the Office of Civil Rights.