I am required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information.  If you have questions about this notice, please contact Dr. Froman at East Maine Plaza, Quincy, IL. (217) 224-4080.  This Notice of Privacy Practices is provided to you as required by the Health Insurance Portability and Accountability Act (HIPAA).  It describes how I may use or disclose your protected health information, with whom that information may be shared, and the safeguards I have in place to protect it.  This notice also describes your rights to access and amend your protected health information.  You have the right to approve or refuse  the release of specific information outside our department except when the release is required or authorized by law or regulation. Illinois law or regulation that is stricter than the HIPAA act supercedes its provisions, and affords you the greater protection.

Acknowledgment Of Receipt Of This Notice: Your contract for services provides a signed statement acknowledging this notice. Our Duties Regarding Protected Health Information: Protected health information is individually identifiable health information.  This information relates to your past, present or future physical or mental health or condition or related health care services.  I am required by law to do the following: a) Make sure that your protected health information is kept private b) Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information C) Follow the terms of the notice currently in effect d) Communicate any changes in the notice to you.

I reserve the right to change this notice.  The effective date of this notice is at the top of the first page and the bottom of the last page.  I reserve the right to make the revised or changed notice effective for health information I already have about you as well     as any information I receive in the future. You may obtain a current Notice of Privacy Practices by calling me, as above, and requesting that a copy be mailed to you, or by asking for a copy at your next appointment.  If I change our privacy practices and you continue to receive health care from us at the time of the change, you will receive a revised copy.

How I May Use Or Disclosure Your Protected Health Information:   By law, I must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you.  Following are examples of permitted uses and disclosures of your protected health information not requiring your written authorization.  These examples are not exhaustive.

Required Uses And Disclosures: I must disclose protected health information to the Secretary of the federal Department of Health and Human Services for investigations or determinations of our compliance with laws on the protection of your health information.

Treatment: I will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services including the coordination or management of your health care with a third party.  For example, I may disclose your protected health information as necessary, to confer with our consulting psychologist, psychiatrist, or to coordinate with  a  residential facility that provides care for you.  If you require emergency treatment, I will use and disclose your protected health information to provide the treatment you require.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. I will submit your health care information to your private insurance carrier or similar payor to receive payment for services you have received.  Information submitted could include your diagnosis and the treatment or services provided.

Health Care Operations: I may use or disclose your protected health information, as needed, to improve the quality or cost of services provided  to you. These activities may include but are not limited to evaluating or examining the effectiveness and  quality of your services compared to similar individuals served elsewhere. I may look at your protected health information to determine the date and time of your next appointment, and send you a letter notifying or reminding you of the appointment.  I may contact you to provide information about treatment alternatives or other health-related benefits and services that may interest you.  I may disclose your protected health information to business associates with whom I have a contract or agreement.  A business associate  would     be a person other than a member of our department who performs a function or assists our department with activities such as accounting, auditing, computer network and information systems, or legal services.  I may also disclose your health information  to  a collection agency or court to collect payment of medical bills.

As Required Or Permitted By Law: I may use or disclose your protected health information if law or regulation requires such disclosure.  For example, I may disclose information to law enforcement agencies, court officials, or other government agencies in order to report child abuse or neglect or to respond to a court order.  I may disclose that I believe you are a victim of abuse, neglect, or domestic violence,  to  a government agency authorized by law to receive such reports.

Public Health Activities: I may disclose your protected health information to a public health authority to prevent or control disease, injury, or disability.  This could include the reporting of birth or death information, and child abuse or neglect.  It could also include reporting such things as adverse events or product defects to the Food and Drug Administration.  I may have to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or a condition.  I may also have  to report certain work-related illnesses or injuries so your workplace can be surveyed for safety.

Health Oversight Activities: I may disclose protected health information to a health oversight agency for activities authorized by law such as audits, investigations, and inspections.  These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, or other government regulatory programs which determine compliance with program standards or civil rights laws.

Legal Proceedings; I may disclose your protected health information during any judicial or administrative proceeding in response to an order of a court or administrative tribunal (if such disclosure is expressly authorized) or, in certain instances in response to a subpoena, discovery request, or other lawful process.
Law Enforcement: I may disclose your protected health information for law enforcement purposes as required by law and in response to legal proceedings: a) For the purpose of identifying or locating a suspect, fugitive, material witness or missing person
b) Upon a law enforcement official’s request for information about an individual who is suspected to be a victim of a crime c) To report on an individual who has died if I suspect the death may have resulted from criminal conduct d) To report criminal conduct that has occurred on the premises e) To respond to a medical emergency  believed to result from criminal conduct.

Coroners, Medical Examiners, And Funeral Directors: I may disclose protected health information to coroners or medical examiners for the purpose of identification, to determine the cause of death, or for the performance of other duties as authorized by law.  I may also disclose protected health information to funeral directors to carry out their duties as authorized by law.  Protected health information may be used  or disclosed for cadaver organ, eye, or tissue donations.

Research: I have no research activities within this practice that would apply.

Provision Of Public Benefits And Health Plans: I may have to disclose your protected health information as it relates to eligibility for enrollment to another agency administering a government program of public benefits, if the sharing or maintenance of such information in a single or combined data system accessible to all such government agencies is required or expressly authorized by statute or regulation.  Similarly, I may disclose protected health information as necessary to coordinate the covered function of such programs or to improve administration and management of such programs.

To Avert A Serious Threat To Health Or Safety: Under applicable federal and state laws, I may disclose your protected health information if I believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.  I may also disclose protected health information if it is necessary for law enforcement authorities   to identify or apprehend  an individual who has escaped from lawful custody or may have participated in a violent crime.

Military Activity And National Security: If you are in the Armed Forces or involved with national security or intelligence activities, I may disclose your protected health information to the proper federal authorities to enable them to carry out their duties under the law.  I may disclose your protected health information to federal officials conducting national security and intelligence activities including protective services  to the President or others.

Workers’ Compensation: I may disclose protected health information to comply with Workers’ Compensation laws or other programs established  by law that provide benefits for work-related injuries or illness.

Correctional Institutions And Other Law Enforcement Custodial Situations: I may use or disclose your protected health information   if you are an inmate of a correctional institution or are otherwise in the custody of a law enforcement official, if the disclosure is necessary for the institution to provide you with health care, for your health and safety or the health and safety of others, or for      the safety and security of the correctional institution.

Individuals Involved With Your Health Care: Unless you object, i may disclose to a member of your family, a relative, a close friend, or any other person you  identify, your protected health information that directly relates to that person’s involvement in your health care.  I may also give information to someone who helps pay for your care.  Additionally, I may use or disclose protected health information to notify or assist  in  notifying  a family member, personal representative, or any other person who is responsible for your care, of your  location, general condition, or death.  You have the right to object to such a disclosure, and I  may  allow you  to do so unless there is an emergency or you are unable to function or are incapacitated.   Finally, I may use or disclose your protected  health  information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures  to family or other individuals involved in your health care.

Access To Protected Health Information By Parents, Guardians, Or Other Legally Authorized Personal Representatives: Illinois law permits or requires disclosure of protected health information under most circumstances to parents of minor children, guardians of children or adults, and to other persons acting in a similar legal   capacity on behalf of an individual.  I will act consistently with state law with respect to treatment and disclosure.

Authorization To Disclose: Other uses and disclosures of your protected health information will be made only with your written authorization.  You may revoke your authorization at any time by submitting a request in writing to me.

Your Rights Regarding Health Information:   Right To Inspect And Copy: You may inspect and obtain a copy of your protected health information for as long as I maintain your records.  I will charge you a fee for copies of your records as permitted  by law. This right does not include inspection and copying of the following records: a) Psychotherapy notes b) Information    compiled in reasonable anticipation of or use in a civil, criminal, or administrative action or proceeding c)Protected health  information that is subject to law  that prohibits access to it.

Right To Request Restrictions: You may ask us not to use or disclose any part of your protected health information for treatment, payment, or  health care operations.  Your request must be made in writing to me.  I are not required to agree to a requested restriction.  However,  I  will attempt to accommodate reasonable requests, whenever possible.  If the restriction is mutually agreed upon, I will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment.

Right To Request Confidential Communications: You may request that I communicate with you using alternative means or at an alternative location.  I  will  accommodate reasonable requests.

Right To Request An Amendment: If you believe that the information I have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as I maintain it.  While I will accept reasonable requests for an amendment, I am not required  to agree to the amendment.

Right To And Accounting Of Disclosures: You may request that I provide you with an accounting of the disclosures I have made of your protected health information, except disclosures made prior to April 14, 2003, and no more than six years from the date of request.  This right excludes disclosures made to carry out treatment, payment, and health care operations, and excludes certain other types of disclosures as outlined by law.
Right To Obtain A Copy Of This Notice: You may obtain a paper copy of this notice from me, or my web site at http://www.psychassoc.com ..

State And Other Privacy Laws: This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA).  There are numerous other federal and state laws concerning the confidentiality of client/patient information.  These laws shall be followed by me and have been taken into consideration in developing this notice.

Complaints: If you believe your privacy rights have been violated, you may file a complaint me.  You may also file a complaint with the Secretary of the federal Department of Health and Social Services.  No retaliation against you will occur for filing a complaint.

Contact For Additional Information: You may contact me, as above, for any additional information.