Notice of Privacy Practices | Authentic Services

Authentic Therapeutic Services L.L.C.

Caroline Kading, LMFT

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

NOTICE OF PRIVACY PRACTICES (NPP)

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.

I am required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices (“Notice”). I must abide by the terms of this Notice, and I must notify you if a breach of your unsecured PHI occurs. I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

Except for the specific purposes set forth below, I will use and disclose your PHI only with your written authorization (“Authorization”). It is your right to revoke such Authorization at any time by giving me written notice of your revocation.

Uses (Inside Practice) and Disclosures (Outside Practice) Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Written Consent. I can use and disclose your PHI without your Authorization for the following reasons:

For your treatment. I can use and disclose your PHI to treat you, which may include disclosing your PHI to another health care professional. For example, if you are being treated by a physician or a psychiatrist, I can disclose your PHI to him or her to help coordinate your care, although my preference is for you to give me an Authorization to do so.
To obtain payment for your treatment. I can use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you. For example, I might send your PHI to your insurance company to get paid for the health care services that I have provided to you, although my preference is for you to give me an Authorization to do so.
For health care operations. I can use and disclose your PHI for purposes of conducting health care operations pertaining to my practice, including contacting you when necessary. For example, I may need to disclose your PHI to my attorney to obtain advice about complying with applicable laws.

Certain Uses and Disclosures Do Not Require Your Authorization. Subject to certain limitations mandated by law, I can use and disclose your PHI without your Authorization for the following reasons:

Serious Threat To Health of Safety-- If I believe that you present a clear and imminent risk of serious physical harm to another person; I may disclose any necessary information to help protect the threatened individual. If I believe there is a clear and imminent risk that you will physically harm yourself; I may disclose any necessary information to seek hospitalization or other treatment for you, or to contact any person involved in your protection (ex. Parent/guardian).
Abuse of a Child of Vulnerable Adult-- If I reasonably believe that a child of vulnerable adult, either in treatment with the therapist or not, is being abused or neglected, the law requires that I file a report with the appropriate authorities.
Judicial and Administrative Proceedings-- If you are involved in a judicial proceeding and a court order has been issued for specific information from your therapy file or information and the services you are receiving, I must provide that information.
Health Oversight Activities-- If a government health agency or authority, such as one of the boards that licenses mental health professionals in Minnesota, requests information about your treatment here, I am required to provide the specified information under certain circumstances (ex. Misconduct investigation).
Law enforcement purposes-- If a crime occurs on my premise, I reserve the right to report to law enforcement, including any necessary PHI.
Workers' Compensation Claim-- If you file a worker’s compensation claim, I must provide any requested information concerning your physical or mental health condition relative to the claim.
Complaints of Lawsuits—If you file a complaint or lawsuit against any member of Authentic Therapeutic Services, L.L.C., we must provide any requested information, or any information relating to the therapist’s defense of themselves.
Appointment Reminders--I may use and disclose your PHI to contact you to remind you that you have an appointment with me.

Certain Uses and Disclosures Require You to Have the Opportunity to Object.

Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

YOUR RIGHTS YOUR REGARDING YOUR PHI
You have the following rights with respect to your PHI:

The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you.
I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.
The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice electronically. And, even if you have agreed to receive this Notice electronically, you also have the right to request a paper copy of it.

COMPLAINT PROCEDURE

If you think I may have violated your privacy rights, you may file a complaint with Caroline Kading, as the Privacy Officer for Authentic Therapeutic Services L.L.C., and the address and telephone number are: 4141 Old Sibley Memorial Hwy, Eagan, MN, 55122; 612-482-3995.

You can also 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.

I will not retaliate against you if you file a complaint about my privacy practices.

EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on 1/16/2024