Notice Of Privacy Practices

Psychiatric Services, P.C.

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.

If you have any questions about this Notice, please contact our Privacy Contact at (402) 399-9305, X111who is our office manager.

This Notice of Privacy Practices describes how we may use and disclose your protected health information. It also describes your rights to access and control your protected health information. "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 or condition and related health care services. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you a copy of the revised Notice of Policy Practices.

1. Uses and Disclosures of Protected Health Information

The following are some of the ways we may use or disclose your protected health information. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office. For many of these uses your prior written authorization, you may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician's practice has already taken an action in reliance on the use or disclosure indicated in the authorization.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time to time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your health care by providing assistance with your health care diagnosis or treatment to your physician.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Health care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at out office. In addition, we may use a sign-in-sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when you physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We will also share your protected health information with third party "business associates" that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we have a written contract that contains terms that will protect the privacy of your protected health information. We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. To the extent a communication to you is about the following, it is not considered marketing, and does not require your prior authorization: (i)communications about participating providers and health plans in a network, the services we offer or the benefits covered by a health plan; (ii) your treatment; or (iii) case management or care coordination for you, directions or recommendations for alternative treatments, therapies, health care providers, or setting of care. All other marketing communications and disclosures require your prior written authorization except when (i) the communication occurs in a face-to-face encounter between us and you, or (ii) the communication involves a promotional gift of nominal value. The following are examples of permitted marketing without your prior authorization: your name and address may be used to send you a newsletter about our practice and the services we offer; and we may send you information about products or services that we believe may be beneficial to you. You may contact our Privacy Contact at any time to request that these marketing materials not be sent to you. We may also use or disclose your demographic information and the dates that you received treatment from you physician, as necessary, in order to contact you for fundraising activities supported by our office. If you do not want to receive fundraising materials, please contact our Privacy Contact to request that these materials not be sent to you. To the extent any marketing or fundraising activities will use or disclose to others information as to your diagnosis, the nature of the services you received, your treatment or disclosure of the place where you received services (to the extent such disclosure would identify the type of treatment or your condition), we are required to first obtain your prior authorization to use or disclose this information.

Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic products deviations, track products; to enable product recalls, to make repairs or replacements, or to conduct post-marketing surveillance, as required.

Law Enforcement and Legal Proceedings : We may disclose protected health information, so long as applicable legal requirements are met, for the following purposes: (1) to identify or locate a suspect, fugitive, material witness or missing person; (2) to the extent it is information about a victim of a crime, if, under certain limited circumstances, we are unable to obtain the person's agreement; (3) to the extent the information is about a death we believe may be the result of criminal conduct; (4) in the event that a crime occurs on the premises of the practice, (5) in a medical emergency to report a crime, the location of a crime or victims, or to identify, description or location of the person who committed the crime; and (6) we may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administration tribunal, or in certain conditions in response to a subpoena, discovery request or other lawful process.

Coroners, Funeral Directors, and Organ Donation : We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadavers, organ, eye, or tissue donation purposes.

Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

To Avert a Serious Threat to Health or Safety : Consistent with applicable federal and state laws, we may disclose your protected health information, 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.

National Security and Intelligent Actions : We may release medical information about you to authorized federal officials for intelligence, counter-intelligence and other national security activities by law.

Workers' Compensation : Your protected health information may be disclosed by us as authorized to comply with workers' compensation laws and other similar legally established programs.

Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and you physician created or received your protected health information in the course of providing care for you.

Special Situations

Others Involved in Your Health Care : Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally; we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals in your health care.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your physician or another physician in the practice is required is required by law to treat you, and the physician has attempted to obtain your consent but is unable to obtain you consent, he or she may still use or disclose your protected health information to treat you.

Communication Barriers : We may use and disclose your protected health information if you physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers, and the physician determines, using professional judgment, that you intend to consent to use or disclose under the circumstances.

2. 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 inspect and copy your protected health information.This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that your physician and the practice use for making decisions about you. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. If you are denied access to your protected health information, you may request that the denial be reviewed.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment of health care operations. You may also request that nay part of your protected health information not be disclosed to family members or friends who may be involved in you care or for notification purposes as described in this Notice of Privacy Practices. Your request must be made in writing to the Privacy Contact and must state the specific restriction requested and to whom you want the restriction to apply. You physician is not required to agree to a restriction that you may request.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. Your request must be in writing to the Privacy Contact and must specify how or where you wish to be contacted. We will accommodate reasonable requests.

You may request an amendment to your protected health information. If you review your protected health information and believe it is in error or incomplete, you may make a written request to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. The request must be made in writing to the Privacy Contact, and must contain a reason to support your request. We may deny your request for an amendment if the information sought to be amended is not part of the medical information kept by or for us, was not created by us, unless the person or entity that created the information is no longer available to make the amendment, is not part of the information which you are permitted to inspect and copy, or is, in our reasonable belief, accurate and complete. If we deny you request for amendment, we must provide you with a written explanation for the denial and an explanation of your right to submit a written statement disagreeing with the denial.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. You may make a written request to the Privacy Contact for an accounting or disclosures of your protected health information made by us for a a period up to the last six years. The first accounting request made by you within a 12-month period is free; you will be charged for additional requests within the 12-month period. The right to receive this information is subject to certain exceptions, restrictions, and limitations, including the following. We do not have the account for disclosures (i) made to carry out treatment, payment or health care operations; (ii) made to you or your representatives; (iii) to correctional institutions or law enforcement officials, or (iv) for national security or intelligence purposes.

You have the right to obtain a paper copy of this notice from us, Upon request, even if you have agreed to accept this notice electronically.

3. Complaints

If you believe your privacy rights have been violated, you may file a written complaint with the Privacy Contact or the Secretary of Health and Human Services. We may not retaliate against you for filing a complaint. You may contact the Privacy Contact at (402) 399-9305 X 111, for further information about the complaint process.

This notice was published and becomes effective on April 14, 2003.