Amplified Life Network, LLC, d/b/a Amplified Life Counseling & Coaching
7791 Byron Center Ave. SW
Byron Center, MI 49315
616-499-4711 | www.amplife.us
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on May 12, 2023
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
OUR PLEDGE REGARDING HEALTH INFORMATION
Amplified Life Network, LLC (dba Amplified Life Counseling & Coaching; “Amplified Life”) understands that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:
- Make sure that protected health information (“PHI”) that identifies you is kept private.
- Give you this notice of our legal duties and privacy practices with respect to health information.
- Follow the terms of the notice that is currently in effect.
- We can change the terms of this Notice, and such changes will apply to all information that we may use or disclose after the change of this Notice of Privacy Practices. The new Notice will be available upon request, in our office, and on our website.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of another health care provider who is directly involved in your care. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order, subject to the scope of Michigan law and HIPAA, and applicable exceptions. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested and in compliance with Michigan law and HIPAA, and applicable exceptions.
CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION
Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:
Required By Law – Under the law, we may disclose your PHI to you upon your request. In addition, we must make disclosures to the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the HIPAA Privacy Rule.
- For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
- For health oversight activities authorized by law, such as audits, inspections, and investigations. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors based on your prior consent) and peer review organizations performing utilization and quality control.
- For judicial and administrative proceedings, including responding to a court or administrative order or subpoena (with your authorization), subject Michigan law and HIPAA law and applicable exceptions.
- For law enforcement purposes, including reporting crimes occurring on our premises, identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, subject to applicable subpoena, court order, administrative order and in compliance with Michigan law and HIPAA, as consistent with exceptions to Michigan law and/or HIPAA.
- To coroners or medical examiners, when such individuals are performing duties authorized by law.
- For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
- For workers’ compensation purposes (with your authorization), subject Michigan law and HIPAA law and applicable exceptions.
- Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.
- Medical Emergencies - For medical emergencies we may use or disclose your PHI to medical personnel.
CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE RIGHT TO OBJECT:
- Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI - You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request.
The Right to Request Restrictions for Out-of-Pocket Expenses You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone), or to send mail to a different address, and we will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. You have a right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a “designated record set”. A designated record set contains mental health and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations when there is compelling evidence that access would cause serious harm to you, if the information is contained in separately maintained psychotherapy notes, or if your treatment involved more than one person in the therapeutic environment and a signed release is not obtained by the other party or parties. Our office will charge a reasonable, cost-based fee for copies. You may also request that a copy of your PHI be provided to another person. You have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.
The Right to Get a List of the Disclosures we Have Made. You have the right to request, in writing, a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. Your written request for disclosures will be for a timeframe, not to exceed six years. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost-based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
Breach Notification – If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer, Lyle Labardee, LPC or with the Secretary of the Health and Human Services Department at 200 Independence Avenue, S.W., Washington, D.C., 20201 or by calling (202) 619-0257. We will not retaliate against you for filing a complaint.
Acknowledgement of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.