Privacy Practice

T. W. Ponessa & Associates Counseling Services Inc.
Patient Notice of Privacy Practices for Protected Health Information

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.

A. How T. W. Ponessa & Associates Uses and Discloses Your Health Information:

T. W. Ponessa & Associates provides a broad range of services through a wide variety of health and human services programs. If you receive services from T. W. Ponessa & Associates, the program may use your protected health information and disclose it for one or several of the following reasons:

• 1. Plan and provide your care and treatment
• 2. Communicate with other health care professionals who care for you
• 3. Describe the care you receive
• 4. Obtain reimbursement from private insurers or government programs
• 5. Verify that services billed were actually provided
• 6. Educate health professionals
• 7. Inform public health officials charged with improving healthcare
• 8. Administration of T. W. Ponessa & Associates programs which provide treatment services.
• 9. Assess and improve the services provided and the outcomes achieved
• 10. Pay for services you receive
• 11. Inform you about other public programs and services

T. W. Ponessa & Associates will not use or disclose your protected health information except as described in this notice, or otherwise authorized by law.

B. Examples of Disclosures for Treatment, Payment and Health Operations:

     1. We will use your health information for treatment.
For example: Information obtained by a therapist, psychiatrist, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that is best suited for your needs.

     2. We will use your health information for payment.
For example: A bill may be sent to you or any private or public source of health coverage you have identified. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, testing, and supplies used.

     3. We will use your health information for regular health operations.
For example: Members of a clinical assessment team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

C. Others who may receive your health information

1. Business Associates: there are some services provided in our organization through contracts with business associates. When these services are contracted we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do. However, we require the business associate to appropriately protect your information.
2. Research: We may disclose information to researchers when the information is de-identified or when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
3. Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
4. Funeral Directors: We may disclose health information to funeral directors to carry out their duties, as required by law.
5. Public health: We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
6. Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof any health information necessary for your health and the health and safety of other individuals, or for the administration of the institution.
7. Law enforcement: We may disclose health information for law enforcement purposes.

D. Your Health Information Rights.You have the right to:

1. Request a restriction on certain uses and disclosures of your protected health information
2. Obtain a paper copy of this Notice of Information Practices upon request
3. Inspect and copy your protected health information
4. Request amendments to your protected health information
5. Obtain an accounting of disclosures of your protected health information
6. Request communications of your protected health information by alternative means or at an alternative address
7. Revoke your consent to use or disclose protected health information to the extent that it has not already been relied upon
8. File a complaint to the Chief Executive Officer and/or the Secretary of the U.S. Department of Health and Human Service if you believe your privacy rights have been violated.

E. T. W. Ponessa & Associates Responsibilities:

T. W. Ponessa & Associates has a duty to:

1. Maintain the privacy of your protected health information
2. Provide you with a notice as to our legal duties and privacy practices with respect to protected health information we collect and maintain about you
3. Abide by the terms of this notice
4. Notify you if we are unable to agree to a requested restriction
5. Accommodate reasonable requests you may have to communicate health information by alternative means or at an alternative address
6. Provide an accounting of disclosures of your protected health information

T. W. Ponessa & Associates may change its privacy practices and make the new privacy practices effective for all protected health information we maintain. Should our privacy practices change, we will mail a revised notice to the address you have supplied us or provide a copy during an office visits.

F. For More Information or to Report a Problem:

If you have questions and would like additional information, you may contact the Chief Executive Officer at: T.W. Ponessa & Associates 2141 Oregon Pike Lancaster, PA 17601.

If you believe your privacy rights have been violated, you can file a complaint with Chief Executive Officer or with the Secretary of the United States Department of Health and Human Services. There will be no retaliation for filing a complaint.

T. W. Ponessa & Associates reserves the right to change its privacy practices and will notify me of any revision.