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*** If YOU NEED EMERGENCY HELP , PLEASE CALL 911 or call OR CALL OR SEND A TEXT TO 988 (988lifeline.org) AND YOU'LL BE CONNECTED TO SOMEONE WHO CAN HELP YOU *** LIFEWATCH THERAPY & COUNSELING PRIVACY POLICY *** SMS TERMS AND CONDITIONS LIFEWATCH THERAPY & COUNSELING is a private, out-patient Psychotherapy Practice and SMS messages sent to you will provide information about registering and scheduling appts; contacting Administrative or Billing Staff or answering insurance and claims-related questions you may have about your care. You can cancel the SMS service at any time. Simply text "STOP" to the number provided. Upon sending "STOP," we will confirm your unsubscribe status via SMS. Following this confirmation, you will no longer receive SMS messages from us. To rejoin, sign up as you did initially, and we will resume sending SMS messages to you. If you experience issues with the messaging program, reply with the keyword HELP for more assistance, or reach out directly by calling 757-271-2953 and leaving a voice message or emailing Robin Shelton, LCSW at rshelton51867@gmail.com Carriers are not liable for delayed or undelivered messages. As always, message and data rates may apply for messages sent to you from us and to us from you. Message frequency varies. For questions about your text plan or data plan, contact your wireless provider. *** WE DO NOT SELL OR SHARE YOUR SMS CONSENT AND PHONE NUMBERS WITH ANY THIRD PARTY UNDER ANY CIRCUMSTANCES *** LIFEWATCH THERAPY & COUNSELING maintains strict privacy policies, ensuring that maintains strict privacy policies, ensuring that personal information and mobile information of our users and members is not sold, shared, rented, released, or traded to third parties for marketing/promotional purposes. *** THANK YOU FOR REACHING OUT Perhaps you've learned about therapy services at LIFEWATCH THERAPY & COUNSELING through the "Find a Therapist" feature on the Psychology Today Website. Or maybe you've been referred; by a friend, family member, medical provider or your insurance company. No matter how you got here, we look forward to communicating with you about your interest in pursuing Individual, couples, marital and family telehealth therapy services. And we offer a 15-20 minute free "getting to know you" interview so that we can better determine whether or not it seems like I would be "the right fit" for the needs you've identified. *** IN ORDER TO INSURE THAT YOU ARE COMPLETELY ADVISED ABOUT THE METHODS WE USE TO COMMUNICATE WITH YOU AND MAINTAIN THE SECURITY OF YOUR PHI we are providing a clear explanation for how we insure your privacy and respond correctly to your communication requests: *** THERAPYNOTES is the electronic medical records system used to create and store medical records; both those which are sent from another source and those which document the care you receive here. *** RING CENTRAL is the phone/email/text dedicated phone line used for phone contact or Voice Mail, email messages and text messages. *** DOXY.ME is the telehealth platform you'll use for all telehealth contacts. Once you begin scheduling therapy session appointments you'll be provided the link to the Doxy platform and this link will remain the same every time you log on for a session. Each of these documentation and communication tools are HIPPA compliant. *** THIS IS HOW YOU CAN MAINTAIN CONTROL OVER THE COMMUNICATION METHODS YOU REQUEST When you initially contact LIFEWATCH THERAPY & COUNSELING ( https://www.lifewatch-therapy.com) and ask for information or follow up, we receive your request by email, via the Psychology Today Find A Therapist web site page at https://psychologytoday.com or by voice mail at the business line; 757-271-2953 or by text message at 757-271-2953 If our initial contact is by phone ie - you place a call and its answered immediately ( it could happen !) or you leave a message and we call you back; you will be verbally asked if you are giving permission for email, voice mail and/or text messages. Once you indicate your preference for contact, this will be documented. Additionally, when you register as a new patient you'll be asked to indicate the way in which you want to be contacted on the Patient Information Form and this form will be kept on file. *** LIFEWATCH THERAPY & COUNSELING is committed to protecting your Health Information, otherwise, referred to as "PHI". Federal law requires that your PHI be maintained carefully and confidentially in order to protect your privacy. PHI is any information obtained in order to provide your care which could be used to identify you. *** THE FOLLOWING EXPLAINS how LIFEWATCH THERAPY & COUNSELING may use and disclose your PHI in accordance with the Health Insurance Portability and Accountability Act ( HIPPA ), regulations, including HIPAA Privacy and Security Rules and applicable laws mandated in the State of Virginia. If it ever becomes necessary to modify or otherwise change any of these privacy practices, the change in management of your PHI will apply to all information which we have obtained in order to provide your care. A copy of the document explaining the up to date revisions made in the management of your PHI will be posted on your patient portal. *** FOR TREATMENT: Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating or managing your healthcare treatment and related services. This includes consultation with clinical supervisors or other treatment team members who are directly affiliated with LIFEWATCH THERAPY & COUNSELING. Any Clinical Consultation related to the care you receive at LIFEWATCH THERAPY & COUNSELING with other ( outside) medical or behavioral health providers from whom you receive services will be conducted only after you have authorized such contact; by signing a Release of Information form, which specifies the nature, content, form and time frame within which any such communication occurs. *** FOR PAYMENT: LIFEWATCH THERAPY & COUNSELING may use and disclose PHI so that we can receive payment for treatment services provided to you. This will not be done unless you specifically authorize these disclosures in writing. *** EXAMPLES OF PAYMENT - RELATED SERVICES: making a determination of eligibility or coverage for insurance benefits processing claims with your insurance company reviewing services provided to you to determine medical necessity undertaking utilization review activities If it becomes necessary to use collection processes due to lack of payment for services, only the minimum amount of PHI will be disclosed. *** FOR HEALTH CARE OPERATIONS LIFEWATCH THERAPY & COUNSELING may use or disclose, as needed; your PHI in order to support business activities, including, but not limited to, quality assessment activities, licensing and conducting or arranging for other business services, such as billing or typing. Any service provided to LIFEWATCH THERAPY & COUNSELING by business, auditing or licensing entities will only occur with a Business Associate Agreement with that entity which clearly outlines their legal commitment to maintaining the confidentiality of your PHI. ***REQUIRED BY LAW: Under federal and state law, you are entitled to and must receive your PHI upon your request. In addition, federal law requires LIFEWATCH THERAPY & COUNSELING make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with HIPPA requirements. *** WITHOUT AUTHORIZATION: The following is a list of the categories of uses and disclosures permitted by HIPPA without your authorization. Applicable law and ethical standards outlined by the Virginia State Board of Social Work requires the disclosure of your PHI without your authorization in only a limited number of situations. As a provider of Licensed Mental Health Services the following reasons for disclosure, as per the Code of Ethics and HIPPA requirements are as follows: *** CHILD ABUSE OR NEGLECT Licensed Mental Health Providers are mandated reporters and must disclose PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect. ***JUDICIAL and ADMINISTRATIVE PROCEEDINGS Your PHI may be disclosed pursuant to a subpoena ( with your written consent), court order, administrative order or similar process. ***DECEASED PATIENTS LIFEWATCH THERAPY & COUNSELING may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend who was involved in your care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person's estate or the person identified as next-of -kin. PHI of persons that have been deceased for more than 50 years is not protected under HIPPA. *** MEDICAL EMERGENCIES LIFEWATCH THERAPY & COUNSELING may use or disclose your PHI in medical emergency situations to medical personnel only in order to prevent serious harm. *** FAMILY INVOLVEMENT IN CARE Disclosure of your PHI to close family members or friends directly involved in your care may occur, based on your written or verbal consent ( verbal consent will be documented and a copy of this documentation will be uploaded to your patient portal) or as necessary to prevent serious harm. *** HEALTH OVERSIGHT PHI disclosure required by Health oversight agency for activities authorized by law, such as audits, investigations and inspections may occur. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance ( such as third party payors based on your prior consent ) and peer review organizations performing utilization and quality control. *** LAW ENFORCEMENT PHI disclosures will be made to law enforcement as required by law, in compliance with a subpoena ( with your written consent ), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency or in connection with a crime on the premises. *** SPECIALIZED GOVERNMENT FUNCTIONS LIFEWATCH THERAPY & COUNSELING may review requests from U.S. military command authorities if you have served as a member of the armed forces, from authorized officials for national security and intelligence reasons and for medical suitability determinations. Your PHI may be disclosed; based on your written consent. In the event that mandatory disclosure laws and the need to prevent serious harm require disclosure of your PHI you will be advised of such, except when to do so would endanger you or a family member or friend. ***PUBLIC HEALTH If required by law, LIFEWATCH THERAPY & COUNSELING may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury or disability; or if directed by a public health authority, to a government agency that is collaborating with that public health authority. *** PUBLIC SAFETY LIFEWATCH THERAPY & COUNSELING may use or disclose your PHI if necessary to prevent or lessen a serious and imminent threat to health or safety of a person or to the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat. *** WORKER'S COMPENSATION : To comply with workers' compensation laws or support claims. ***TO COMPLY WITH OTHER REQUESTS Coroners and Funeral Directors: To perform their legally authorized duties. Inmates: The Practice created or received your PHI in the course of providing care. Business Associates: To organizations that perform functions, activities or services on our behalf. RESEARCH *** LIFEWATCH THERAPY & COUNSELING will disclose your PHI only with your written or verbal authorization. Generally, you will complete a release of information form online, which you'll find on your Patient Portal. VERBAL AUTHORIZATION: Your PHI will be used or disclosed to family members or friends directly involved with your care; with your verbal permission. VERBAL AUTHORIZATION WILL BE DOCUMENTED AND UPLOADED TO YOUR PATIENT PORTAL. WRITTEN AUTHORIZATION: LIFEWATCH THERAPY & COUNSELING will disclose your PHI only with your written authorization, which may be revoked by you at any time, except to the extent that disclosures have previously been made as per your written consent. The following disclosures of your PHI requiring your written consent are as follows: * most uses and disclosures of your psychotherapy notes which are separated from the rest of your medical record; * copies of your record of care provided with LIFEWATCH THERAPY & COUNSELING * specific requests made by you; ie - a request for a letter justifying the need for an emotional support animal. ***YOUR RIGHTS Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address provided. RIGHT OF ACCESS TO INSPECT AND COPY PHI MAINTAINED IN A DESIGNATED RECORD SET A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your access to these records will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is contained in separately maintained psychotherapy notes; or if the information was sent to LIFEWATCH THERAPY & COUNSELING from another source or provider. You have a right to have this decision reviewed. TO AMEND PHI You can ask to correct PHI you believe is incorrect or incomplete . Your request will be documented and any modifications made to your PHI will also be documented and you will be advised of such; and when you've been advised as to the changes made that will be documented as well. However, LIFEWATCH THERAPY & COUNSELING is not required to make amendments to the PHI contained. If your request is denied, you will receive a written explanation for the denial and you will be allowed to submit a written statement of disagreement. TO REQUEST CONFIDENTIAL COMMUNICATIONS You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests. TO LIMIT THE USE OR SHARING OF YOUR PHI You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer. You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply. TO OBTAIN A LIST OF THOSE WITH WHOM YOUR PHI HAS BEEN SHARED You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently. Generally, the only outside party with whom your PHI would be shared would be your insurance company. You will receive written documentation of any claims filed from your insurance company and if at any time you wish to receive a "superbill" outlining your dates of service, the charge and the claim filed, that can be provided; usually via your portal. TO RECEIVE A COPY OF THIS NOTICE This notice is a copy of the Privacy Practices Document you will review when you register for services and it will be available for your review any time you wish; it can also be downloaded and printed. TO CHOOSE SOMEONE ELSE TO ACT FOR YOU If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights. TO FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS HAVE BEEN VIOLATED •You can file a complaint by contacting the Practice: LIFEWATCH THERAPY & COUNSELING 109 G Gainsborough Square, #185 Chesapeake, Virginia, 23320 Robin Shelton, LCSW, PLLC https://www.lifewatch-therapy.com 757-271-2953 • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. • LIFEWATCH THERAPY & COUNSELING WILL NEVER RETALIATE AGAINST YOU FOR FILING A COMPLAINT * TO OPT OUT OF RECEIVING FUNDRAISING COMMUNICATIONS: We will not contact you for any fundraising reason, ever, at any time. If a patient asks for a donation referral; one will be provided. You may revoke any authorization you have provided, at any time, by contacting the Practice in writing, using the information above. The Practice will not use or share PHI other than as described in Notice unless you give your permission in writing. OUR RESPONSIBILITIES • The Practice is required by law to maintain the privacy and security of PHI. • The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law. • The Practice reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy which will automatically be uploaded to your patient portal. • The Practice will inform you if PHI is compromised in a breach. And we all pray that that will never happen ! *** If YOU NEED EMERGENCY HELP , PLEASE CALL 911 or call OR CALL OR SEND A TEXT TO 988 (988lifeline.org) AND YOU'LL BE CONNECTED TO SOMEONE WHO CAN HELP YOU *** This Notice is effective on January 4, 2024
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