Recipients Rights Notification
As a recipient of services at our facility, we would like to inform you of your rights as a patient. The information explains your rights and the process of complaining if you believe your rights have been violated.
Your rights as a patient
1. Complaints. We will investigate your complaints.
2. Suggestions. You are invited to suggest changes in any aspect of the services we provide.
3. Civil Rights. Federal and state laws protect your civil rights.
4. Cultural/Spiritual/Gender Issues. You may request services from someone with training or experiences from a specific cultural, spiritual, or gender orientation. If these services are not available, we will help you in the referral process.
5. Treatment. You have the right to take part in formulating your treatment plan.
6. Denial of services. You may refuse services offered and be informed of any potent consequences.
7. Record Restrictions. You may request restrictions on the use of your protected health information; however, we are not required to agree with the request.
8. Availability of Records. You have the right to obtain a copy and/or inspect your protected health information; however, we may deny access to certain records in which we will discuss this decision with you.
9. Amendment of Records. You have the right to request an amendment in your records; if your request is denied, your request will be kept in the records.
10. Medical/Legal Advice. You may discuss your treatment with your doctor/attorney.
11. Disclosures. You have the right to receive an accounting of disclosures of your protected health information that you have not authorized.
Your rights to receive information
1. Costs of Services & Policy Changes. We will inform you of cost and policy changes.
2. Termination of Services. You will be informed as to what behaviors or violations could lead to termination of services at our clinic.
3. Confidentiality. You will be informed of the limits of confidentiality and how your protected health information will be used.
Our ethical obligations
1. We dedicate ourselves to serving the best interest of each client.
2. We will not discriminate between clients or professionals based on age, race, creed, disabilities, handicaps, preferences, or other personal concerns.
3. We maintain an objective and professional relationship with each client.
4. We respect the rights and views of other mental health professionals.
5. We will appropriately end services or refer clients to other programs when appropriate.
6. We will evaluate our personal limitations, strengths, biases, and effectiveness on an ongoing basis for the purpose of self-improvement. We will continually attain further education and training.
7. We hold respect for various institutional and managerial policies, but we will help improve such policies if the best interest of the client is served.
Patient’s responsibilities
1. You are responsible for your financial obligations to the clinic as outlined in the Payment Contract for Services and following policies of the clinic.
2. You are responsible to treat staff and fellow patients in a respectful, cordial manner in which their rights are not violated.
3. You are responsible to provide accurate information about yourself
Email/Phone Correspondence
The internet and cell phones are never a totally secure medium for purposes of transmitting client-counselor or other privileged information. SOS Life Ring PLLC is not responsible for any invasion of privacy or loss of privileged information that may occur via the internet or cell phones. Privileged information will not by transmitted via email or text unless the client has given the counselor written permission. A client communicating with a counselor via email or text first will also count as giving the counselor permission to communicate via that same medium.
What to do if you believe your rights have been violated
If you believe that, your patient rights have been violated contact SOS Life Ring at (281) 726-4231.
HIPAA Rights Notification
Privacy of Information
This form describes the confidentiality of your medical records, the use of the medical information, your rights, and the process for obtaining this information.
Our Legal Duties
State and Federal laws require that we keep your medical records private. Such laws require that we provide you with this notice informing you of our privacy of information policies, your rights, and our duties. We are required to abide by these policies until replaced or revised. We have the right to revise our privacy policies for all medical records, including records kept before policy changes were made. Any changes in this notice will be made available upon request before changes take place. The contents of material disclosed to us in an evaluation, intake, or counseling session are covered by the law as private information. We respect the privacy of the information you provide us and we abide by ethical and legal requirements of confidentiality and privacy of records.
Use of Information
Information about you may be used by the personnel associated with this clinic for diagnosis, treatment planning, treatment, and continuity of care. We may disclose it to health care providers who provide you with treatment, such as doctors, nurses, mental health professionals, and mental health students and mental health professionals or business associates affiliated with this clinic such as billing, quality enhancement, training, audits, and accreditation. Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client’s legal guardian or personal representative. It is the policy of this clinic not to release any information about a client without a signed release of information except in certain emergencies or exceptions in which client information can be disclosed to others without written consent. Some of these situations are noted below, and there may be other provisions provided by legal requirements.
Duty to Warn and Protect
When a client discloses intentions or a plan to harm another person or persons, the health care professional is required to warn the intended victim and report this information to legal authorities. Incases in which the client discloses or implies a plan for suicide, the health care professional is required to notify legal authorities and make reasonable attempts to notify the family of the client.
Public Safety
Health records may be released for the public interest and safety for public health activities, judicial and administrative proceedings, law enforcement purposes, serious threats to public safety, essential government functions, military, and when complying with worker’s compensation laws.
Judicial or Administrative Proceedings
Health care professionals are required to release records of clients when a court order has been placed.
Minors/Guardianship
Parents or legal guardians of non-emancipated minor clients have the right to access the client’s records.
Abuse
If a client states or suggests that he or she is abusing a child or vulnerable adult, or has recently abused a child or vulnerable adult, or a child (or vulnerable adult) is in danger of abuse, the health care professional is required to report this information to the appropriate social service and/or legal authorities. If a client is the victim of abuse, neglect, violence, or a crime, and their safety appears to be at risk, we may share this information with law enforcement officials to help prevent future occurrences and capture the perpetrator.
Prenatal Exposure to Controlled Substances
Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful.
In the Event of a Client’s Death
In the event of a client’s death, the spouse or parents of a deceased client have a right to access their child or spouse’s records.
Professional Misconduct
Professional misconduct by a health care professional must be reported by other health care professionals. In cases in which a professional or legal disciplinary meeting is being held regarding the health care professional’s actions, related records may be released in order to substantiate disciplinary concerns.
Other Provisions
When payment for services are the responsibility of the client, or a person who has agreed to providing payment, and payment has not been made in a timely manner, collection agencies may be utilized in collecting unpaid debts. The specific content of the services (e.g., diagnosis, treatment plan, progress notes, testing) is not disclosed. If a debt remains unpaid it may be reported to credit agencies, and the client’s credit report may state the amount owed, the time frame, and the name of the clinic or collection source. Insurance companies, managed care, and other third-party payers are given information that they request regarding services to the client. Information, which may be requested, includes type of services, dates/times of services, diagnosis, treatment plan, description of impairment, progress of therapy, and summaries. Information about clients may be disclosed in consultations with other professionals in order to provide the best possible treatment. In such cases the name of the client, or any identifying information, is not disclosed. Clinical information about the client is discussed. In the event in which the clinic or mental health professional must telephone the client for purposes such as appointment cancellations or reminders, or to give/receive other information, efforts are made to preserve confidentiality. Please notify us in writing where we may reach you by phone and how you would like us to identify ourselves. Otherwise, first we will ask to speak to the client (or guardian) without identifying the name of the clinic. If the person answering the phone asks for more identifying information, we will say that it is a personal call. We will not identify the clinic (to protect confidentiality).
Your Rights
You have the right to request to review or receive your medical files. The procedure for obtaining a copy of your medical information is as follows. You may request a copy of your records in writing with an original(not photocopied) signature. If your request is denied, you will receive a written explanation of the denial. Records for non-emancipated minors must be requested by their custodial parents or legal guardians. The charge for this service is$1.00 per page, plus postage. You have the right to cancel a release of information by providing us a written notice. If you desire to have your information sent to a location different from our address on file, you must provide this information inwriting. You have the right to restrict which information might be disclosed to others. However, if we do not agree with these restrictions, we are not bound to abide by them. You have the right to request that information about you be communicated by other means or to another location. This request must be made to us in writing. You have the right to disagree with the medical records in our files. You may request that this information be changed. Although we might deny changing the record, you have the right to make a statement of disagreement, which will be placed in your file. You have the right to know what information in your record has been provided to whom. Request this in writing.