PRIVACY NOTICE Rev. 02/17
Privacy Officer: Dr. Jeremy Bidwell (email: email@example.com; phone: 847-802-4058)
What information do we collect?
We collect information from you when you pay your bill, subscribe to a newsletter, respond to a survey or fill out a form.
When completing forms on our site, as appropriate, you may be asked to enter your: name, e-mail address, mailing address or phone number. You may, however, visit our site anonymously.
What do we use your information for?
Any of the information we collect from you may be used in one of the following ways:
; To personalize your experience
(your information helps us to better respond to your individual needs)
; To improve our website
(we continually strive to improve our website offerings based on the information and feedback we receive from you)
; To improve customer service
(your information helps us to more effectively respond to your customer service requests and support needs)
; To process transactions
Your information, whether public or private, will not be sold, exchanged, transferred, or given to any other company for any reason whatsoever, without your consent, other than for the express purpose of delivering the purchased service requested.
; To administer a survey or other site feature
; To send periodic status emails
The email address you provide may be used to send you information, respond to inquiries, and/or other requests or questions.
How do we protect your information?
We implement a variety of security measures to maintain the safety of your personal information when you enter, submit, or access your personal information.
We offer the use of a secure server. All supplied sensitive/credit information is transmitted via Secure Socket Layer (SSL) technology and then encrypted, or collected directly via secure third party form, into our Payment gateway providers database only to be accessible by those authorized with special access rights to such systems, and are required to keep the information confidential.
After a transaction, your private credit card information will not be stored on our servers.
Yes (Cookies are small files that a site or its service provider transfers to your computers hard drive through your Web browser (if you allow) that enables the sites or service providers systems to recognize your browser and capture and remember certain information
Do we disclose any information to outside parties?
We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information. This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.
Third party links
Occasionally, at our discretion, we may include or offer third party products or services on our website. These third party sites have separate and independent privacy policies. We therefore have no responsibility or liability for the content and activities of these linked sites. Nonetheless, we seek to protect the integrity of our site and welcome any feedback about these sites.
California Online Privacy Protection Act Compliance
Because we value your privacy we have taken the necessary precautions to be in compliance with the California Online Privacy Protection Act. We therefore will not distribute your personal information to outside parties without your consent.
Childrens Online Privacy Protection Act Compliance
We are in compliance with the requirements of COPPA (Childrens Online Privacy Protection Act), we do not collect any information from anyone under 13 years of age. Our website, products and services are all directed to people who are at least 13 years old or older.
Protected Health Information
At The LodeStone Center, P.C. (MBH), protected health information (PHI) is handled responsibly. Below are the procedures utilized to safeguard PHI, the circumstances under which your personal health information may be disclosed, and your rights as they relate to this information. The rules for confidentiality of mental health records are recorded in the privacy rules of the Health Insurance Portability and Accountability Act (HIPAA). It is in your best interests to review these provisions in order to fully understand MBH’s procedures and your rights.
We strive to protect your personal health information (PHI).
At The LodeStone Center, P.C. (MBH), every effort is made to keep your PHI private. If you have any questions or concerns about your privacy, please address them with your therapist.
You are entitled to copy or review your mental health records.
You have the right to ask to see or get a copy of your mental health record. MBH will provide a copy or a summary of your mental health information, usually within 30 days of your request. A reasonable, cost-based fee may be assessed. You can ask MBH to correct health information about you that you think is incorrect or incomplete. MBH may say “no” to your request, but you will be given a reason why in writing within 60 days.
You can request confidential communications.
You have the right to ask MBH to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
You can request limitations on information sharing.
You have the right to ask MBH not to use or share certain information for treatment, payment, or mental health care operations. MBH is not required to agree with your request and might say “no” if it would affect your care. If you pay for counseling services out-of-pocket in full, you can ask MBH not to share that information for the purpose of payment or or our operations with your insurance company. MBH will say “yes” unless a law requires the information to be shared.
You can request a list of those with whom MBH has shared information.
You have the right to ask for a list (accounting) of the times MBH has shared your mental health information for up to six years prior to the date you ask, who it has been shared with, and why. MBH will provide one accounting per year year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You can obtain a copy of this privacy notice.
You have the right to ask for a paper copy of this notice at any time. You will be provided one promptly.
You can choose someone to act for you.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your mental health information. MBH will ensure the person has this authority and can act for you before taking any action.
You can file a complaint if you feel your rights are violated.
You can complain if you feel MBH has violated your rights by contacting the office via the contact information listed on page one. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/. MBH will not retaliate against you for filing a complaint.
For certain information, you can tell MBH your choices about what to share.
If you have a clear preference for how your information is shared in the situations described below, let MBH know and your instructions will be followed. Please note: MBH does not use your PHI for marketing purposes and does not sell it.
In these cases, you have both the right and choice to tell MBH to: 1) share information with your family, close friends, or others involved in your care; 2) share information in a disaster relief situation.
If you are unable to tell MBH your preference, for example if unconscious, MBH may share your information if it is in your best interests. MBH may also share your information when needed to lessen a serious and imminent threat to health or safety.
Other Uses and Disclosures
MBH typically uses or shares your mental health information in the following ways:
1) Providing treatment: MBH can use your mental health information and share it with other professionals who are treating you.
Example: A doctor treating you asks another doctor about your overall mental health condition.
2) Running this organization:MBH can use and share your mental health information to run this practice, improve your care, and contact you when necessary. Example: MBH uses information about you to manage your treatment and services.
3) Billing your services:MBH can use and share your information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
MBH is also allowed or required to share your information in the following ways:
MBH may use your information in ways that contribute to the public good, such as public health and research. Many conditions in the law have to be met before your information can be shared for these purposes.
For more information, see:www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
The following individuals can access a mental health record without written authorization.
1) An adult recipient of services; 2) the parent or guardian of a child who is under 12 years of age; 3) a recipient who is 12 years of age or older; 4) the parent or guardian of a recipient who is at least 12, but under 18, if the recipient does not object or if the therapist does not find compelling reason for denying access; 5) a legal guardian of a recipient who is 18 or older. MBH provides assistance in understanding the mental health record.
MBH is required by law to maintain the privacy and security of your PHI. You will be informed promptly if a breach occurs that may have compromised the privacy or security of your information. MBH is obligated to follow the duties and privacy practices described in this notice and provide you a copy of it. MBH will not use or share your information other than as described here unless you provide consent in writing. Once you have provided consent, you may change your mind at any time. Let MBH know in writing if you change your mind.
For more information see: www. hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice