THIS NOTICE INVOLVES YOUR PRIVACY RIGHTS AND DESCRIBES HOW INFORMATION ABOUT YOU MAY BE DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Confidentiality
As a rule, Southeast Kentucky Behavioral Health, LLC (SEKYBHLLC) will disclose no information about you, or the fact that you are a client, without your written consent. The formal Mental Health Record describes the services provided to you and contains the dates of your sessions, diagnosis, functional status, symptoms, prognosis and progress, and any testing reports. Health care providers are legally allowed to use or disclose records or information for treatment, payment, and health care operations purposes. However, SEKYBHLLC does not routinely disclose information in such circumstances, so SEKYBHLLC will require your permission in advance, either through your consent at the onset of our relationship (by signing the attached Informed Consent form), or through your written authorization at the time the need for disclosure arises. You may revoke your permission, in writing, at any time, by contacting our office.
II. “Limits of Confidentiality”
Possible Uses and Disclosures of Mental Health Records without Consent or Authorization
There are some important exceptions to this rule of confidentiality – some exceptions created voluntarily due to SEKYBHLLC policies in this office/agency, and some required by law. If you wish to receive mental health services from SEKYBHLLC, you must sign the attached form indicating that you understand and accept the policies about confidentiality and its limits. Discussion may be held regarding these issues now, but you may reopen the conversation at any time during your services received through SEKYBHLLC.
SEKYBHLLC may use or disclose records or other information about you without your consent or authorization in the following circumstances, either by policy, or because legally required:
Emergency – If you are involved in a life-threatening emergency and SEKYBHLLC cannot ask your permission, SEKYBHLLC may share information if SEKYBHLLC believe you would have wanted me to do so, or if SEKYBHLLC or your therapist believes it will be helpful to you.
Child Abuse Reporting: If SEKYBHLLC or your therapist has reason to suspect that a child is abused or neglected, SEKYBHLLC will be required by Kentucky law to report the matter immediately to the Kentucky Department of Community Based Services.
Adult Abuse Reporting: If SEKYBHLLC or your therapist has reason to suspect that an elderly or incapacitated adult is abused, neglected or exploited, SEKYBHLLC will be required by Kentucky law to immediately make a report and provide relevant information to the Kentucky Department of Community Based Services.
Health Oversight: Kentucky law requires that Licensed Clinical Social Workers report misconduct by a health care provider of their own profession. By policy, SEKYBHLLC or your therapist also reserve the right to report misconduct by health care providers of other professions. By law, if you describe unprofessional conduct by another mental health provider of any profession, SEKYBHLLC will be required to explain to you how to make such a report. If you are yourself a health care provider, SEKYBHLLC will be required by law to report to your licensing board that you are in treatment with me if SEKYBHLLC or your therapist believes your condition places the public at risk. Kentucky Licensing Boards have the power, when necessary, to subpoena relevant records in investigating a complaint of provider incompetence or misconduct.
Court Proceedings: If you are involved in a court preceding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law, and SEKYBHLLC will not release information unless you provide written authorization or a judge issues a court order. If SEKYBHLLC or your therapist receives a subpoena for records or testimony, SEKYBHLLC or your therapist will notify you so you can file a motion to quash (block) the subpoena. However, while awaiting the judge’s decision, SEKYBHLLC may be required to place said records in a sealed envelope and provide them to the Clerk of Court. In civil court cases, therapy information is not protected by patient-therapist privilege in child abuse cases, in cases in which your mental health is an issue, or in any case in which the judge deems the information to be “necessary for the proper administration of justice.” In criminal cases, Kentucky has no statute granting therapist-patient privilege, although records can sometimes be protected on another basis. Protections of privilege may not apply if SEKYBHLLC or your therapist completes an evaluation for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.
Serious Threat to Health or Safety: Under Kentucky law, if SEKYBHLLC or your therapist is engaged with professional duties and you communicate to me a specific and immediate threat to cause serious bodily injury or death, to an identified or to an identifiable person, and SEKYBHLLC or your therapist believes you have the intent and ability to carry out that threat immediately or imminently, SEKYBHLLC or your therapist will be legally required to take steps to protect third parties. These precautions may include
- warning the potential victim(s), or the parent or guardian of the potential victim(s), if under 18,
- notifying a law enforcement officer, or
- Seeking your hospitalization.
By policy, SEKYBHLLC may also use and disclose medical information about you when necessary to prevent an immediate, serious threat to your own health and safety. If you become a party in a civil commitment hearing, SEKYBHLLC may be required to provide your records to the magistrate, your attorney or guardian ad litem, a CSB evaluator, or law enforcement officer, whether you are a minor or an adult.
Workers Compensation: If you file a worker’s compensation claim, SEKYBHLLC will be required by law, upon request, to submit your relevant mental health information to you, your employer, the insurer, or a certified rehabilitation provider.
Records of Minors: Kentucky has a number of laws that limit the confidentiality of the records of minors. For example, parents, regardless of custody, may not be denied access to their child’s records; and CSB evaluators in civil commitment cases have legal access to therapy records without notification or consent of parents or child. Other circumstances may also apply, and we will discuss these in detail if SEKYBHLLC or your therapist provides services to minors.
Other uses and disclosures of information not covered by this notice or by the laws that apply will be made only with your written permission.
III. Client’s/Individaul’s Rights and Provider’s Duties:
Right to Request Restrictions-You have the right to request restrictions on certain uses and disclosures of protected health information about you. You also have the right to request a limit on the medical information SEKYBHLLC disclose about you to someone who is involved in your care or the payment for your care. If you ask me to disclose information to another party, you may request that SEKYBHLLC limit the information SEKYBHLLC disclose. However, SEKYBHLLC may not be required to agree to a restriction that you request. To request restrictions, you must make your request in writing, and tell SEKYBHLLC:
- what information you want to limit;
- whether you want to limit my use, disclosure or both; and
- to whom you want the limits to apply.
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. (For example, you may not want a family member to know that you are seeing me. Upon your request, SEKYBHLLC will send your bills to another address. You may also request that SEKYBHLLC contact you only at work, or that SEKYBHLLC do not leave voice mail messages.) To request alternative communication, you must make your request in writing, specifying how or where you wish to be contacted.
Right to an Accounting of Disclosures – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in section II of this Notice). On your written request, SEKYBHLLC will discuss with you the details of the accounting process
Right to Inspect and Copy – In most cases, you have the right to inspect and copy your medical and billing records. To do this, you must submit your request in writing. If you request a copy of the information, SEKYBHLLC may charge a fee for costs of copying and mailing. SEKYBHLLC may deny your request to inspect and copy in some circumstances. SEKYBHLLC may refuse to provide you access to certain psychotherapy notes or to information compiled in reasonable anticipation of, or use in, a civil criminal, or administrative proceeding.
Right to Amend – If you feel that protected health information that SEKYBHLLC has about you is incorrect or incomplete, you may ask SEKYBHLLC or your therapist to amend the information. To request an amendment, your request must be made in writing, and submitted to SEKYBHLLC. In addition, you must provide a reason that supports s your request. SEKYBHLLC may deny your request if you ask SEKYBHLLC or your therapist amend information that:
- was not created by me; SEKYBHLLC will add your request to the information record;
- is not part of the medical information maintained by SEKYBHLLC or your therapist;
- is not part of the information which you would be permitted to inspect and copy;
- is accurate and complete.
Right to a copy of this notice – You have the right to a paper copy of this notice. You may ask me to give you a copy of this notice at any time. Changes to this notice: SEKYBHLLC reserve the right to change policies and/or to change this notice, and to make the changed notice effective for medical information SEKYBHLLC already have about you as well as any information SEKYBHLLC receives in the future. The notice will contain the effective date. A new copy will be given to you or posted in the waiting room. SEKYBHLLC will have copies of the current notice available on request.
Complaints: If you believe your privacy rights have been violated, you may file a complaint. To do this, you must submit your request in writing to my office. You may also send a written complaint to the Kentucky Board of Social Work at PO BOX 1360 Frankfort KY 40602.
For Addition Information of your Rights, continue reading information on Informed Consent.