Privacy Policy

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. 

 Metro Psychology Support Services (“MPSS”) is required by law to maintain the privacy of your Protected Health Information (“PHI”). MPSS must give you this Notice about its legal duties and privacy practices with respect to PHI. 

 MPSS will abide by this Notice. 

 “PHI” is information about your past, present, or future physical or mental health or condition; information about healthcare you receive; or information about the past, present, or future payment for healthcare you receive. 

 Your Rights: 

 Access to PHI: You have the right to inspect, review and obtain copies of your PHI. You must request access to your PHI in writing. You may request that your PHI be provided to you electronically. If you make a written request to receive your PHI electronically, MPSS will try to accommodate your request. MPSS may charge a fee for copying, mailing, and labor costs in providing your PHI to you in the format you request. MPSS may deny you certain access to your PHI in accordance with the law. If your request is denied, MPSS will provide a written denial and will tell you about rights you may have for a review of the denial. 

 Amendments: You have the right to request that information in your PHI be amended when it is incorrect or incomplete. You must make such a request in writing and explain why you believe your PHI should be changed. If your request is accepted by MPSS, you will be notified and the amendment will be added to your PHI. MPSS will make reasonable efforts to provide the amendment to individuals you identify in writing as needing the amended PHI and others that MPSS knows may have relied on the PHI without the amendment to your detriment.  If your request is denied, you may file a written statement of disagreement. 

 Disclosures: You have the right to receive a list of disclosures of your PHI made by MPSS or its Business Associates. You must request a list of disclosures in writing and indicate the time period you want the list to include. The list will not include disclosures made for treatment, payment, or health care operations (which are discussed under “Uses and Disclosures of PHI”). The list also will not include disclosures you authorized MPSS to make, disclosures made directly to you or to those you have designated as being involved in your care, disclosures for notification purposes, disclosures made more than six years before the date of your request, or other disclosures allowed by law. If you request more than one list of disclosures in a 12-month period, you may be charged a fee for each extra list. 

 Restrictions: You have the right to request restrictions on the way your PHI is handled and disclosed. Such requests must be made in writing and include specific instructions about the restrictions you would like imposed and list to whom the restrictions apply. MPSS will review and consider all requests, but is not required to agree to a requested restriction except when:  

• the request restricts disclosure of information to a health plan that would otherwise be made for payment or health care operations,
• the disclosure is not required by law, and
• the PHI pertains only to an item or service for which you have paid in full.

 Communication of PHI: You have the right to receive confidential communications of PHI. You may request that MPSS communicate with you about PHI by alternate means or alternate location. For example, you may request that MPSS contact you about medical records only in writing or at a different address or telephone number than the ones listed in your chart. You must make such requests in writing, state how and when you would like to be contacted, and provide an alternate telephone number or address if appropriate. Reasonable requests will be granted. Unless you provide written notice to MPSS that you wish to receive communications of PHI in a different manner, MPSS will communicate with you about your PHI by the phone number and address in your chart. 

Notice: You are entitled to receive a paper copy of this Notice if you request it. 

 Breach: You have the right to be notified if there is an unpermitted use or disclosure of your unprotected PHI. 

Protection of Your PHI:

Your PHI will not be disclosed except as described in this Notice or when there is specific authorization in law for the disclosure.

MPSS will make a reasonable effort to use, disclose, and request only the minimum necessary PHI for any given purpose.

Whenever possible, your PHI will be encrypted to protect your personal information and identity. 

 Uses and Disclosures of PHI: 

 To effectively serve you, certain uses and disclosures of PHI are necessary and allowed by law. Examples of those uses and disclosures are:·       

Treatment: To ensure you are receiving effective and appropriate care, PHI may be disclosed to provide or coordinate healthcare services for you, which may include consulting another healthcare provider.·       

Payment: PHI may be disclosed to obtain payment for services provided to you.·       

Health Care Operations: PHI may be disclosed for non-treatment and non-payment reasons that are directly related to the ability of MPSS to run its business, including reviewing the competence or qualifications of health care professionals employed by MPSS and evaluating the performance of practitioners and providers employed by MPSS. 

 MPSS may also use or disclose your PHI for the following reasons: 

Medical Emergency: MPSS may disclose your PHI if it is needed to help you in a medical emergency. Even if you have requested a restriction on certain uses and disclosures of your PHI to which MPSS agreed, MPSS may release the restricted PHI when it is needed in an emergency for your treatment.

Duty to Warn: In certain situations, MPSS may disclose your PHI if it is needed to protect your safety or the health and safety of others.

Reporting Abuse: MPSS may disclose certain PHI when there is a reasonable belief that a child is being neglected or physically or sexually abused. MPSS may also disclose certain PHI when there is a reasonable belief that a vulnerable adult has been maltreated or sustained an unreasonable physical injury. If there is a reasonable belief that you are the victim of abuse, neglect, or domestic violence, MPSS may disclose your PHI, but only with your permission or as authorized by law.

Other Providers: MPSS may disclose your PHI to related health care entities when it is necessary for your current treatment.

Legal Process: MPSS may disclose your PHI in response to a Court Order or when there is specific authorization in law to do so.

Law Enforcement Agency: Certain PHI may be disclosed to law enforcement officials. Reasons this information may be disclosed include identifying or locating a missing person or when there is a serious threat to the health or safety of someone else. 

 Health records related to your mental health may be released if a law enforcement agency provides your name, and you are currently involved in an emergency interaction, and disclosure of the health records are needed to protect your health and safety or the health and safety of someone else. 

 Family or Caretaker: MPSS may disclose limited information to your family member or caretaker. These disclosures may include: your diagnosis, name and dosage of prescribed medications, medication side effects, and consequences of failing to take medication. Certain disclosures will only be made when it is verified that your family member or caretaker lives with you, provides care for you, or is directly involved in monitoring your treatment and when the disclosure is necessary to assist in your care. If you do not want this information shared, it will not be disclosed. In addition, if MPSS reasonably determines providing this information would be harmful to your health or is likely to cause harm to you or another, it will not be released. 

 Appointment Reminders: MPSS may use your PHI to remind you about an appointment.

Workers Compensation and Related Laws: Your PHI may be disclosed to comply with workers compensation and similar legal programs.

Employer: Your PHI may be disclosed to your employer only if MPSS is providing services to you at the request of your employer for the purpose of an evaluation relating to medical surveillance at the workplace, or to evaluate whether you have a work-related illness or injury.

Death: Certain PHI may be disclosed to your next-of-kin if you die. This information may also be disclosed to coroners and medical examiners. However, your privacy rights will be protected for 50 years after your date of death.

Health Care Facility: MPSS may disclose PHI if you are returning to a health care facility and are unable to provide consent. MPSS may also disclose PHI if you receive services from MPSS while living in a health care facility and are unable to provide consent.

Inmates: If you are an inmate, PHI may be disclosed as allowed by law to a correctional facility.

Armed Forces Personnel: PHI may be disclosed to armed forces personnel under certain circumstances and to authorized federal authorities for national security or intelligence activities.  

Minnesota Department of Human Services and the Federal Administration: Your PHI may be disclosed to the Minnesota Department of Human Services and the Federal Administration in certain circumstances because MPSS is funded by state and federal funding.

Health Oversight Activities: PHI may be disclosed for actions allowed or required by law to government, licensing, auditing, and accrediting agencies for health oversight activities.

Public Health: PHI may be disclosed to authorized public health authorities for the purpose of preventing or controlling disease, injury, or disability. Examples of activities for which these disclosures may be made include public health surveillance and public health investigations. PHI may also be disclosed as allowed by law to a person who may have been exposed to a communicable disease.

Complaint Investigation: PHI may be disclosed to the Office of Health and Human Services when it is needed in connection with a complaint investigation or compliance review.

Record Locator Service: PHI and the location of your health records may be released to a record locator service. You may choose to not allow this type of release. If you do not want your PHI released to record locator services, please inform us in writing.

Research: PHI may be disclosed when allowed by law for research, or if you have given permission for MPSS to release your PHI for research.

Business Associates: PHI may be disclosed to entities that help MPSS run its business including its accountants, lawyers, and financial service professionals.

FDA: PHI may be disclosed when required by the FDA to report adverse effects or product defects, track problems, or make repairs or replacements. 

 Aside from the disclosures of PHI described by this Notice, MPSS will not disclose or release your PHI without your written authorization and consent. In particular, most uses and disclosures of psychotherapy notes will only be made with your express, written authorization. Uses and disclosures of PHI for marketing purposes and disclosures that constitute a sale of PHI also will not be made without your authorization. 

 If you have authorized disclosure of your PHI through a written consent, you may withdraw it at any time. Your withdrawal must be made in writing and delivered to MPSS. Upon receipt of your written withdrawal of consent, MPSS will stop using or disclosing the PHI that was previously permitted by your authorization. However, the revocation will not apply to disclosures MPSS made in reliance on your authorization before receiving the withdrawal of your consent. 

 Your refusal to consent to certain disclosures as allowed by law will not result in any reprisal from MPSS. 

 Complaint Procedure and Contact:

If you have questions about the privacy of your PHI or if you believe your rights have been violated, you may file a complaint with MPSS and/or with the Secretary of the Department of Health and Human Services through the Office for Civil Rights (“OCR”). MPSS will not retaliate against you for filing a complaint and filing a complaint will not impact the services or care you receive from MPSS. The Complaint must be in writing delivered by mail to:

Dona Mathews PsyD LP
Metro Psychology Support Services
2550 University Avenue W. #163 So.
St. Paul, MN 55114
651-645-7971. 

This same contact information may be used for further information about matters covered by this Notice.

 Changes to Privacy Practices Described by this Notice:

MPSS reserves the right to change the terms of this Notice and make the new notice provisions effective for all PHI that it maintains. In the event there is a revised notice, it will be posted on the MPSS website, along with the effective date, and also available in paper copy by request at the MPSS office. 

Effective Date: This Notice is effective as of March 26, 2013.