Effective date: February 21, 2025
This notice describes how medical and mental health information about you may be used and disclosed by Alfrey and Pruitt Counseling Services, and how you can get access to this information. Please review it carefully. A paper copy is available at our office at any time.
Purpose of This Notice
This document explains how your Protected Health Information (PHI) may be used and disclosed by Alfrey and Pruitt Counseling Services and how you can access your information. It complies with:
- The Health Insurance Portability and Accountability Act (HIPAA) of 1996
- The HIPAA Privacy Rule (45 CFR Parts 160 and 164)
- The Nebraska Mental Health Practice Act
- Nebraska Revised Statutes on Health Information Privacy (§71-8402 et seq.)
Under these laws, we are required to:
- Maintain the privacy and security of your PHI
- Provide you with this Notice of Privacy Practices
- Follow the terms of this Notice currently in effect
- Notify you promptly if a breach of unsecured PHI occurs
Acknowledgment of Receipt
HIPAA requires that we ask you to acknowledge that you have received this Notice. New clients sign this acknowledgment with their intake paperwork. If you have questions, we encourage you to ask before signing.
How We Use and Disclose Your PHI
We may use or disclose your PHI without your written authorization in certain circumstances, as outlined below. In all other cases, we will require your explicit written consent.
1. Treatment, Payment and Healthcare Operations
- For Treatment – We use PHI to provide, coordinate, and manage your care. This may include communication with other healthcare providers involved in your treatment.
- For Payment – We may use PHI to bill and obtain payment from insurance companies or other payers. If you pay in full out-of-pocket, you have the right to request that we do not disclose that service to your insurer unless required by law.
- For Healthcare Operations – We may use PHI to improve our services, conduct internal audits, and provide staff training.
2. Business Associates and Third-Party Service Providers
We may share PHI with business associates (e.g., billing services, electronic records management, IT support) who perform services on our behalf. These associates must sign a HIPAA-compliant Business Associate Agreement (BAA) ensuring they protect your information and use it only for agreed-upon services.
3. Situations Where Disclosure Is Required or Permitted by Law
A. Legal and Court-Ordered Disclosures
- If you are involved in a legal proceeding, your PHI is protected by Nebraska’s psychologist-patient privilege law (§27-504).
- We cannot release your records without your written authorization, a court order, or a valid subpoena.
- If we receive a subpoena, we will notify you so that you may contest it.
B. Health Oversight and Government Agency Requests
- If a government agency requests PHI for legally authorized health oversight activities, we may be required by law to provide it.
C. Workers’ Compensation
- If you file a Workers’ Compensation claim, we are required by Nebraska state law (§48-120) to submit treatment reports to your employer, insurer, or an authorized rehabilitation provider.
Mandatory Reporting and Public Safety Exceptions
Certain situations require us to disclose PHI to protect you or others. These include:
1. Child and Vulnerable Adult Abuse Reporting
- If we suspect or know that a child under 18 has been abused, neglected, or abandoned, we are legally required to report it to the Nebraska Abuse Hotline (§28-711).
- If we suspect abuse, neglect, or exploitation of a vulnerable adult, we must report it to the Nebraska Department of Health and Human Services (DHHS) Adult Protective Services (§28-372).
2. Duty to Warn and Protect
If we determine that you pose a clear and immediate danger to yourself, others, or society, we may be legally obligated to disclose PHI to law enforcement, a potential victim, a family member, or emergency services. We will disclose only the minimum information necessary to fulfill legal and ethical obligations.
Your Rights Under HIPAA and Nebraska Law
As a client, you have the following rights regarding your Protected Health Information (PHI):
1. Right to Access and Copy Your Records
- You may request a copy of your treatment records in electronic or paper form.
- Nebraska law (§71-8404) allows fees up to $0.50 per page for paper copies and $20.00 for electronic copies.
2. Right to Request Amendments
- If you believe your records are inaccurate or incomplete, you may request a correction in writing.
- We must respond within 60 days with approval or an explanation for denial.
3. Right to Confidential Communications
You may request that we communicate with you in an alternative manner (e.g., phone instead of mail) or at an alternative location.
4. Right to Restrict Disclosures
If you pay in full out-of-pocket, you can request that we do not disclose that service to your insurance. We are required to honor this request, unless state or federal law requires disclosure.
5. Right to an Accounting of Disclosures
You may request a list of certain disclosures of your PHI, excluding those for treatment, payment, and operations.
6. Right to a Copy of This Notice
You have the right to receive a paper or electronic copy of this Notice at any time.
7. Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:
- Alfrey and Pruitt Counseling Services (contact our office using the information below)
- Nebraska DHHS (regarding state violations)
- The U.S. Department of Health and Human Services, Office for Civil Rights (for HIPAA violations): www.hhs.gov/ocr/complaints
We will not retaliate against you for filing a complaint.
Changes to This Notice
We reserve the right to update or modify this Notice of Privacy Practices as required by law. If significant changes occur, we will provide a revised copy electronically or in person, post an updated version at our office and on this website, and notify you in writing of any material changes. Until a revised notice is issued, we will continue to abide by the terms currently in effect.
Contact Us
If you have questions about this Notice or your privacy rights, please contact our office:
Alfrey and Pruitt Counseling Services
403 Lexington Cir, Grand Island, NE 68803
Phone: (308) 675-2858
Email: info@alfreyandpruittcounseling.com