Notice of Privacy Practices

Effective March 1, 2009

This notice describes how medical/health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Pastoral Counseling of Northern Virginia (PCNV) is deeply committed to protecting the privacy and confidentiality of its clients. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information (protected health information) used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. We are required by the HIPAA law to provide you this detailed explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

1. Uses and Disclosures with Your Authorization

Except as described in this Notice, we will use and disclose your Protected Health Information (PHI) only with your written Authorization. You may revoke an Authorization in writing at any time. If you revoke an Authorization, we will no longer use or disclose your PHI for the purposes covered by that Authorization, except where we have already relied on that Authorization.

2. How We May Use and Disclose Medical/Health Information About You

The following categories describe different ways that we may use and disclose medical/health information referred to as your Protected Health Information. While all of the categories may not apply to pastoral counseling, all of the ways we are permitted to use and disclose information fall into one of these categories.

For Treatment. We may use and disclose your PHI to provide you with pastoral counseling or services. We may disclose medical information about you only to others who are involved in providing you care at our office(s). We are not aware of any circumstance where this situation would occur. It is only with your written permission that we will disclose information to family members, friends, clergy or other professionals involved in your care.

For Payment. We may use and disclose your PHI for billing and payment purposes. This means that we may use and disclose PHI about you so that pastoral counseling and services you receive at our office(s) may be billed to you and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan a diagnostic code(s), procedure code(s), dates of service and/or amount charged so your health plan will pay us or reimburse you for pastoral counseling or services.

For Health Care Operations. We may use and disclose you PHI as necessary for our health care operations, such as management, personnel evaluation, consultation, education and training (PHI is not used in our consultation, education and training procedures) as well as quality assurance for our pastoral counseling or services.

Appointment Reminders. We may use and disclose your PHI to contact you as a reminder that you have an appointment for pastoral counseling or services at our office(s).

Treatment Alternatives and Health-Related Benefits and Services. We may use and disclose your PHI to tell you about or recommend possible treatment options or alternatives as well as health-related benefits or services that may be of interest to you.

3. Specific Uses and Special Situations

Psychotherapy Notes. HIPAA affords psychotherapy notes more protection—most notably from third-party payers—than they'd been given in the past. Under HIPAA, psychotherapy notes are the sole property and privilege of the counselor and may not be shared with anyone under any circumstance.

Under HIPAA, psychotherapy notes are defined as "notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record."

Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date. Patients do not have the right to obtain a copy of these under HIPAA except in certain States (not in Virginia). When a counselor denies a patient access to these notes, the denial isn't subject to a review process, as it is with other records.

Code of Virginia. Paragraph § 8.01-400. Communications between ministers of religion and persons they counsel or advise.

"No regular minister, priest, rabbi, or accredited practitioner over the age of eighteen years, of any religious organization or denomination usually referred to as a church, shall be required to give testimony as a witness or to relinquish notes, records or any written documentation made by such person, or disclose the contents of any such notes, records or written documentation, in discovery proceedings in any civil action which would disclose any information communicated to him in a confidential manner, properly entrusted to him in his professional capacity and necessary to enable him to discharge the functions of his office according to the usual course of his practice or discipline, wherein such person so communicating such information about himself or another is seeking spiritual counsel and advice relative to and growing out of the information so imparted."

(Code 1950, § 8-289.2; 1962, c. 466; 1977, c. 617; 1979, c. 3; 1994, c. 198.)

Individuals Involved in Your Care or Payment for Your Care. At your request and with your permission, we will disclose your PHI to you, your Personal Representative (a person who is authorized by law to act on your behalf with respect to health care matters), a friend, family member or other person you choose.

As Required By Law. We may use or disclose your PHI when required by law to do so. Any session summary notes related to your pastoral counseling will not be released without your consent unless required by law.

Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities may be audits, investigations, inspections, licensures, etc. These activities are necessary for the government to monitor the health care system, some government programs and compliance with civil rights.

Workers' Compensation. We may use or disclose your PHI for workers' compensation or similar programs.

Lawsuits and Disputes. We may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested, including motions to quash.

Law Enforcement. We may use or disclose you PHI if asked to do so by a law enforcement official, but only: in response to a court order, subpoena, warrant, summons or similar process;

• To identify or locate a suspect, fugitive, material witness or missing person;
• About the victim of a crime if, under certain limited circumstances we are unable to obtain the person's agreement;
• About a death that may be the result of criminal conduct;
• About criminal conduct at our office(s);
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who may have committed the crime.

Research. We may use or disclose your PHI for research purposes if the privacy aspects of the research have been reviewed and approved, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure.

Military, Veterans and other Specific Government Functions. If you are a member of the armed forces, we may use and disclose your PHI as required by military command authorities. We may use and disclose your PHI to authorized federal officials for national security purposes, intelligence, counterintelligence and other national security activities authorized by law. We may use and disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your PHI to a coroner, medical examiner, funeral directors, or, if you are an organ donor, to an organ procurement organization.

To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclose, however, would only be to someone able to help prevent the threat.

Reporting Victims of Abuse, Neglect or Domestic Violence. If we suspect that you have been the victim of abuse, neglect or domestic violence, we may use and disclose your PHI to notify a government authority if authorized by law or if you agree to the report.

Inmates/Law Enforcement Custody. If you are under the custody of a law enforcement official or a correctional institution, we may use and disclose your PHI to the official or institution for certain purposes including the health and safety of you and others.

4. Your Rights Regarding Health Information About You

Listed below are rights you may have regarding your PHI. Each of these rights is subject to certain requirements, limits and exceptions. Exercise of these rights requires submitting a written request to PCNV. At your request, PCNV will provide you with the appropriate form to complete. You have the right to:

Request Restrictions. You have the right to request restrictions on our use and disclosure of your PHI for treatment, payment, or health care operations. You also have the right to request restrictions one your PHI we disclose about you to a family member, friend or other person who is involved in your care or the payment of your care. Your request must be in writing.

We are not required to agree with your requested restriction (except that if you are mentally competent, you may restrict disclosures to family members or friends). If we do agree to accept your requested restriction, we will comply with your request except as needed to provide to emergency treatment or in accordance with federal and state laws.

Access to Personal Health Information. You have the right to inspect and obtain a copy of your clinical or billing records or other written information that may be used to make decisions about your care, subject to some exceptions. Your request must be in writing. In most cases we may charge a reasonable fee for our costs in copying and mailing your requested information.

We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to health information, in some cases you have a right to request review of the denial. This review would be performed by an equivalent professional that did not participate in the decision to deny.

Request Amendment. You have the right to request amendment of your PHI maintained by PCNV for as long as the information is kept by PCNV (usually seven years). Your request must be in writing and must state the reason for the requested amendment. We may deny your request for an amendment if the information was not (a) created by PCNV, unless the originator of the information is no longer available to act on your request; (b) is not part of the health information maintained by PCNV; (c) is not part of the information to which you have the right of access; or (d) is already accurate and complete, as determined by PCNV.

Request an Accounting Disclosure. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of you PHI. Your request must be in writing.

Request Confidential Communications by Alternative Means. You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. For example, you can ask that we only contact you at home, or at work, or by mail. Your request must be in writing and must be very specific as to how you would like that we communicate with you or not communicate with you. We will not ask you the reason for your request. We will accommodate all reasonable requests.

Right to a Paper Copy of this Notice. You have the right to request a paper copy of this notice. You may ask us to give you a copy of this notice at any time and one will be furnished to you in a reasonable amount of time (usually immediately). You may also obtain a copy of this notice at our website www.PastoralCounselingNV.com.

5. Changes to This Notice

We are allowed to reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI that we have already as well as any information we receive in the future. We will post a copy of the current notice with the effective date on our website as well as in our office(s)

6. For Further Information or to File a Complaint

You have the right to request additional information and/or to file a formal written complaint regarding our privacy practices from us and from the Office of Civil Rights in the U.S. Department of Health and Human Services.

Privacy Practices
Pastoral Counseling of Northern Virginia
4094 Majestic Lane #237
Fairfax, VA 22033-2104

The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201