DUI Evaluations | DOT SAP Evaluations | Substance Abuse Treatment | Family & Marriage Counseling         Aurora • Bartlett • Crystal Lake • Geneva • West Dundee IL        (800) 428-7260
Professional Consultations, Inc.
Counseling and DUI Services in Bartlett, Crystal Lake, West Dundee, Geneva, Aurora, Illinois
Family Counseling and DUI Centers since 1985

Notice of Privacy Practices

(Effective 04/01/2003)
(Reviewed 1/1/2012)

If you are a client at Professional Consultations, this notice describes how your health information may be used and disclosed and how you can get access to this information. This Notice is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Please review it carefully.

1. OUR PLEDGE REGARDING HEALTH INFORMATION

Professional Consultations, Inc., its professional staff, employees, consultants, and trainees follow the policies and procedures described in the Notice. Professional Consultations keeps your personal information in records that will be maintained and protected in a confidential manner, as required by law. Please note, that in order to provide you with the best possible care all professional staff involved in your treatment and professionals involved in the operations of the agency may have access to your records.

2. WHAT ARE TREATMENT AND HEALTH CARE OPERATIONS?

If you are seeing a counselor, he/she may share information in the process of coordinating your care with staff. Treatment records may be reviewed as part of an ongoing process directed toward assuring the quality of facility services. Staff members designated by the Quality Improvement Committee may access records periodically to verify that Agency standards are met.

3. HOW WILL PROFESSIONAL CONSULTATIONS, INC. USE MY PROTECTED HEALTH INFORMATION?

If you are receiving mental health services, Professional Consultations, Inc. will retain your record for approximately eight years or more after your last clinical contact with the agency. State law requires that all substance abuse clinical records be maintained for at least five years. After that time has elapsed, the record will be shredded or burned or otherwise destroyed in a way that protects your privacy. Until the records are destroyed, they may be used for the following purposes unless you ask for restrictions on a specific use or disclosure.

We may discuss your health information to permit your health plan or other third party payer to take certain actions before your health plan approves to pay for your services. These actions may include making a determination of eligibility or coverage for health insurance, reviewing your services to determine medical necessity, to determine if sessions/services were appropriately authorized or certified in advance or during your care.

Appointment reminders, notification when an appointment is canceled or rescheduled by the agency or mailing of announcements or billing information may be conducted. A message may be left on a personal answering machine regarding appointments.

As required by law we may disclose the following information:

For public health purposes such as reporting of child or elder abuse/neglect or domestic violence;

Mental health oversight activities, e.g., audits, inspections or investigation of the facility;

Lawsuits and disputes (We will attempt to provide you advance notice of a court ordered subpoena before disclosing information from your record);

Law enforcement to identify or locate an individual being sought by authorities, about a victim of a crime under restricted circumstances; about a death that may be the result of criminal conduct; about criminal conduct that occurred in the agency, or when emergency circumstances occur relating to a crime;

To prevent a serious threat to health or safety or to obtain emergency care, or to Medical examiners as necessary by law to carry out identification of deceased persons and determine cause of death;

To carry out treatment and health care operations functions through medical transcription services, to coordinate and manage your care among clinicians and other staff/consultants, and for healthcare operations;

National security, intelligence activities, or protection of the President or other authorized persons.

Alcoholism and substance abuse treatment information has special provisions. Professional Consultations will not disclose any information identifying an individual as being a client or provide any mental health or information relating to a person's substance abuse treatment unless: (1) the client consents in writing; (2) a court order requires disclosure of the information; (3) medical personnel need the information to meet a medical emergency; (4) qualified personnel use the information for research, management audits, or program evaluation; or (5) it is necessary to report a crime or a threat to commit a crime or to report abuse or neglect as required by law.

Uses and disclosures not described above will generally only be made with your written permission. You have the right to revoke an authorization at any time, otherwise it remains in effect for 12 months after discharge. You have the right to amend any health information used to make decisions about your care. This may include clinical and billing records, but not psychotherapy notes. You must contact the Privacy Officer in writing to amend your record. We have the right to deny an amendment, and you will be given a written response outlining the reason for the denial. In this case, we will attach your written request and the response to all future disclosures of health information that are the subject of your request.

4. YOUR AUTHORIZATION IS REQUIRED FOR OTHER DISCLOSURES

Except as described previously, we will not use or disclose information from your record unless you authorize (permit) in writing to do so. You may revoke your permission, which will be effective only after the date of your written revocation.

5. YOU HAVE RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding your health information, provided you make a written request to invoke the right on the form provided by Professional Consultations:

*Right to request restriction(s) or limitations on the mental health information. We may disclose, but we are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment. To request a restriction, you must request the restriction in writing to the Privacy Officer.

*Right to confidential communication. You may request communications in a certain way or at a certain location, but you must specify how or where you wish to be contacted. This request must be made in writing to the Privacy Officer and we will accommodate all reasonable requests.

*Right to inspect and copy your mental health information regarding decisions about your care. Psychotherapy notes may not be inspected and copied. We may charge a fee for copying, mailing, and supplies. Under limited circumstances, your request may be denied. You may request a review of the denial by another licensed mental health professional chosen by Professional Consultations.

*If you believe that the information we have about you is incorrect or incomplete, you may ask to add clarifying information. You may ask for a form for that purpose and the form will require certain specific information. The agency is not required to accept the information that you propose.

*Right to accounting of any disclosures from your record. You may request a list of the disclosures of your clinical information that have been made to persons or entities other than for treatment or health care operations in the last six (6) years, but not prior to April 14, 2002.

*You have a right to request a copy of this Notice. A copy is also provided on our website.

6. REQUIREMENTS REGARDING THIS NOTICE

Professional Consultations, Inc. is required to provide you with this notice and may change its policies or procedures in regard to privacy practices. If and when changes occur, the changes will be effective for health information we have about you as well as any information we receive in the future. Any time you come to this agency you may request a copy of the Privacy Notice that is in effect at the time.

7. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with Professional Consultations, Inc. or with the Secretary of the US Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint. Complaints to the agency should be made in writing to the Privacy Officer, Professional Consultations, Inc., 745 South 8th St., W. Dundee, Illinois.

Counseling and
Administration Office:

(Century Plaza at Rt. 31)
745 South 8th Street
West Dundee, IL 60118

Counseling Locations:
West Dundee, IL
Geneva, IL
Aurora, IL
Crystal Lake, IL
Bartlett, IL

For Information or Referral Call:
(800) 428-7260
24 Hour Helpline &
All Illinois Locations
(Se Habla Espaņol)


(847) 428-7269 Fax

Office Hours:
Mon. - Fri. 8:30 a.m. to 9:00 p.m. Sat. 8:30 a.m. to 3:00 p.m.

DUI Services
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(All Illinois Locations)

All services are available
in Spanish by
Bilingual and Bicultural
Counselors.
(Todos los programas son ofrecidos en espaņol)

 

Chicago Area Family Counseling & DUI Centers since 1985 with offices in Aurora, Bartlett, Crystal Lake, Geneva, and West Dundee IL.
© 2012 Professional Consultations, Inc. • 745 South 8th Street, West Dundee, IL 60118 • (800) 428-7260