I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We, Bayani Wellness and Counseling (BWC) PLLC and Dr. Jennifer Tang Cole, LMSW, Ph.D. (herein referred as we), are required by law to maintain the privacy and security of your protected health information ("PHI") and to provide you (the identified patient(s)) with this Notice of Privacy Practices ("Notice") of our practice. This Notice explains when, why, and how we would use and/or disclose your PHI. We must abide by the terms of this Notice, and we must notify you if a breach of your unsecured PHI occurs. We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, client portal, and our website.
NOTICE OF Privacy PRACTICES (NPP)
A. Uses and Disclosures Related To Treatment, Payment Or Healthcare Operations Do Not Require Your Prior Written Consent.
Bayani Wellness and Counseling PLLC, Dr. Jennifer Tang Cole, LMSW, Ph.D. or her contractor associates may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes without your consent.
B. Certain Uses and Disclosures Requiring Authorization
We may use and/or disclose your PHI without your consent or authorization for the following reasons:
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
We may provide your PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.
D. Other Uses and Disclosures Require Your Prior Written Authorization.
In any other situation not described in Sections IIIA, IIIB, and IIIC above, we will request your written authorization before using or disclosing any of your PHI. Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (assuming that we haven't taken any action subsequent to the original authorization) of your PHI by us.
Bayani Wellness and Counseling PLLC, Dr. Jennifer Tang Cole, LMSW, Ph.D. or her contractor associates may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes without your consent.
- For treatment. We can use your PHI within our practice to provide you with mental health treatment, including discussing or sharing your PHI with psychotherapy consultants, BWC staff, and interns. We may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. Example: If a psychiatrist is treating you, we may disclose your PHI to her/him in order to coordinate your care.
- For health care operations. We may disclose your PHI to facilitate the efficient and correct operation of our practice (e.g. internal operation audits). We may also provide your PHI to other professionals including consultants to make sure that we are in compliance with applicable laws.
- To obtain payment for treatment. We may use and disclose your PHI to bill and collect payment for the treatment and services we provided you. We could also provide your PHI to business associates, such as billing companies, claims processing companies, and others that process health care claims for our office.
- Other disclosures. Examples: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. In the event that we try to get your consent but you are unable to communicate with us (for example, if you are unconscious or in severe pain) but we think that you would consent to such treatment if you could, we may disclose your PHI.
B. Certain Uses and Disclosures Requiring Authorization
We may use and/or disclose your PHI without your consent or authorization for the following reasons:
- Disclosures required by federal, state or local law; judicial, board, or administrative proceedings; or, law enforcement: We may make a disclosure to the appropriate officials when a law requires us to report information to government agencies, law enforcement personnel and/or in an administrative proceeding. If disclosure is required by a search warrant lawfully issued to a governmental law enforcement agency. If disclosure is compelled by the patient or the patient's representative pursuant to Michigan Health and Safety Codes or to corresponding federal statutes of regulations, such as the Privacy Rule that requires this Notice
- Serious Threat to Health or Safety: If we believe that you pose a clear and substantial risk of imminent serious harm, or a clear and present danger, to yourself or another person we may disclose your relevant confidential information to public authorities, the potential victim, other professionals, and/or your family in order to protect against such harm. If you communicate to us an explicit threat of inflicting imminent and serious physical harm or causing the death of one or more clearly identifiable victims, and we believe you have the intent and ability to carry out the threat, then we may take one or more of the following actions in a timely manner: 1) communicate to a law enforcement agency and, if feasible, to the potential victim(s), or victim's parent or guardian if a minor, all of the following information: a) the nature of the threat, b) your identity, and c) the identity of the potential victim(s). We will inform you about these notices and obtain your written consent if I deem it appropriate under the circumstances. 2) we must also follow all applicable state laws given the circumstance which may include: contacting your emergency contact (noted in your intake forms), contacting 911 or local authorities, filing an extreme risk protection order or she may make recommendations for higher level psychiatric care including emergency psychiatric services or hospitalization services.
- Abuse, Neglect, and Other Forms of Violence: If we know or have reason to suspect that a child under 18 years of age or a developmentally disabled, or physically impaired child under 21 years of age has suffered or faces a threat of suffering any physical, emotional, verbal abuse, injury, disability, or condition of a nature that reasonably indicates abuse or neglect, the law requires that we file a report with the appropriate government agency, usually the Michigan Child Protective Services. If we have reasonable cause to believe that a developmentally disabled adult, or an elderly adult iis being abused, neglected, or exploited, the law requires that we report such belief to the appropriate governmental agency, usually Michigan Adult Protective Services. In both cases when a report is filed, we may be required to provide additional information to government agencies, law enforcement and/or in an administrative proceedings.. If Dr. Cole knows or has reasonable cause to believe that a patient or client has been the victim of domestic violence, she must note that knowledge or belief and the basis for it in the patient(s) medical records.
- Worker’s Compensation: If you file a worker’s compensation claim, we may be required to give your mental health information to relevant parties and officials.
- For Health Oversight Activities: We may use and disclose PHI if a government agency is requesting the information for health oversight activities. Some examples could be audits, investigations, or licensure and disciplinary activities conducted by agencies required by law to take specified actions to monitor healthcare providers, or reporting information to control disease, injury or disability.
- For Specific Governmental Functions: We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, and for national security reasons, such as for protection of the President.
- For Lawsuits and Other Legal Proceedings: If you are involved in a court proceeding and a request is made for information concerning your evaluation, diagnosis or treatment, such information is protected by law. We cannot provide any information without your (or your personal or legal representative’s) written authorization, or a court order, or at times an administrative subpoena, unless the information was prepared for a third party. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order Dr. Cole to disclose information. If a patient files a complaint or lawsuit against Dr. Cole may disclose relevant information regarding that patient in order to defend herself.
- For public health activities. In the event of your death, if a disclosure is permitted or compelled, we may need to give the county coroner information about you
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
We may provide your PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.
D. Other Uses and Disclosures Require Your Prior Written Authorization.
In any other situation not described in Sections IIIA, IIIB, and IIIC above, we will request your written authorization before using or disclosing any of your PHI. Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (assuming that we haven't taken any action subsequent to the original authorization) of your PHI by us.
III. USES AND DISCLOSURE OF PATIENT’S PROTECTED HEALTH INFORMATION
These are your rights with respect to your PHI:
- Right to Inspect and Receive Copies of Your PHI – In general, you have the right to inspect or obtain a copy (or both) of PHI in your medical and billing records used to make decisions about you for as long as the PHI is maintained in the record, except under some limited circumstances. Requests must be submitted in writing or completed using BWC request form in the client portal. Under certain limited circumstances, we may feel we must deny your request to inspect and/or copy your record or parts of your record. If a request is denied, we will explain verbally (via telehealth or phone) and in writing through the client portal. Under certain circumstance where we feel, for clearly stated treatment reasons, the disclosure of your record might have an adverse effect on you, we will provide your records to another mental health therapist of your choice and provided releases of information are signed by you. If you request physical copies of your PHI, we contact you to discuss methods to receive copies and associated fees related to shipping and copying ($0.05 per page).
- Right to Request Restriction on use and Disclosures of Your PHI –You have the right to request restrictions on certain uses and disclosures of your protected health information. While we will consider your request, we are not legally bound to agree. If we do agree to your request, we will put those limits in writing and abide by them except in emergency situations. You do not have the right to limit the uses and disclosures that we are legally required or permitted to make.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – It is your right to ask that your PHI be sent to you at an alternate address (for example, sending information to your work address rather than your home address) or by an alternate method (for example, via e-mail instead of by regular mail). We are obliged to agree to your request providing that we can give you the PHI, in the format you requested, without undue inconvenience. We may not require an explanation from you as to the basis of your request as a condition of providing communications on a confidential basis.
- Right to Amend or Request Record Clarification – If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that we correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of my receipt of your request. We may deny your request, in writing, if we find that: the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of our records, or (d) written by someone other than me. Our denial must be in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and my denial be attached to any future disclosures of your PHI. If I approve your request, we will make the change(s) to your PHI. Additionally, we will tell you that the changes have been made, and we will advise all others who need to know about the change(s) to your PHI.
- Right to an List of Disclosures – With certain exceptions, you generally have the right to receive an accounting of disclosures of PHI, not including disclosures for treatment, payment or health care operations for paper records on file for the past six years and for an accounting of disclosures made involving electronic records, including disclosures for treatment, payment or health care operations; neither will the list include disclosures made for national security purposes, to corrections or law enforcement personnel, or disclosures made before April 30, 2024. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. I will provide the list to you at no cost, unless you make more than one request in the same year, in which case I will charge you a reasonable sum based on a set fee for each additional request.
- Right to a Copy of this Notice – You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically. You also have the right to receive a copy of this notice by email.
IV. PATIENT’S RIGHTS REGARDING YOUR PHI
If you have any questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint, contact:
Privacy Officer,: Dr. Jennifer Tang Cole, LMSW, Ph.D., Founder/Manager Member of Bayani Wellness and Counseling, PLLC, by email at: dr.cole@bayaniwellness.com or by phone at 734-219-4070.
VI. PRIVACY AND SECURITY OFFICER:
In the case of a breach, Bayani Wellness and Counseling PLLC requires to notify each affected individual whose unsecured PHI has been compromised. Even if such a breach was caused by a business associate, Bayani Wellness and Counseling PLLC is ultimately responsible for providing the notification directly or via the business associate. If the breach involves more than 500 persons, U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) must be notified in accordance with instructions posted on its website. Bayani Wellness and Counseling bears the ultimate burden of proof to demonstrate that all notifications were given or that the impermissible use or disclosure of PHI did not constitute a breach and must maintain supporting documentation, including documentation pertaining to the risk assessment.
VII. NOTIFICATIONS OF BREACHES
Generally, PHI excludes any health information of a person who has been deceased for more than 50 years after the date of death. Bayani Wellness and Counseling may disclose deceased individuals' PHI to non-family members, as well as family members, who were involved in the care or payment for healthcare of the decedent prior to death; however, the disclosure must be limited to PHI relevant to such care or payment and cannot be inconsistent with any prior expressed preference of the deceased individual.
VIII. PHI AFTER DEATH
This notice will go into effect the week beginning April 30, 2024. Bayani Wellness and Counseling reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that they maintain. Bayani Wellness and Counseling will provide you with a revised notice by posting on their website and you will be asked to sign a form indicating that you have seen and agree to abide by the changes.
