Notice of Privacy POLICIES
NOTICE OF PRIVACY PRACTICES “THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.”
A. Introduction: As part of your healthcare, Misti Luke, LCSW Private Practice (the “Misti Luke, LCSW”) originates and maintains various medical, billing, and other related records which contain information identifying you and describing your health history, symptoms, test results, diagnosis, treatment, and any plans for future care.
This notice describes how this information may be used and disclosed by Misti Luke, LCSW as well as your rights and Misti Luke LCSW duties with respect to such information.
B. Your Health Information Rights: Although all records relating to the treatment you receive at the Facility are the property of the Facility, you have the following rights with respect to your health information:
• the right to request restrictions on certain uses and disclosures of your health information as provided by 45 C.F.R. 164.522. The Facility is not required to agree to any requested restriction.
• the right to obtain a copy of this notice upon request.
• the right to inspect and obtain a copy of your health information as provided in 45 C.F.R. 164.524.
• the right to amend your health information as provided in 45 C.F.R. 164.526.
• the right to obtain an accounting of disclosures of your health information as provided in 45 C.F.R. 164.528. A Request for Accounting of Disclosures of Health Information must be made in writing. Copies of these forms are available at our office.
• the right to receive confidential communications of your health information as provided in 45 C.F.R. 164.522(b), as applicable.
• the right to receive notifications of breaches of unsecured PHI as provided in 45 C.F.R. 164.520
(b)(1)(v)(A)). You may exercise any of these rights by contacting the Facility representative listed below.
C. Facility Responsibilities: Misti Luke, LCSW Private Practice is required by law to maintain the privacy of your health information and to provide you with a notice as to Misti Luke, LCSW Private Practice's legal duties and privacy practices with respect to your health information. Misti Luke, LCSW Private Practice is also required to abide by the terms of this Notice, as it may be revised from time to time.
2 Misti Luke, LCSW Private Practice reserves the right to change the terms of this Notice and to make any revisions to the Notice effective for all your health information that Misti Luke, LCSW Private Practice maintains. Should Misti Luke, LCSW Private Practice change the terms of this Notice it will either hand-deliver or mail you a revised notice as well as post the revised notice in an area accessible to residents/clients/persons.
D. For More Information or to Report a Problem: If you have questions or would like additional information, or believe your rights have been violated, you can file a complaint with Misti Luke at 580-212-2283 or with the Secretary of the Department of Health and Human Services for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201 by calling 1-877-696-6775, or visiting You may also file a complaint with the Oklahoma Licensed Board of Social Work at You can file a complaint without fear of retaliation. All complaints should be in writing.
E. Use and Disclosure of Your Health Information. As a general rule, Misti Luke, LCSW may use or disclose your health information in the following ways:
Treatment: Misti Luke, LCSW will use your health information in the provision and coordination of your healthcare. We may disclose all or any portion of your health information to other health care providers who have a legitimate need for such information in your care and continued treatment. Misti Luke, LCSW Private Practice also may disclose your health information to people outside Misti Luke, LCSW Private Practice who may be involved in your medical care after you discontinue services, such as family members, clergy, and others used to provide services that are part of your care with your written permission.
Family/Friends: In certain situations, Misti Luke, LCSW Private Practice may release health information about you to a friend or family member who is legally involved in your care, or to someone who helps pay for your care with your written permission.
Payment: Misti Luke, LCSW Private Practice may release health information about you for the purposes of determining coverage, billing, claims management, medical data processing, and reimbursement.
Your health information may be released to an insurance company, third party payer or other entity (or their authorized representatives) involved in the payment of your medical bill and may include copies or excerpts of your medical record which are necessary for payment of your account.
For example, a bill sent to a third party payer may include information that identifies you, your diagnosis, and the services and supplies provided to you.
Routine Healthcare Operations: Misti Luke, LCSW Private Practice may use and disclose your health information during routine healthcare operations, including, but not limited to, quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing or credentialing activities of Misti Luke, LCSW Private Practice.
Business Associates: Misti Luke, LCSW Private Practice may disclose certain health information about you to business associates. A business associate is an individual or entity under contract with Misti Luke, LCSW Private Practice to perform or assist Misti Luke, LCSW in a function or activity which necessitates the use or disclosure of health information. Examples of business associates, include, but are not limited to, consultants, accountants, lawyers, medical transcriptionist and third-party billing companies. Misti Luke, LCSW requires the business associate to protect the confidentiality of your health information.
Marketing: Misti Luke, LCSW Private Practice may disclose certain contact information to a third party to provide marketing materials and information to you.
Regulatory Agencies: Misti Luke, LCSW Private Practice may disclose your health information to a health oversight agency for activities authorized by law, including, but not limited to, licensure, certification, audits, investigations and inspections. These activities are necessary for the government and other health oversight agencies to monitor the healthcare system, government programs, and compliance with civil rights.
Law Enforcement/Litigation: Misti Luke, LCSW may disclose your health information for law enforcement purposes as required by law or in response to a valid subpoena or court order.
Public Health: As required by law, Misti Luke, LCSW may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Victims of Abuse: Misti Luke, LCSW Private Practice may disclose your health information to government authorities, such as social services authorities or protective agencies, if Misti Luke, LCSW Private Practice reasonably believes that you are a victim of abuse, neglect, or domestic violence.
Required by Law: Misti Luke, LCSW Private Practice will disclose medical information about you when required to do so by law. Coroners, Medical Examiners, Funeral Directors: In the event of your death, Misti Luke, LCSW Private Practice may release your health information to a coroner or medical examiner. This may be necessary, for example, to determine a cause of death. Misti Luke, LCSW Private Practice may also release your health information to funeral directors as necessary to carry out their duties.
Appointment Reminders/Treatment Alternatives: Misti Luke, LCSW Private Practice may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Safety: Misti Luke, LCSW Private Practice may disclose your health information if Misti Luke, LCSW Private Practice in good faith believes that disclosure is necessary to prevent serious harm to an individual or the public.
Other Uses: Any other uses or disclosures of your health information will be made only with your written authorization. You may revoke an authorization, in writing, at any time except to the extent that Misti Luke, LCSW Private Practice has relied on your authorization.
F. The following uses and disclosures require authorization from you:
• Most uses and disclosures of psychotherapy notes (where applicable).
• Uses and disclosures of PHI for marketing purposes; and
• Uses and disclosures that constitute the sale of PHI.
F. Confidentiality of Substance Abuse Treatment Records. Federal regulations (42 C.F.R. Part 2) provide special protection for the confidentiality of certain alcohol and drug abuse treatment records. To the extent that Misti Luke, LCSW Private Practice maintains any records or other health information about you that is protected from disclosure by these regulations, Misti Luke, LCSW Private Practice will only disclose such information as permitted by these regulations.
G. Mental Health Care Treatment Records. State law and/or regulations may provide special protection for mental health care treatment records. To the extent that Misti Luke, LCSW Private Practice maintains any records or other health information about you that is protected from disclosure by such state law and/or regulations, Misti Luke,, LCSW Private Practice will only disclose such information as permitted by state law and/or regulations.