Notice of Informed Consent and Privacy Practices
For RnR Therapy LLC
5010 Mayfield Road, Suite #105, Lyndhurst, OH 44124
THIS NOTICE DESCRIBES CLIENT RIGHTS AND PRIVACY PRACTICES. PLEASE REVIEW IT CAREFULLY.
Dear Client,
Therapy is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in counseling, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. These rights and responsibilities are described in the following sections.
Counseling. Counseling has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of counseling often requires discussing the unpleasant aspects of your life. However, counseling has been shown to have benefits for individuals who undertake it and often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress, and resolutions to specific problems. While there are no guarantees, RnR Therapy counselors work collaboratively with clients to ensure best outcomes.
Unconditional positive regard and trust forms the foundation of the counseling relationship. At RnR Therapy, we have the responsibility to respect and safeguard your right to privacy and confidentiality. We understand that your health information is personal to you, and we are committed to protecting the information about you. Counselors request private information from clients only when it is beneficial to the counseling process. We rely on you to give us complete and accurate information about your condition, symptoms and health history to provide you with professional mental wellness services. We appreciate how you trust us with this information.
This Notice of Privacy Practices (or “Notice”) describes how we will use and disclose protected information and data that we receive or create related to your counseling services as well as your rights regarding your private information. We are required by law to maintain the privacy of your health record and to give you this Notice describing our legal duties and privacy practices. If you have any questions about our Privacy Practices, including your rights and ability to voice your concerns, please call 216.714.2682 or email robin.rnrtherapy@gmail.com.
Clinical Records. RnR Therapy LLC, as prescribed by the American Counseling Association Code of Ethics, create and maintain records and documentation necessary for rendering professional services. RnR Therapy LLC staff ensures that records and documentation are secure and only authorized persons have access to them. Documentation includes intake information (identifying information, treatment history, consent forms for treatment, release of information forms when appropriate, and other pertinent data collected to support treatment), treatment goals and progress, progress notes, payment record and if applicable, records received and/or sent to other providers with client consent.
Client Access to Records. RnR Therapy may provide reasonable access to records and copies of records when requested by competent clients. Counselors limit the access to records, or portions of one’s record, when there is compelling evidence that such access would cause harm to the client. In situations involving multiple clients, such as couples counseling or group therapy, counselors provide individual clients with only those parts of records that relate directly to them and do not include confidential information related to any other client.
To inspect or copy your clinical record. You must submit your request in writing to RnR Therapy LLC. As stated above, there are a few limited situations in which we can refuse to permit access or copying. For the most part, however, you will be able to review or have a copy of your record within 30 days of your request. You may be charged a fee for the cost of copying and mailing in advance. If you are denied access to your record, we will send you a written explanation. You may request that the denial be reviewed. Another licensed health care professional will then review your request and the denial. The person conducting the review will not be the person who denied your request. RnR Therapy LLC will comply with the outcome of the review.
How We May Use and Disclose Health Information About You. The most common reason why we use or disclose your health information is for treatment, payment, or health care operations. Your medical records are used to provide treatment, bill and receive payments, and conduct healthcare operations. Examples of these activities include, but are not limited, to review treatment records to ensure appropriate care, electronic or mail delivery of billing for treatment to you or other authorized payers, appointment reminder telephone calls, and records review to ensure completeness and quality of care. Use and disclosure of medical records is limited to the internal use by RnR Therapy LLC except when required by law or authorized by the client or legal representation.
Appointment Reminders: We will call to remind you of scheduled appointments, missed appointments, or that it is time to make your appointment. We may also call or write to notify you of other treatments or services available that might benefit you. Unless you tell us otherwise, we will leave you a reminder message by way of voice mail, text and/or email.
Payment: We will use and disclose your personal information to obtain or provide compensation or reimbursement for providing your health care. For example, a bill will be sent to you if you have an outstanding balance or to an outside collection agency if your account becomes delinquent. The information on or accompanying the bill may include information that identifies you.
Health Care Operations: We will use and disclose your health information to deal with certain administrative aspects of your health care and to efficiently manage our business; for example, financial or billing audits, internal quality assurance, participation in managed care plans, defense of legal matters, business planning, and outside storage of our records.
Public Health: Federal and State laws require counselors to be mandated reporters of abuse, neglect, domestic violence and threats. As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including harm to self, harm to others or others harming the client.
Abuse, Neglect or Domestic Violence: We may disclose your health information to appropriate governmental agencies, such as adult protective or social services agencies, if we reasonably believe you are a victim of abuse, neglect or domestic violence.
Law Enforcement: Under certain circumstances, we may disclose your health information to law enforcement officials. These circumstances include reporting required by certain laws pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, crimes in emergencies, or to protect your health and safety or the health and safety of others.
We may not make any other use or disclosure of your personal health information without your written authorization. Once given, you may revoke the authorization in writing to RnR Therapy LLC. Understandably, we are unable to take back any disclosure we have already made with your permission.
Individual Rights: You have client rights concerning the confidentiality of your health information. You have the right:
· To request restrictions on the health information we may use and disclose for treatment, payment and health care operations. We are not required to agree to these requests. To request restrictions, please send a written request to RnR Therapy LLC.
· To receive confidential communications of health information about you in a certain manner or at a certain location. For instance, you may request that we only contact you at work or by mail. To make such a request, send a written request of how or where you wish to be contacted to RnR Therapy LLC.
To amend health information. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must write to RnR Therapy LLC. You must also give us a reason to support your request. A request for disclosure may be denied under the following circumstances: disclosure would likely endanger the life or physical safety of you or another person, requested information references other persons, except another healthcare provider, or if released to a legal representative would likely result in harm. We may also deny your request if: 1. The information was not created by us, unless the person who created the information is no longer available to make the amendment; 2. The information is not part of the health information kept by or for us; 3. The information is not part of the information you would be permitted to inspect or copy; or 4. The information is accurate and complete.
To receive an accounting of disclosures of your health information, you must submit a request in writing to RnR Therapy LLC. Not all health information is subject to this request. Your request must state a time period of no longer than six years. Your request must state how you would like to receive the report. There may be a charge for this service. We will notify you of this cost and you may choose to withdraw or modify your request before charges are incurred.
Complaints: If you believe that your privacy rights have been violated, please contact RnR Therapy LLC. You may also submit a complaint to the Secretary of the Department of Health and Human Services. RnR Therapy LLC will not retaliate against you for filing a complaint.
Changes to This Notice. RnR Therapy LLC reserves the right to change our privacy practices and to apply the revised practices to the health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, you will be notified of any such change. Revisions will be posted on our Web site.
Updated 10.14.19