THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Uses and Disclosures for Treatment, Payment, and Health Care Operations

The Texas State Counseling Center (CC) staff may use or disclose your protected health information (PHI) for treatment, payment and health care purposes with your consent.

• PHI refers to information in your Counseling Center record that could identify you and that concerns your past, present or future health condition.
• Treatment includes when CC staff provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be consulting with a referral source, another therapist, or a treating physician or psychiatrist in the Student Health Center.
• Payment – Counseling Center services are free; no payment is involved
• Health Care Operations are activities that relate to the performance and operation of the CC. Examples of health care operations are quality assessment, business-related matters such as audits and administrative services, and case management and care coordination.
• Use applies only to activities within the Counseling Center (including psychiatrists under contract with the CC) such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
• Disclosure applies to activities outside the CC such as releasing, transferring, or providing access to information about you to other parties.

Uses and Disclosures Requiring Authorization

Counseling Center staff may use or disclose PHI for purposes outside of treatment and health care operations when your appropriate authorization is obtained. An authorization is written permission above and beyond general consent that permits only specific disclosures. We will obtain an authorization from you before releasing information for purposes outside of treatment and health care operations. You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that it has already been relied upon in releasing PHI.

Uses and Disclosures with Neither Consent nor Authorization

CC staff may use or disclose PHI without your consent or authorization in the following circumstances:

• Child Abuse: If a staff member has reason to believe that a child has been, or may be, abused, neglected, or sexually abused, he/she must make a report of such within 48 hours to the Texas Dept. of Protective and Regulatory Services (DPRS) or to any local or state law enforcement agency.
• Adult Abuse: If a staff member has reason to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation, she/he must immediately report such to DPRS.
• Health Oversight: If a complaint is filed against your therapist with their respective state licensing board, they have the authority to subpoena confidential mental health information from the CC relevant to that complaint.
• Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law and it will not be released by the CC, without written authorization from you or your personal or legally appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
• Serious Threat to Health or Safety: If a CC staff member determines that there is a probability of imminent physical injury by you to yourself or others, or there is a probability of immediate mental or emotional injury to you, they may disclose relevant confidential mental health information to medical or law enforcement personnel.
• Worker’s Compensation: If you file a worker’s compensation claim, the CC may disclose records relating to your diagnosis and treatment to your employer’s insurance carrier.
• Abuse or Sexual Exploitation by Therapist: Texas law requires a counselor to report client abuse or sexual exploitation by a previous therapist to the appropriate county district attorney and licensing board.
• As Otherwise Required by Law: For example, for national security or intelligence purposes

Client’s Rights and CC’s Duties

Client’s Rights:

• Right to Request Restrictions – You have the right to ask the CC to limit how it uses and discloses your PHI. The CC will consider your request but is not required to agree to it. If the CC agrees to your request, it will put the agreement in writing and will follow the agreement unless you need emergency treatment, and the information that you asked be limited is needed for your emergency treatment. You cannot limit the uses and disclosures that the CC is legally required to make.
• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations (e.g., you may not want your roommate or parents to know that you are being seen and may ask to receive your appointment reminder calls on your cell phone). You must be specific about where/how to contact you.
• Right to Inspect and Copy – You have the right to inspect and/or obtain a copy of the PHI contained in your official CC record for as long as the PHI is maintained in the record. The CC may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, CC staff will discuss with you the details of the request and denial process.
• Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. CC staff may deny your request under certain circumstances. On your request, CC staff will discuss with you the details of the amendment process.
• Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization. On your request, CC staff will discuss with you the details of the accounting process.
• Right to a paper copy – You have the right to obtain a paper copy of this notice upon request.

Counseling Center’s Duties:

• The CC is required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
• The CC reserves the right to change the privacy policies and practices described in this notice at any time and to make the new notice provisions effective for all PHI that it maintains.
• If the CC makes an important change that affects what is in this notice, such revisions will be noted on its web site, and a copy of the revised notice will be distributed to current clients at their next appointment. A revised notice will be distributed to past clients upon their next contact with the CC.

Questions and Complaints

If you have questions about this notice, disagree with a decision that is made about access to your records, or have other concerns about your privacy rights, you may contact the Texas State Counseling Center Privacy Officer at 245-2208. If you believe that your privacy rights have been violated and wish to file a complaint with the CC, you may send or deliver your written complaint to: Privacy Officer, Counseling Center, Texas State University-San Marcos, 601 University Drive, San Marcos, TX 78666. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The Privacy Officer can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule. CC staff will not retaliate against you for exercising your right to file a complaint.

This notice will go into effect on September 1, 2003.