Dakota Counseling Institute, Inc.
Notice of Health Information Practices
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.
Introduction
At Dakota Counseling Institute, we are committed to treating and
using protected health information about you responsibly. This
Notice of Health Information Practices describes the personal information
we collect, and how and when we use or disclose that information.
It also describes your rights as they relate to your protected
health information. This Notice is effective April 14, 2003, and
applies to all protected health information as defined by federal
regulations.
Understanding Your Health Record / Information
Each time you visit Dakota Counseling Institute, a record of
your visit is made. Typically, this record contains your symptoms,
examination
and test results, diagnoses, treatment, and a plan for future
care or treatment. This information, often referred to as your
health
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 this state and the nation,
-
A source of data for
our 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 accuracy, better
understand who, what,
when, where, and why others may access your health information,
and make more informed decisions when authorizing disclosure
to others.
Your Health Information Rights
Although your health record is the physical property of Dakota
Counseling Institute, the information belongs to you. You
have the right to:
-
Obtain a paper copy of this notice of information
practices upon request,
-
Inspect and copy your health record
as provided for in
45 CFR 164.524,
-
Amend your health record as provided
in 45 CFR 164.528,
-
Obtain an accounting of disclosures
of your health information as provided in 45 CFR 164.528,
-
Request
communications of your health information by alternative
means or at alternative
locations,
-
Request a restriction on certain uses
and disclosures of your information
as provided
by 45 CPR 164.522,
and
-
Revoke your authorization
to use or disclose health information
except
to the extent
that action has already been
taken.
Our Responsibilities
Dakota Counseling Institute is required
to:
-
Maintain the privacy of your health information,
-
Provide
you with this 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 notices,
-
Notify
you if we are unable to agree to a requested restriction,
and
-
Accommodate reasonable requests you
may have to communicate health
information by alternative
means or at alternative
locations.
We reserve the right to change
our practices and to
make the new provisions
effective
for all protected
health
information we maintain.
You may request a copy
of the current notice from any
of our
locations.
We will not use or disclose
your health information
without your
authorization, except
as described in this
notice.
We will also
discontinue to use
or disclose your
health
information after we
have received
a written revocation
of the authorization
according
to the procedures included
in the authorization.
For More Information
or to Report a Problem
If you have questions
and would like
additional information,
you may contact
the practice's
Privacy Officer,
Michelle
Carpenter,
Executive Director,
at (605) 996-9686
or
at
m.carpenter.dakotacounseling@midconetwork.com.
If you believe
your privacy
rights have
been violated,
you can file
a complaint
with the
practice's Privacy
Officer
or with the
Office for Civil
Rights, U.S.
Department of
Health and Human
Services. There
will be no retaliation
for filing
a complaint
with either
the Privacy Officer
or the Office
for Civil Rights.
The address
for the OCR
is listed
below:
Office for Civil
Rights
U.S. Department
of Health and
Human Services
200 Independence
Avenue, S.W.
Room 509F,
HHH Building
Washington,
D.C. 20201 |
