THIS NOTICE DESCRIBES HOW INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
We respect client confidentiality and will
only release information about you in accordance with applicable State and
Federal law. If state law is stricter, these more stringent provisions will
always take precedence. This notice describes our policies related to the use
of your coaching and/or mental health records. We are required by law to
maintain the privacy of protected health information and to provide you with
notice of our legal duties and privacy practices. In accordance with state and
federal law, we will make reasonable efforts to limit use, disclosure of and
requests for protected health information to the minimum necessary to
accomplish the intended purpose.
Effective Date: January 1, 2020
Privacy Contact: If you have any questions
about this policy or your rights, contact the Privacy Contact at CuraLinc Healthcare, 314 W. Superior Street, Suite 601,
Chicago, IL, 60654, 800-490-1585.
USE AND DISCLOSURE OF PROTECTED HEALTH
In order to provide you care, there are
times when we will need to share your information with others. This includes
the following times, under 45 C.F.R. 164.502:
Treatment: Information about you may be
disclosed for treatment purposes. For example, information may be disclosed to
a clinical supervisor, consulting Coach or therapist or member of a team
providing services to provide, coordinate, or manage your care.
Payment: Information may be used for
payment purposes. Information may be used to collect sums or receive third
party payment for certain mental health services, but disclosure will be
limited only to information needed to pursue collection.
Healthcare Operations: Information about
you may be used to coordinate healthcare operations. For example, the
information may be used in conducting a peer review of the services being
However, if state law is more restrictive,
your protected health information will be disclosed to a third person or for
billing purposes only to the minimum extent necessary and in accordance with
such state law.
INFORMATION DISCLOSED WITHOUT YOUR CONSENT
Pursuant to Federal Statute 45 C.F.R.
164.512, information about you can be disclosed without your consent in the
following circumstances (certain records, such as Coaching notes, are subject
to additional disclosure restrictions):
Emergencies: In case of an emergency, and
if you are not able to give or refuse permission, we will share only the
information that is directly necessary for obtaining emergency care for you,
according to our professional judgment.
Danger to Self and/or Others: Information
may be disclosed if you are a danger to yourself or others. CuraLinc
may disclose information to the appropriate authorities if we reasonably
believe such disclosure is necessary to protect you or a third party from a
clear imminent risk of serious physical or mental injury or disease or death.
class=SpellE>CuraLinc may report information in the event of a serious
threat of physical violence against a reasonably identifiable victim.
Use for Public Health Activities:
Information may be disclosed to a public health authority that is authorized by
law to collect or receive information for public health activities.
Abuse or Neglect: Information about you may
be disclosed if CuraLinc has a reasonable basis to
believe that abuse or neglect may have occurred, whether it be child abuse,
elder abuse, institutional abuse or domestic violence.
As Required by law: CuraLinc
must disclose information if required to do so by a court order, judicial or
administrative proceeding, or for other law enforcement purposes.
Health Oversight Activities: Information
about you may be disclosed to a health oversight agency that is authorized by
law to collect or receive certain information for the appropriate oversight of
the health care system, eligibility for government benefit programs, compliance
with government regulatory programs, or compliance with civil rights laws.
In the Event of Death: Information may be
disclosed to a coroner or medical examiner for the purposes of identification,
determination of the cause of death, or other duties as authorized by law.
Research: Information may be used or
disclosed for research purposes in such manner as authorized by law.
Specialized Government Functions:
Information may be disclosed for specialized functions related to, but not
limited to, military and veterans activities, national
security and intelligence activities, or medical suitability determinations.
Workers' Compensation: Information about
you may be disclosed to the extent necessary to comply with workers'
compensation laws or other similar programs that provide benefits for
work-related injuries or illness.
INFORMATION DISCLOSED WITH YOUR CONSENT
Other uses and disclosures of your
protected health information will be made only with your written authorization.
You may consent in writing to (via a CuraLinc
Authorization for Disclosure of Records and Communications Form) a release of
your records to yourself or others for any purpose you choose.
You may revoke any such authorization in
writing at any time unless we have already acted in reliance upon it.
We may contact you to provide information
about treatment alternatives or other health related benefits and services that
may be of interest to you.
INDIVIDUAL PRIVACY RIGHTS
Pursuant to Federal statute 45 C.F.R. 164,
you have the following rights under law:
Right to Inspect and Copy Your Record: With
limited exceptions, you are entitled to inspect the mental health records we
have generated about you. You are also entitled to a copy of these records.
Please make a request in writing to the Privacy Contact to inspect and/or copy
your records. We may charge you a reasonable fee for copying and mailing your
Right to Restriction of Record: You may ask
us not to use or disclose part of the record. This request must be in writing
to the Privacy Contact. CuraLinc is not required to
agree to your request if we believe it is in your best interest to permit
disclosure of the information.
Right to Confidential Communications: You
may request that we communicate with you about your information by different
means or at different locations. Your request must be made in writing to the
Privacy Contact. CuraLinc is required to accommodate
any reasonable request you make concerning such contact.
Right to Amend Record: You may request that
we amend your mental health records by adding or deleting certain information
that is incomplete or inaccurate. This request must be made in writing to the
Privacy Contact. We may deny your request if we did not create the information
you want changed, or for certain other reasons. If we deny your request, we
will provide you with a written explanation. You may then respond with a
statement of disagreement that will be added to your records. If we accept your
request to change the information, we will make reasonable efforts to tell
others, including people you name, of the amendment and to include the
amendment in any future sharing of that information.
Right to Copy of Privacy Notice: You have
the right to obtain a paper copy of this notice upon request, even if you have
agreed to receive this notice electronically.
Right to Accounting of Disclosures: You
have a right to receive a list of all the times during the six
year period prior to the date of your request that we or a business
associate shared your information for purposes other than treatment, payment,
and health care operations, and other specified exceptions. This request must
be made in writing to the Privacy Contact.
QUESTIONS AND COMPLAINTS
If you have any questions about this
notice, or if you think we have violated your privacy rights, please contact
the Privacy Contact at CuraLinc Healthcare, 314 W.
Superior Street, Suite 601, Chicago, IL, 60654, 800-490-1585. You may also
submit a written complaint to the U.S. Department of Health and Human Services,
200 Independence Avenue SW, Washington D.C., 20201, (877) 696-6775. We will not
retaliate in any way if you choose to file a complaint.
RESPONSIBILITY TO COMPLY WITH NOTICE
lang=EN-US>CuraLinc is required to comply with
the terms of the Privacy Notice currently in effect. However,
based on its needs and changes in State and Federal law. Any material change in