OFFICE POLICIES & PROCEDURES

 

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 the Privacy Officer. contact@rx14health.com

Effective Date: July 1, 2024 

​

HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT (HIPAA)

This document contains important information about federal law, the Health Insurance Portability and Accountability Act (HIPAA), that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations.

HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice explains HIPAA and its application to your PHI in greater detail.

We are required by law to maintain the privacy of your PHI. We will follow the terms outlined in this Notice. We may change our Notice, at any time. Any changes will apply to all PHI. Upon your request, we will provide you with any revised Notice by:

• Posting the new Notice in our office.

• If requested, making copies of the new Notice available in our office or by mail.

• Posting the revised Notice on our website.

​

USES AND DISCLOSURES OF PHI 

We may use or disclose (share) your PHI to provide health care treatment for you.

Your PHI may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you.

EXAMPLE: Your PHI may be provided to a physician to whom you have been referred for evaluation to ensure that the physician has the necessary information to diagnose or treat you. We may also share your PHI from time-to-time with another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance, to your physician, with your health care diagnosis or treatment.

We may also share your PHI with people outside of our practice that may provide medical care for you such as home health agencies.

We may use and disclose your PHI to obtain payment for services. We may provide your PHI to others in order to bill or collect payment for services. There may be services for which we share information with your health plan to determine if the service will be covered.

​

PHI may be shared with the following:

• Billing companies

• Insurance companies, health plans

• Government agencies in order to assist with qualification of benefits.

• Collection agencies

​

EXAMPLE: You are seen at our practice for a procedure. We will need to provide a listing of services such as x-rays to your insurance company so that we can get paid for the procedure. We may at times contact your health care plan to receive approval PRIOR to performing certain procedures to ensure the services will be covered. This will require sharing of your PHI.

​

We may use or disclose, as needed, your PHI in order to support the business activities of this practice, which are called health care operations.

​

EXAMPLES: Training students, other health care providers, or ancillary staff such as billing personnel to help them learn or improve their skills. Quality improvement processes which look at delivery of health care and for improvement in processes which will provide safer, more effective care for you. Use of information to assist in resolving problems or complaints within the practice.

​

We may use and disclosure your PHI in other situations without your permission:

If required by law: The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. For example, we may be required to report suspected abuse or neglect. Public health activities: The disclosure will be made for the purpose of controlling disease, injury or disability and only to public health authorities permitted by law to collect or receive information. We may also notify individuals who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition. Health oversight agencies: 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. Legal proceedings: To assist in any legal proceeding or in response to a court order, in certain conditions in response to a subpoena, or other lawful process. Police or other law enforcement purposes: The release of PHI will meet all applicable legal requirements for release. Coroners, funeral directors: 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 Medical 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. Special government purposes: Information may be shared for national security purposes, or if you are a member of the military, to the military under limited circumstances. Correctional institutions: Information may be shared which is necessary for your health or the health and safety of other individuals if you are an inmate or under custody of 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.

 

Other uses and disclosures of your health information.

Business Associates: Some services are provided through the use of contracted entities called “business associates”. We will always release only the minimum amount of PHI necessary so that the business associate can perform the identified services. We require the business associate(s) to appropriately safeguard your information. Examples of business associates include billing companies, collection agencies or transcription services. Health Information Exchange: We may make your health information available electronically to other healthcare providers outside of our facility who are involved in your care. Treatment alternatives: We may provide you notice of treatment options or other health related services that may improve your overall health.

​

Appointment reminders: We may contact you as a reminder about upcoming appointments or treatment.

We may use or disclose your PHI in the following situations UNLESS you object.

We may share your information with friends or family members, or other persons directly identified by you at the level they are involved in your care or payment of services. If you are not present or able to agree/object, the healthcare provider using professional judgment will determine if it is in your best interest to share the information. For example, we may discuss post procedure instructions with the person who drove you to the facility unless you tell us specifically not to share the information. 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. We may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts.

​

The following uses and disclosures of PHI require your written authorization: Marketing

​

Disclosures for any purposes which require the sale of your information All other uses and disclosures not recorded in this Notice will require a written authorization from you or your personal representative. Written authorization simply explains how you want your information used and disclosed. Your written authorization may be revoked at any time, in writing. Except to the extent that your doctor or this practice has used or released information based on the direction provided in the authorization, no further use or disclosure will occur.

​

CLIENT RIGHTS AND CLINICIANS DUTIES

Use and Disclosure of Protected Health Information:

• For Treatment – We use and disclose your health information internally in the course of your treatment. If we wish to provide information outside of our practice for your treatment by another health care provider, we will have you sign an authorization for release of information. Furthermore, an authorization is required for most uses and disclosures of psychotherapy notes.

• For Payment – We may use and disclose your health information to obtain payment for services provided to you as delineated in the Therapy Agreement.

• For Operations – We may use and disclose your health information as part of our internal operations. For example, this could mean a review of records to assure quality. We may also use your information to tell you about services, educational activities, and programs that we feel might be of interest to you.

​

PATIENTS RIGHTS

Right to Treatment – You have the right to ethical treatment without discrimination regarding race, ethnicity, gender identity, sexual orientation, religion, disability status, age, or any other protected category. Right to Confidentiality – You have the right to have your health care information protected. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will agree to such unless a law requires us to share that information. Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, we are not required to agree to a restriction you request. Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI. Records must be requested in writing and release of information must be completed. Furthermore, there is a copying fee charge of $1.00 per page. Please make your request well in advance and allow 2 weeks to receive the copies. If we refuse your request for access to your records, you have a right of review, which we will discuss with you upon request. Right to Amend – If you believe the information in your records is incorrect and/or missing important information, you can ask us to make certain changes, also known as amending, to your health information. You have to make this request in writing. You must tell us the reasons you want to make these changes, and we will decide if it is and if I refuse to do so, we will tell you why within 60 days. Right to a Copy of This Notice – If you received the paperwork electronically, you have a copy in your email. If you completed this paperwork in the office at your first session a copy will be provided to you per your request or at any time. Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI regarding you. On your request, I will discuss with you the details of the accounting process. Right to Choose Someone to Act for You – If someone is your legal guardian, that person can exercise your rights and make choices about your health information; we will make sure the person has this authority and can act for you before we take any action. Right to Choose – You have the right to decide not to receive services and its providers. If you wish, we will provide you with names of other qualified professionals. Right to Terminate – You have the right to terminate therapeutic services with us at any time without any legal or financial obligations other than those already accrued. We ask that you discuss your decision with your clinician in session before terminating or at least contact us by phone letting us know you are terminating services. Right to Release Information with Written Consent – With your written consent, any part of your record can be released to any person or agency you designate. Together, we will discuss whether or not we think releasing the information in question to that person or agency might be harmful to you.

 

Clinician's Duties: We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI. We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect. If we revise our policies and procedures, we will provide you with a revised notice in office during our session.

By checking the box and submitting the intake privacy form you indicate that you have read this agreement and agree to its terms and also serves as acknowledgement that you have received the HIPAA notice form described above.

​

INFORMED CONSENT

I understand practice policies, HIPAA and consent. I have discussed any questions that I have regarding this information with RX14 Health PLLC/ The Pageant RX. By completing intake froms and having an appointment,  I am voluntarily giving my informed consent to receive therapy and/or medication management services and agree to abide by the agreement and policies listed in this consent. I authorize RX14 Health PLLC/The Pageant RX and/or its providers to provide therapy and/or medication management services that are considered necessary and advisable.

​

I authorize the release of treatment and diagnosis information necessary to process bills for services and request payment of benefits to RX14 Health PLLC/The Pageant RX. I acknowledge that I am financially responsible for payment whether or not covered by insurance. I understand, in the event that fees are not covered by insurance, RX14 Health PLLC/The Pageant RX may utilize payment recovery procedures after reasonable notice to me, including a collection company or collection attorney.

​

Consent to Treatment of Minor Child(ren): I hereby certify that I have the legal right to seek mental health treatment for minor(s) in my custody and give permission to RX14 Health PLLC/The Pageant RX and its providers to provide treatment to my minor child(ren). If I have unilateral decision-making capacity to obtain mental health services for my minor, I will provide the appropriate court documentation to RX14 Health PLLC/The Pageant RX prior to or at the initial session. Otherwise, I will have the other legal parent/guardian sign this consent for treatment prior to the initial session.

​

Consent to Telehealth: Telehealth is typically an electronic transmission of data, using video calling, using technologies provided by the electronic health record, for improved patient access and convenience, which can result in a better patient care experience. Telehealth does have some considerations:

The inability to have direct, physical contact with the patient is a primary difference between telehealth and direct in-person service delivery. I agree that the clinician determines whether or not the condition being diagnosed and/or treated is appropriate for a telemedicine encounter.

​

The knowledge, experiences, and qualifications of the EHR providing data and information to the provider of the telehealth services need not be completely known to and understood by the practice. RXNT does take active and layered security measures with the use of telemedicine technologies.

In addition, the quality of transmitted data may affect the quality of services provided by the provider. The patient agrees to hold the clinician and RX14 Health PLLC/The Pageant RX harmless for information lost due to technical failures.The practice may, in some cases, be required to forward patient-identifiable information to a third party, for instance upon request by your insurance company. This is not different than the requirements for other non-telehealth medical records.

​

Complaints

If you think we have violated your rights or you have a complaint about our privacy practices you can contact:

Privacy Officer
Mail: 2711 Buford Road Suite #122 North Chesterfield, VA 23235

You may also complain to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. If you file a complaint we will not retaliate against you for filing a complaint.

​

This notice was published and becomes effective on July 1, 2024