Samaritan San Angelo

Samaritan - a non-profit agency providing basic outpatient mental health services to the citizens of San Angelo and the Concho Valley

Samaritan

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Privacy Practices

Notice of the Samaritan Counseling Center Privacy Practices

This notice tells you how we make use of your health information at our Center, how we might disclose your health information to others, and how you can get access to the same information.

Please review this notice carefully and feel free to ask for clarification about anything in this material you might not understand. The privacy of your health information is very important to us and we want to do everything possible to protect that privacy.

We have a legal responsibility under the laws of the United States and the state of Texas to keep your health information private. Part of our responsibility is to give you this notice about our privacy practices. Another part of our responsibility is to follow the practices in this notice.

This notice takes effect on April 14, 2003 and will be in effect until we replace it. We have the right to change any of these privacy practices as long as those changes are permitted or required by law.

Any changes in our privacy practices will effect how we protect the privacy of your health information. This includes health information we will receive about your or that we create here at the Samaritan Counseling Center. These changes could also effect how we protect the privacy of any of your health information we had before the changes.

When we make any of these changes, we will also change this notice and give you a copy of the new notice. When you are finished reading this notice, you may request a copy of it at no charge to you. If you request a copy of this notice at any time in the future, we will give you a copy at no charge to you.

If you have any questions or concerns about t the material in this document, please ask us for assistance, which we will provide at no charge to you.

Here are some examples of how we use and disclose information about your health information.

We may use or disclose your health information...

• To your physician or other healthcare provider who is also treating you.
• To anyone on our staff involved in your treatment program.
• To any person required by federal, state, or local laws to have lawful access to your treatment program.
• To receive payment from a third party payer for services we provide for you.
• To our own staff in connection with our Center's operations. Examples of these include, but are not limited to the following: evaluating the effectiveness of our staff, supervising our staff, improving the quality of our services, meeting accreditation standards, and in connection with licensing, credentialing, or certification activities.
• To anyone you give us written authorization to have your health information, for any reason you want. You may revoke this authorization in writing anytime you want. When you revoke an authorizations it will only effect your health information from that point on.
• To a family member, a person responsible for your care, or your personal representative in the event of an emergency. If you present in such a case, we will give you an opportunity to object. If you object, or are not present, or are incapable of responding, we may use or disclose your health information in your best interest at that time. In so doing, we will only use or disclose the aspects your health information that is necessary to respond to the emergency
• To the appropriate State agency if, we suspect the neglect or abuse of a minor or adult. If, in our professional judgment, we believe that a patient is threatening serious harm to another, we are required to take protective action, which may include notifying the police, or seeking the client's hospitalization. If a client threatens to harm him or herself, we may be required to seek hospitalization.

We will not use your health information in any of our Center's marketing, development, public relations, or related activities without your written authorization. We cannot use or disclose your health information in any ways other than those described in this notice unless you give us written permission.

As a client of the Samaritan Counseling Center, you have these important rights:

1. With limited exceptions, you can make a written request to inspect your health information that is maintained by us for our use.
2. You can ask us for photocopies of the information in "1" above.
3. You will not be charged for copies made here at the Center and picking them up. If you need copies of your health information due to a Third party request, we will charge a fee of $25.00 for the first 10 pages, then $1.00 for each additional page.
4. You have the right to a copy of this notice at no charge.
5. You can make a written request to have us communicate with you about your health information by alternative means, at an alternative location. (An example would be if you request that we contact you on an alternative phone number other than your residence, or if your primary language is not spoken at this Center). Your written request must specify the alternative means and location.
6. You can make a written request that we place other restrictions on the ways we use or disclose your health information. We may deny any or all of your requested restrictions. If we agree to these restrictions, we will abide by them in all situations except those which, in our professional judgment, constitute an emergency.
7. You can make a written request that we amend the information in part "1" above.
8. If we approve your written amendment, we will change our records accordingly. We will also notify anyone else who may have received this information, and anyone else of your choosing.
9. If we deny your amendment, you can place a written statement in our records disagreeing with our denial of your request.
10. You may make a written request that we proved you with a list of those occasions where we or our business associates disclosed your health information for purposes other than treatment, payment, or our Center's operations. This ca go back as far as six years, but not before April 14, 2003.
11. If you request the accounting in "10" above more than once in a 12 month period we may charge you a fee based on our costs of tabulating these disclosures.
12. If you believe we have violated any of your privacy rights, or your disagree with a decision we have made about any of your rights in this notice you may complain to us in writing to the following person

    Compliance Officer: Angela R. Clayton
    Telephone: 325-944-2561
    Fax: 325-653-4218
    Address: 242 N. Magdalen, San Angelo, TX 76903

*You may also submit a written complaint to the United States Department of Health and Human Services. We will provide you with that address upon written request.