2 Corinthians 1:3-4 "Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort; who comforts us in all our affliction so that we may be able to comfort those who are in any affliction with the comfort with which we ourselves are comforted by God."
FAMILY LIFE MINISTRIES
5970 Godown RoadColumbus, Ohio 43235
614-459-1God
Notice of Privacy Practices This notice describes how counseling information about you may be used and disclosed and how you can obtain access to this information.
Please review it carefully.
Click here for a downloadable Adobe Acrobat version of this notice
This Notice of Privacy Practices describes how Family Life Ministries may use and disclose your Protected Health Information (PHI) to carry out counseling or health care operations for the purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information (PHI). 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 and related counseling services. We are required to abide by the terms of our Notice of Privacy Practices. We may change the terms of our notice at any time, A revised copy will be posted in the FLM office. You may’ request a copy of any new Privacy Notices. Upon your request in writing we will provide you with a revised Notice of Privacy
1. Uses and Disclosures of Protected Health Information based upon your written Consent: You will be asked by your Counselor to sign a “Counseling Advisement and Consent Form”. Once you have signed the form and consented to use and disclosure of your PHI for counseling, or health care operations. your counselor will use or disclose your information for the following:
- A basis for planning your counseling.
- A means of communication among FLM staff who may contribute to your counseling.
- A tool for routine health care operations such as quality assurance and Counselor review.
Counseling: We will use and disclose your PHI to provide, coordinate, or manage your counseling and any related services. This includes coordination or management of your counseling care with a third party that has already obtained permission to have access to your PHI. For example, we would disclose information as necessary to a Psychologist that provides care to you. When we have the necessary authorization from you, we will also disclose PHI to other health care providers that may be treating you. For example, your PHI may be disclosed to a Medical Doctor or Psychiatrist to whom you have been referred, to ensure that he has the necessary information to diagnosis and treat you.
Healthcare Operations: We may use, or disclose as needed, your Protected Health Care Information (PHI) in order to support the operations of Family Life Ministries. These activities include, but are not limited to, employee review’ activities, training of counselor trainees, and program development. Examples of this are: we may call you by first name in the waiting room when your Counselor is ready to see you, and we may use your information to contact you to remind you of your appointment.
On occasion we may use your PHI to inform you of classes or seminars that may be of interest to you. We may’ also disclose use your information for FLM marketing such as providing you with a newsletter about our ministry. You may contact your Counselor to request that this information not be sent to you.
Uses and Disclosures Of Protected Health Information Based upon your Written Authorization: Other uses of your Protected Health Information (PHI) will be made only with your written Authorization, unless otherwise permitted, or required by law as described below. You may revoke this Authorization in writing at any time, except to the extent that your Counselor has taken an action in reliance on the use or disclosure indicated in the Authorization.
Other Permitted and Required uses and Disclosures that may be made with your Consent, Authorization and Opportunity to Object: We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your Protected Health Information (PHI).lf you are not present or able to agree or object to the use or disclosure of your PHI, your Counselor may, use his/her judgment to determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your counseling care will be disclosed.
Others involved with your Health Care: Unless you object, we may provide PHI to a family member, friend, or other individual whom you indicate is involved with your case. Retroactive consent may be obtained in emergency situations. Emergencies: We may use or disclose your Protected Health Information (PHI) in emergency treatment situations. If this happens, your Counselor shall try to obtain your Consent as soon as reasonably practical after the delivery of the counseling. If your Counselor or another Counselor within Family Life Ministries (FLM) is required by law to treat you for an emergency Situation and they have attempted to obtain your consent but are unable to do so at that time they may still use or disclose your PHI for your care.
Communication Barriers: We may use or disclose your PHI if your Counselor, or another Counselor at FLM attempts to obtain consent from you but is unable to do so due to substantial communication barriers, and the Counselor determines, using his best judgment under the circumstances, that you intend to consent to use or disclosure of your information.
2. Other Permitted and Required Uses and Disclosures that may be made without your Consent, Authorization or Opportunity to Object: We may use or disclose your Protected Health Information (PHI) in the following situations without your Consent or Authorization or Opportunity to Object.
Required by Law: We may use or disclose your PHI to the extent that it is required by law. This consent or disclosure will be made in compliance with the law and will be limited to relevant requirements of the law. You will be notified, as required of any such uses or disclosures.
Communicable Diseases: We may disclose your PHI if authorized by law, to a person who may have been exposed to a communicable disease or condition.
Health Oversight: We may disclose your PHI to a health oversight agency for activities authorized by law such as investigations or inspections. Oversight agencies seeking this information include government agencies that over see the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Legal Proceedings: We ma disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal in response to subpoena, discovery request or other lawful process.
Abuse or Neglect: We may disclose your Protected Health Information (PHI) to Public Health authorities that are authorized by law to receive reports of child abuse and neglect. In addition we may disclose your PHI to the government entity or agency authorized to receive such information if we believe you have been a victim of abuse, neglect. or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws
Law Enforcement: We may also disclose PHI so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include 1) legal processes otherwise required by law, 2) limited information requests for identification and location purposes, 3) pertaining to victims of crime, 4) suspicion that death has occurred as a result of criminal conduct, 5) in the event that a crime occurs on the property of FLM, and 6) medical emergency (not on FLM property) and it is likely that a crime has occurred.
Criminal Activity: In accordance with federal and state Laws, we may disclose your Protected Health Information (PHI), if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply. we may use or disclose Protected Health information (PHI) of individuals who are Armed Forces Personnel 1) for activities deemed necessary by appropriate military command authorities, and 2) for the purpose of a determination of your eligibility benefits from the Department of Veterans Affairs. We may also disclose your protected health information to authorized Federal officials for conducting national security and intelligence activities.
Workers’ Compensation: Your PHI may he disclosed by us as authorized to comply with Workers’ Compensation laws and under similar legally established programs.
3. Required uses and Disclosures Under the law, we must make disclosures to you when we are required by the Secretary’ of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et.seq
4. Your Rights Following is a statement of your rights with respect to your Protected Health Information, and a brief description of how you may exercise these rights.
You have the right to see and receive a copy of your Protected Health Information.
This means that you may see and receive a copy of your PHI contained in a designated record set. A designated record set contains Personnel Data Inventory (PD1) information and other records used for making decisions about you. Under Federal law, however, you may not inspect or copy the following records; psychotherapy notes, information complied in a reasonable anticipation of, or use in, civil, criminal, or administrative action or proceeding or any PHI that law prohibits access to. Depending on the circumstances, a decision to deny access to PHI may’ he given. If access is denied, your counselor will give you reasons for the denial in writing. He she will explain your right to have the denial reviewed.
You have the right to request a restriction of your Protected Health information.
You have the right to ask that all or a part of your PHI not be used or disclosed for your care. This includes disclosures to family and friends invoked in your care as outlined in the Family Life Ministries Privacy Notice. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply. Your counselor will consider your request but is not legally bound to agree. If he/she believes it is in your best interest to permit use and disclosure of your PHI, it will not he restricted. If they do agree, they will put the restrictions in writing and abide by them except in emergency situations. You do not have the right to limit the uses or disclosures that they are legally required by’ law or permitted to make.
You have the right to request to receive confidential communications from us by alternative means or at alternative locations.
We will accommodate reasonable requests. We will not request an explanation from you as to the basis for your request. Please make the request in writing to your counselor. You have the right to have your Counselor amend your Protected Health Information This means that if you feel there is an error in your PHI or that information has been omitted, it is your right to request a correction. Your request and reason for the request must be made in writing. Family Life Ministries may deny your request if it is found that your PHI is a) correct and complete, b) forbidden to be disclosed by law, c) information not a part of the records. If we deny your request our reasons must be put in writing. You will receive information explaining your right to tile a written objection to the denial. If you do not file a written objection to the denial, you still have the right to request that your request and the FLM denial be attached to any future disclosures of your PHI.
You have the right to receive an accounting of certain disclosures we have made.
You have the right to see a list of disclosures about you made by Family Life Ministries. It will include, date of disclosure, the purpose and recipient of the information. This list will not include uses or disclosures to which you already have consented. i.e.: those for counseling, health care operations, ones already signed by you for Authorization or to family/friends already involved in your care. It will also not include disclosures made prior to April 15th, 2003
5. Complaints You may complain to us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint by notifying Sue Oldford, Privacy Manager, Family Life Ministries 5970 Godown Rd Columbus. Ohio 43235. You will not be retaliated against for filing a complaint.