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Confidentiality and Privacy Practices

Your informed written consent is required for the release of any information about you (or your child) except in the following circumstances:

1. We are legally obligated to inform the police if we have reason to believe a client is likely to inflict bodily harm on another person.

2. If we assess a client to be at high risk of suicide or gravely disabled due to a mental illness we are legally obligated to arrange for protective hospitalization.

3. We are legally obligated to report suspected child abuse to the State Office of Children’s Services (OCS). We are also required by law to report suspected abuse of handicapped or elderly persons.

4. In certain legal situations, our treatment records may be ordered to be released by a court of law. Please discuss with us any concerns in this regard.

5. When an insurance claim is filed for our services the client (or legal guardian) gives their health insurance carrier the right to make inquiries regarding their mental condition. In certain cases, we may be asked to provide details concerning a client’s presenting problem(s) and treatment needs. Insurance companies usually require a signed release from clients in order to pay benefits directly to a health service provider.

6. If necessary, we may release a client’s name to a collection agency. In these cases, no treatment related content would be disclosed.

7. At Fairbanks Therapy Associates we use a team approach, which means we may consult with one or more clinical team members regarding your case. All team members are held to the same confidentiality outlined above. In releasing confidential information, we will only disclose those details of a case that are legally or clinically necessary. If you see someone leaving the office area that you recognize, please respect his or her confidentiality, as you would want them to do the same for you.

Your Health Information Rights:

Your treatment file will be kept for seven years after your last date of service. After that time, it will be destroyed. Although your health record is the physical property of Fairbanks Therapy Associates, under the Health Insurance Portability and Accountability Act of 1996 (HIPPA) you have the right to: 

· Obtain a paper copy of this notice of information on request.

· Inspect and receive a copy of your medical record.

· Request communication of your health information by alternative means.

· Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities:

Our practice 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 the information we collect and maintain about you.

· Abide by terms of this notice.

· Notify you if we are unable to agree to a requested restriction.

· Accommodate reasonable requests you may have to communicate health information by alternative means or at an alternative location.

We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our information or practices change, we will mail a revised notice to the address you’ve supplied. We will not use or disclose your health information without your written 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.

For More Information or To Report A Problem:

If you have questions or would like additional information you may speak with the Executive Director. If you believe your privacy rights have been violated, you can file a complaint with us or with the Office for Civil Rights, US Department of Health and Human Services.

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