Oakwood Clinical Associates

Enhancing the lives of our clients by delivering exemplary psychotherapy services with lasting solutions
Introduction to Our Clients
This notice will tell you about how we handle information about you. It tells how we use this information here in this office, how we share it with other professionals and organizations, and how you can see it. We want you to know all of this so that you can make the best decisions for yourself and your family. We are also required to tell you about this because of the privacy regulations of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Because this law and the laws of this state are very complicated and we don’t want to make you read a lot that may not apply to you, we have simplified some parts. If you have any questions or want to know more about anything in this Notice, please ask our Privacy Officer for more explanation or more details.

What We Mean by Your Medical Information
Each time you visit this office or any doctor’s office, hospital, clinic, or other “healthcare Provider”, information is collected about you and your physical or mental health. This may be information about your past, present or future health conditions. As well as treatment or other services you’re received from us or from others, or about payments for healthcare. The information we collect from you is referred to by the law as, PHI which stands forProtected Health Information. This information goes into your medical or healthcare recordat this office. In this office this PHI is likely to include the following kinds of information:
  • Your history: As a child, in school and at work, and marital and personal history.
  • Reasons you came for treatment: Your problems, complaints, symptoms, needs, goals.
  • Diagnoses: Diagnoses are the medical terms for your problems or symptoms.
  • A treatment plan: These are the treatments and other services which we think will best help you.
  • Progress notes: Each time you come in we write down some things about how your are doing, what we observe about you, and what you tell us.
  • Records: Documents we get from others who treated you or evaluated you including medical records, psychological test scores, school records, etc.
  • Information about medications you took or are taking.
  • Legal matters
  • Billing and insurance information

This list is just to give you an idea and there may be other kinds of information that go into your healthcare record here.  We use this information for many purposes. For example, we may use it:
  • To plan your care and treatment.To decide how well our treatments are working for you.
  • When we talk with other healthcare professionals who are also treating you such as your family doctor or the professional who referred you to us.
  • To show that you actually received the services from us which we billed to you or to your health insurance company.
  • For teaching and training other healthcare professionals.
  • For medical or psychological research.
  • For public health officials trying to improve health care in this country.
  • To improve the way we do our job by measuring the results of our work.

When you understand what is in your record and what it is used for you can make better decisions about whom, when, and why others should have this information.  Although your health record is the physical property of the healthcare practitioner or facility that collected it, the information belongs to you. You can inspect, read, or review it. If you want a copy we can make one for you but may charge you for the costs of copying (and mailing if you want it mailed to you). In some very unusual situations you cannot see all of what is in your records. If you find anything missing you can ask us to amend (add information to) your record although in some rare situations we don’t have to agree to do that. Our Privacy Officer, whose name is at the end of this Notice, can explain more about this. 

Privacy and the Law
The HIPAA law requires us to keep your PHI private and to give you this notice of your legal duties and our privacy practices which is called the Notice of Privacy Practices or NPP. We will obey the rules of this notice as long as it is in effect but if we change it the rules of the new NPP will apply to the entire PHI we keep. If we change the NPP we will post the new Notice in our office where everyone can see. You or anyone else can also get a copy from our Privacy Officer at any time.

How Your Protected Health Information Can Be Used and Shared
When your information is read by staff in this office, it is classified by the law as “use”. If the information is shared with or sent to others outside this office, it is classified by the law as“disclosure”. In some special circumstances, when we use your PHI here or disclose it to others we share only the minimum PHI needed for the purpose. The law gives you the right to know about how your PHI is used. You have the right to dictate how this information is used and we have the responsibility to share how this information is being used with you. We use and disclose PHI for several reasons. Primarily, we will use and disclose (share) PHI for routine purposes, these will be explained below. For uses outside of routine purposes we must have signed authorizations from you. In some circumstances the law may allow or require us to use this information with out your permission.

1.        Uses and Disclosures of PHI in Healthcare with your Consent
 After you read this Notice you will be asked to sign a separate Consent form to allow us to use and share your PHI. In almost all cases we intend to use your PHI within this office or share your PHI to coordinate treatment with other organizations or professionals.  Consent is also needed to arrange payment for our services or other business functions called health care operations.  All together these routine purposes are referred to as TPO. The consent form allows us to use and disclose your PHI for these purposes.

1a.    For Treatment, Payment, or Health Care Operations.
 We need information about you and your condition to provide care for you.  To properly care for and treat your condition we must collect personal information about you. Therefore a consent form must be signed before we begin treating you.  If a consent form is not signed we are  unable to properly coordinate treatment for you and therefore will not be able to provide services to you.   When you come to our office several people may be collecting this information from you and it will become part of your healthcare records. Generally, we may use or disclose your PHI for three purposes: treatment, obtaining payment, and what are called healthcare operations. Let’s see what these are about.

For Treatment
We will use your medical information to provide you with psychological treatment or services. These might include individual, family, or group therapy, psychological, educational, or vocational testing, treatment planning, or measuring the effects of our services.  We may share or disclose your PHI to others who provide treatment to you or to coordinate and supervise your mental health care. Some of your PHI will be shared with staff of Oakwood Clinical Associates through consultation and records management. A state certified clinic such as ours has a mandate to consult with a supervising psychologist or psychiatrist after your initial assessment to review and approve psychotherapy. Additional reviews of ongoing treatment are conducted on a regularly scheduled basis. These are some examples so that you can see how we use and disclose your PHI for treatment.

For Payment
We may use your information to bill you, or Kenosha County Division of Disability Services to be paid for the treatment we provide to you. We may contact your insurance company to verify benefits this process may require disclosing what you are seeking treatment for.  A written and signed authorization is required by WI State Statues to disclose information to your insurance company to bill them for services. This information may include your assessment, diagnosis, type of treatment, treatment plan, duration of treatment or psychotherapy notes and summaries.  You do have the option of paying for psychotherapy privately, in which case your insurance company would not have access to any of your mental health information.

For Health Care Operations
There are some other ways we may use or disclose your PHI which are called health care operations. For example, we may use your PHI to see where we can make improvements in the care and services we provide. We may be required to supply some information to government health agencies for research purposes. If we do, your name and identity will be removed from documents sent.  We may disclose your PHI to government agencies for state mandated review of our clinic to maintain our clinic certification and licensing. We may call you by name in the waiting room. We may contact you by pone or mail regarding appointment scheduling.

1b.  Other Uses in Healthcare
Appointment Reminders. We may use and disclose medical information to reschedule or remind you of appointments for treatment or other care. If you want us to call or write to you only at your home or your work or prefer some other way to reach you, this can be arranged at request.

Treatment Alternatives. We may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of interest to you.
Other Benefits and Services. We may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.  For example, your name and address may be used to send you a newsletter about our practice and the services we offer, or to announce workshops that we are offering.

Research. We may use or share your information to do research to improve treatments. For example, comparing two treatments for the same disorder to see which works better or faster or costs less. In all cases your name, address and other information that reveals who you are will be removed from the information given to researchers. If they need to know who you are we will discuss the research project with you and you will have to sign a special Authorization form before any information is shared.

Business Associates. There are some jobs we hire other businesses to do for us. They are referred to as Business Associates by law. These Business Associates may be transcription services, collection agencies and soft ware and hardware companies. To protect your privacy they have agreed in their contract with us to safeguard your information.

2.      Uses and Disclosures Requiring Your Authorizations
If we want to use your information for any purpose besides the TPO or those we described above we need your written permission on an Authorization form.  If you do authorize us to use or disclose your PHI, you can revoke (cancel) that permission, in writing, at any time. After that time we will not use or disclose your information for the purposes that we agreed to. Of course, we cannot take back any information we had already disclosed with your permission or that we had used in our office.

3.      Uses and Disclosures of PHI from Mental Health Records Not requiring Consent or Authorization
The laws allow us use and disclose some of your PHI without your consent or authorization in some cases.  When required by law: There are some federal, state, or local laws which require us to disclose PHI.   We have to report suspected child abuse or elder abuse.  If you are involved in a lawsuit or legal proceeding and we receive a court order or other lawful process we may have to release some of your PHI. We will only do so after attempting to inform you of the request. A subpoena is insufficient unless signed by a judge of a court of record.  We have to release (disclose) some information to the government agencies which monitor us and our privacy law practices.  For Medical Emergencies: We may use or disclose protected health information to emergency medical personnel or a physician in the event of a life-threatening emergency.  For the Protection of Patient Rights: We may use or disclose your health information to our Client’s Rights Specialist and/or to KCDADS due to a grievance filed over violation of patient rights.  For Law Enforcement Purposes: We may release medical information if asked to do so by a law enforcement official to investigate a crime on our premises.  For public health activities: We might disclose some of your PHI to agencies which investigate diseases or injuries.  Relating to decedents: We might disclose PHI to coroners, medical examiners or funeral directors.  For specific government functions:We may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment, to Workers’ Compensation programs, to correctional facilities if you are an inmate, and for national security reasons.  We may use and disclose protected health information between Kenosha County Division of Disability Services, Kenosha Human Development Services, Community Intervention Center and Oakwood Clinical Associates of patients funded or monitored by these community agencies.  To Prevent a Serious Threat to Health or Safety:  If we come to believe that there is a serious threat to your health or safety or that of another person or the public we can disclose some of your PHI. We will only disclose information to persons who can prevent danger.

4.      Uses and Disclosures Requiring You to Have an Opportunity to Object
We can share some information about you and your protected health information as stated above in this Notice. You can tell us what you want and we will honor your wishes as long as it is not against the law.  If it is an emergency - so we cannot ask if you disagree - we can share information if we believe that it is what you would have wanted and if we believe it will help you if we do share it. If we do share information, in an emergency, we will tell you as soon as we can. If you do not approve   we will stop as long as it is not against the law.

5.      An Accounting of Disclosures
 When we disclose your PHI we keep records to whom it is sent, when it was sent, and what was sent. You can get an accounting (a list) of these disclosures.
If you have questions or problems
If you need more information or have questions about the privacy practices described above please speak to the Privacy Officer whose name and telephone number are listed below. If you have a problem with how your PHI has been handled or if you believe your privacy rights have been violated, contact the Privacy Officer. You have the right to file a complaint with us and with the Secretary of the Federal Department of Health and Human Services. Under no circumstances will we limit your care or take action against you if you file a complaint.

If you have any questions regarding this notice or our health information privacy policies, please contact our Privacy Officer who is Amy Anderson. She can be reached by phone at 
Phone: 262-652-9830
4109 67th Street Kenosha, WI 53142
 or email: info@oakwoodclinical.com

The effective date of this notice is April 14, 2003 (Revised May 2005)