Drake Counseling Services

Health Insurance Portability and Accountability Act (HIPAA)

Notice of Privacy Practices

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

The following notice describes the information privacy practices of Drake Counseling Services, Inc. including:

Any health care professional authorized to enter information into your medical record
All departments and services of the agency
Any member of a volunteer group we allow to help you while you are at the agency
All employees, medical staff and other facility personnel, including interns
All clinics/residences owned and operated by Drake Counseling Services, Inc. including Drake Counseling of Fargo, Grand Forks, Jamestown and Detroit Lakes

All these entities, sites and locations may share medical information with each other when necessary for the purpose of treatment, payment or facility operations as described in this notice.

Our pledge to you :

We understand that medical information about you and your health is personal and we are committed to protecting privacy while providing quality care. This Notice of Information Practices applies to all of the records of your care generated by Drake Counseling Services, Inc. This organization is required by law to:

Maintain the privacy of your health information
Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
Abide by the terms of this notice
Notify you if we are unable to agree to a requested restriction
Accommodate reasonable requests you may have to communicate health information by alternative means or at an alternative location

Understanding your health record / information:

Each time you visit a hospital, doctor or other healthcare provider, a record of your visit is made. We need this record to provide you with quality care and to comply with certain legal requirements. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment. This information, often referred to as your health record or medical record, serves as a:

Basis for planning your care and treatment
Means of communication among the many health professionals who contribute to your care
Legal document describing the care you received
Means by which you or a third-party payer can verify that services billed were actually provided
A tool in educating health professionals
A source of data for medical research
A source of information for public health officials charged with improving the health of the nation
A source of data for facility planning and marketing
A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to:

Ensure it’s accuracy
Better understand who, what, when, where and why others may access your health information
Make more informed decisions when authorizing disclosure of health information to others

Your health information rights:

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

Request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Obtain a paper copy of this Notice of Information Practices upon request
Inspect and copy medical information that may be used to make decisions about your care. Usually this includes medical and billing records but does not include psychotherapy notes.
Amend your health record if you feel that medical information we have about you is incorrect or incomplete
Obtain an accounting of disclosures of your health information. This would be a list of the disclosures we made of medical information about you.
Request communications of your health information by alternative means or at alternative locations

How we may use and disclose medical information about you:

The following categories describe different ways that we use and disclose medical information. Not every use or disclosure in a category can be listed, however, examples are provided to explain some of the categories.

For Treatment: Information obtained by a nurse, doctor or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your primary provider will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way the primary provider will know how you are responding to treatment.
For Payment: We may use and disclose medical information about you so that the treatment and services you receive at this facility may be billed to and payment may be collected from you, an insurance company or a third party.
For Healthcare Operations: We may use and disclose medical information about you for facility operations. These uses and disclosures are necessary to run the facility and insure that all of our clients receive quality care.
Business Associates: There are some services provided in our organization through contracts with business associates. Examples: Physicians/psychiatrists who provide consultation services to the facility, certain laboratory tests. When these services are contracted, we may disclose your health information to our business associate so they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
As Required By Law: We will disclose medical information about you when required to do so by federal, state or local law.
Communication with Family: With express written consent, as defined by federal regulations, health professionals may disclose health information to a family member, other relative, close personal friend or any other person you identify as involved in your medical care. With your written consent, we may also give information to someone who helps pay for your care. With your written consent, we may disclose medical information abut you to an entity assisting in a disaster relief effort so that your family can be notified about your condition and location.
Research: We may disclose information to researchers when their research has been approved by the facility review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Funeral Directors, Coroners, and Medical Examiners: We may disclose health information to funeral directors, consistent with applicable law, to carry out their duties. We may release medical information to a coroner or medical examiner.
Organ and Tissue Donation: Consistent with applicable law, we may disclose health information to organ procurement organization or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.
Appointment Reminders /Treatment Alternatives: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Food & Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, and product defects or post-marketing surveillance information to enable product recalls, repairs or replacement.
Worker’s Compensation: We may disclose health information about you for worker’s compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Correctional Institution: Should you be an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose to the institution, or agents thereof, health information necessary for your health and the health and safety of other individuals.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
Military and Veterans: If you are a member of the armed forces, we may disclose medical information about you as required by military command.
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. The oversight activities may include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance of civil rights laws.
National Security Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state.

Changes to the Notice of Information Practices

We reserve the right to change our information practices and to make the new provisions effective for all protected health information we already have about you as well as any information we receive in the future. Should our information practices change, we will post a copy of the updated notice at Drake Counseling Services, Inc. In addition, each time you register at the facility for treatment or services we will offer you a copy of the current notice in effect. We will mail a revised Notice of Information Practices to the address that you have provided.

Other Uses of Health Information

We will not disclose your health information without your written authorization, except as described in this notice. If you provide us with authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. You understand that we are unable to take back any disclosures we have already made with your permission.

For more information or to report a problem:

If you have questions and/or would like additional information regarding any right included in the Notice of Information Practices, you may contact Miracle Hoff, Executive Director, Drake Counseling Services, Inc. at 701-293-5429. If you believe your privacy rights have been violated, you may file a complaint with Drake Counseling Services, Inc. by phoning 701-293-5429 or writing to Miracle Hoff, Executive Director, Drake Counseling Services, Inc., 1202 23rd Street S., Fargo, ND 58103. You may also contact the United States Secretary of Health and Human Services by phone at 1-877-696-6775 or by emailing hhasmal@os.dhhs.gov. There will be no retaliation for filing a complaint.

Effective April 14, 2003