Notice of Privacy Practices of Sonya Naulta, MSW, CCH
THIS NOTICE
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE
REVIEW IT CAREFULLY.
Sonya Naulta, Clinical Social Worker and Certified Clinical Hypnotherapist, is required by law
to maintain the privacy of certain confidential health care information, known as Protected Health Information or PHI, and
to provide you with a notice of our legal duties and privacy practices with respect to your PHI. Sonya Naulta is also required
to abide by the terms of the version of this Notice currently in effect.
Uses and Disclosures
of PHI: Sonya Naulta may use PHI for the purposes of treatment, payment, and health care operations,
in most cases without your written permission. Examples of our use of your PHI:
- For
treatment. This includes such things as obtaining verbal and written information about your health and treatment from you
as well as from others, such as doctors and nurses who give orders to allow us to provide treatment to you. We may give your
PHI to other health care providers involved in your treatment, and may transfer your PHI via fax or telephone to the hospital
or dispatch center.
- For
payment. This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including
such things as submitting bills to you through the mail, making medical necessity determinations and collecting outstanding
accounts.
- Reminders
for Scheduled Appointments and Information on Other Services. We may also contact you to provide you with health information
pertinent to your treatment and/or follow-up with phone consultation as needed, or to provide information about other services
we provide.
Use and Disclosure
of PH without Your Authorization. Sonya Naulta is permitted to use PHI without
your written authorization, or opportunity to object, in certain situations, and unless prohibited by a more stringent
state law, including:
- For
the treatment, payment or health care operations activities of another health care provider who treats you;
- For
health care and legal compliance activities;
- To
a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal
agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection, and
in certain other circumstances where we are unable to obtain your agreement and believe the disclosure is in your best interests;
- To
a public health authority in certain situations as required by law (such as to report abuse, neglect or domestic violence);
- For
health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other
administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system;
- For
judicial and administrative proceedings as required by a court or administrative order, or in some cases in response
to a subpoena or other legal process;
- For
law enforcement activities in limited situations, such as when responding to a warrant;
- For
military, national defense and security and other special government functions;
- To
avert a serious threat to the health and safety of a person or the public at large;
- For
workers’ compensation purposes, and in compliance with workers’ compensation laws;
- To
coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying
on their duties as authorized by law;
- If
you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation;
- For
research projects, but this will be subject to strict oversight and approvals;
- We
may also use or disclose health information about you in a way that does not personally identify you or reveal who you are.
Any other use
or disclosure of PHI, other than those listed above will only be made with your written authorization. You may revoke your
authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in
reliance on that authorization.
Patient Rights:
As a patient,
you have a number of rights with respect to your PHI, including:
The right to
access, copy or inspect your PHI. This means you may inspect and copy most of the medical information about
you that we maintain. We will normally provide you with access to this information within 30 days of your request. We may
also charge you a reasonable fee for you to copy any medical information that you have the right to access. In limited circumstances,
we may deny you access to your medical information, and you may appeal certain types of denials. We have available forms to
request access to your PHI and we will provide a written response if we deny you access and let you know your appeal rights.
You also have the right to receive confidential communications of your PHI. If you wish to inspect and copy your medical information,
you should contact our privacy officer.
The right to
amend your PHI. You have the right to ask us to amend written medical information that we may have
about you. We will generally amend your information within 60 days of your request and will notify you when we have amended
the information. We are permitted by law to deny your request to amend your medical information only in certain circumstances,
like when we believe the information you have asked us to amend is correct. If you wish to request that we amend the medical
information that we have about you, you should contact our privacy officer.
The right to
request an accounting. You may request an accounting from us of certain disclosures of your medical information that we have made in the
six years prior to the date of your request. We are not required to give you an accounting of information we have used or
disclosed for purposes of treatment, payment or health care operations, or when we share your health information with our
business associates, like our billing company or a medical facility from/to which we have transported you. We are also not
required to give you an accounting of our uses of protected health information for which you have already given us written
authorization. If you wish to request an accounting, contact our privacy officer.
The right to request that we restrict the uses and disclosures of your PHI. You have the right to request that we restrict how we use and disclose your medical information
that we have about you. Sonya Naulta is not
required to agree to any restrictions you request, but any restrictions agreed to by any Ambulance service in writing are
binding on the client, not the practitioner.
Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request. If we maintain
a web site, we will prominently post a copy of this Notice on our web site. If you allow us, we will forward you this Notice
by electronic mail instead of on paper and you may always request a paper copy of the Notice.
Revisions to the Notice: Sonya Naulta reserves
the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to
all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities
and posted to our web site, if we maintain one. You can get a copy of the latest version of this Notice by contacting our
privacy officer.
Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of
the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will
not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments
or complaints you may direct all inquiries to our privacy officer.
Privacy Officer Contact Information:
Sonya Naulta, MSW, CCH
Psychotherapy Alternatives, PLLC
1307 Hixson Pike
Chattanooga, TN
37405
423.874.0155
Effective Date of the Notice: Janurary 1, 2009
