Feeling Whole Counseling Services

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NOTICE OF PRIVACY PRACTICES


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


THIS NOTICE GIVES YOU INFORMATION REQUIRED BY LAW about the duties and privacy practices of the Feeling Whole Counseling Services to protect the privacy of your personal health information. Feeling Whole Counseling Services provides you with behavioral health services. Feeling Whole Counseling Services receives and maintains your personal health information in the course of providing these health services to you. Feeling Whole Counseling Services may contract with companies or individuals to help provide these services to you. These contractors may receive and maintain your personal information.


THE EFFECTIVE DATE OF THIS NOTICE IS AUGUST 1, 2003. Feeling Whole Counseling Services is required to follow the terms of this Notice until the Notice is replaced. Feeling Whole Counseling Services reserves the right to change the terms of this notice at any time. If Feeling Whole Counseling Services makes changes to this Notice, Feeling Whole Counseling Services will revise it and post the new Notice at that time. Feeling Whole Counseling Services reserves the right to make the new changes apply to all your personal behavioral health information maintained by Feeling Whole Counseling Services before and after the date of the new Notice.


Purposes for which Feeling Whole Counseling Services may use or disclose your personal information health information without your authorization.


• Health Care Providers’ Treatment purposes. For example, Feeling Whole Counseling Services may disclose your personal information to your doctor, at the doctor’s request, for treatment by your doctor.


• Payment. For example, Feeling Whole Counseling Services may use or disclose your personal health information to provide eligibility information to your doctor when you receive treatment, to pay for claims for covered healthcare services, or to recover costs from medical insurance or probate estates.


• Health Care Operations. For example, Feeling Whole Counseling Services or their contractors may use or disclose your personal health information (1) to conduct quality assessment and improvement activities; (2) to review applications for services (3) to engage in care coordination or case management; (4) to mange, plan, or develop Feeling Whole Counseling Service’s services and budgets; (5) to coordinate services with another public benefit program; (6) to cooperate with state and federal auditors.


• Health Services. Feeling Whole Counseling Services or their contractor may contact you to give you information about the treatment alternatives or other health-related benefits and services that may be of interest to you.


• As Required by Law. For example, Feeling Whole Counseling Services may disclose your personal health information necessary to comply with workers’ compensations or other laws. Feeling Whole Counseling Services may also be required to disclose personal health information about abuse, neglect or domestic violence to government or social agencies.


For other reasons:


  • • To comply with legal proceeding, such as court or administrative or subpoena.

  • • To law enforcement officials or to correctional institutions for limited law enforcement and health and safety purposes.

  • • With your written authorization, to a family member, friend or other person, to help you with your health care or payment for your health care.

  • • To your personal representative appointed by you or designated by law.

  • • For research purposes in limited circumstances and where the information will be protected by researchers.

  • • To a coroner, medical examiner, or funeral director to identify a deceased person or to arrange payment benefits.

  • • To an organ procurement organization in limited circumstances.

  • • To avert a serious threat to your health or safety or the health and safety of others.

  • • To a governmental agency authorized to oversee government health care programs.

  • • To federal officials for lawful national security purposes.

  • • To public health authorities for public health purposes.

  • • To appropriate military authorities, if you are a member of the armed forces.


Uses and disclosures with your permission


Feeling Whole Counseling Services will not use or disclose your personal health information for any other purposes unless you give Feeling Whole Counseling Services your written authorization to do so. In most cases, you may revoke your written authorization at any time unless Feeling Whole Counseling Services has relied upon your authorization for a continuing disclosure; for example, for a research study. Your revocation will be effective from the date of the Revocation forward, for all your personal health information that Feeling Whole Counseling Services maintains. Authorization and Revocation forms are available at Illinois Department of Human Services facilities or offices.


Your rights


You may make a written request to Feeling Whole Counseling Services to do or more of the following concerning your personal health information that Feeling Whole Counseling Services maintains:


  • • To put additional restrictions on Feeling Whole Counseling Services' use and disclosure of your personal health information. Feeling Whole Counseling Services does not have to agree to your request under certain circumstances.
  • 
• To have Feeling Whole Counseling Services communicate with you in confidence about your personal health information by a different means or at a different location than Feeling Whole Counseling Services is currently doing. Your request must be in writing specifying the alternate means or location to communicate with you.

  • • To see and get copies of your personal health information. You may be charged a nominal fee for the copies.
To correct your personal health information. In some cases, Feeling Whole Counseling Services does not have to agree to your request.
  • • 
To receive a list of disclosures of your personal health information that Feeling Whole Counseling Services and their contractors have made for certain purposes for the last 6 years, but not for disclosures made before August 1, 2003.
To have Feeling Whole Counseling Services send you another copy of this Notice.


If you want to exercise any of these rights described in this Notice, please contact Gay Russell, Privacy Officer at the address below. She will provide the necessary information and forms for you to complete and return to Feeling Whole Counseling Services
.

Complaints


If you believe your privacy rights have been violated by Feeling Whole Counseling Services, you have the right to complain to Feeling Whole Counseling Services or to the Secretary of the U.S. Department of Health and Human Services. You may file a complaint with Feeling Whole Counseling Services at the address below. Feeling Whole Counseling Services will not retaliate against you if you choose to file a complaint with Feeling Whole Counseling Services or with the U.S. Department of Health and Human Services.


Privacy Officer


To request additional copies of this Notice or to receive information about Feeling Whole Counseling Services’ privacy practices or your rights, or to file a complaint, please contact the Privacy Officer at the following address:


Gay Russell, MSW, LCSW serving as Privacy Officer TAX: 20-8928438

Feeling Whole Counseling Services

2500 W. HIggins Road, Suite 1135
Hoffman Estates, IL 60169

PH: 847-524-2110

FAX: 847-524-2224

Click here to download a copy of this policy.

 

 

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