ASU Counseling Services Notice of Privacy Practices

The Arizona State University counseling services (Covered Entity) consists of the counseling centers at ASU Polytechnic Campus, ASU Tempe Campus, and the ASU West Campus.

Our pledge to you: We understand that the information you provide us is personal. We are committed to protecting your information. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. By law we are required to provide you this Notice about our privacy practices, your rights, and our legal responsibilities regarding your protected mental health information (PHI). We are committed to protecting the privacy of your mental health treatment information, and we are required by law to maintain the confidentiality of information that identifies you and the care you receive. We are also required to abide by the privacy policies and practices that are outlined in this notice.

Uses and Disclosures of Your Protected Mental Health Information (PHI)

Information about you may be used or disclosed by ASU counseling services for treatment, payment, and health care operations.

Treatment includes consultation, diagnosis, provision of care, and referrals. We may give information about your psychological condition to ASU counseling services and/or campus health services health care providers to facilitate your treatment, make referrals, or provide consultations. Counseling and/or medical staff will have access to information from your mental health record for this purpose. If your counselor is a trainee, ASU counseling services clinical staff will have access to your information to provide supervision and consultation to insure the quality of your care.

Payment includes everything necessary for billing and collection, such as insurance claims processing. We, or a business associate, will have limited access to your PHI for billing purposes, including contact with your insurer to verify what benefits you are eligible for, to obtain prior authorization, and to receive payment from your insurance carrier. Your health insurance company may request to see parts of your mental health record before they will pay us for your treatment.

Health care operations include the support of day-to-day activities and management of ASU counseling services. For example, your information may be used to evaluate care, for accreditation, and to promote quality services at ASU counseling services.

Other Uses and Disclosures

We may disclose your PHI without your authorization in the following situations.

As required by law, such as the reporting of child abuse, elder abuse, or dependent adult abuse.

To prevent a serious threat to health or safety of an individual or individuals. We may notify the person, tell someone who could prevent the harm, or tell law enforcement officials.

In judicial proceedings in response to court/administrative orders, subpoenas, discovery requests or other legal processes.

To law enforcement. If necessary, information may be released to law enforcement to assist in an involuntary hospitalization process, home visit to assess your welfare, or other actions necessary for your safety and the safety of others.

Appointments and services ASU counseling services staff who contact you regarding an appointment or to tell you about treatment services will have access to your information for that purpose.

Research. ASU counseling services may use or disclose information about you for research projects, such as studying the effectiveness of a treatment you received. All research projects will have been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

If you are a minor (under the age of 18). Information about your care will be disclosed to individuals involved in your care, such as your parents, if you are a minor.

Other Uses and Disclosures Require Your Written Authorization.

We may use or disclose mental health information for purposes not described in this Notice only with your written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of the information that occurred before you notified us of your decision to revoke your authorization.

INDIVIDUAL RIGHTS - Protected Health Information

You have the right to the following:

• Receive confidential communications concerning your mental health condition and treatment.
• Inspect and copy your protected health information.
• Amend or submit corrections to your protected health information.
• Receive an accounting of how and to whom your protected mental health information has been disclosed.
• Receive a printed copy of this notice.
• Request that we not use or disclose mental health information about you except when specifically authorized by you, when required by law, or in an emergency. We will consider your request and work to accommodate it when possible, but we are not legally required to accept it. We will inform you of our decision regarding your request within 60 days.

RIGHT TO REVISE PRIVACY PRACTICES

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected mental health information we maintain.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the HIPAA Privacy Officer by sending a letter outlining your concerns to:

Privacy Officer, ASU Counseling Services (Covered Entity)
Counseling & Consultation
SSV 334, Arizona State University
Box 871012, Tempe, AZ 85287-1012.

You may also send a written complaint to the Secretary of the Department of Health & Human Services.

You will not be penalized or otherwise retaliated against for filing a complaint.