Privacy Practices

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. 

I. LEGAL DUTY TO SAFEGUARD YOUR HEALTH INFORMATION 

CBT Milwaukee LLC is legally required to protect the privacy of your health information and to provide you with a notice of privacy practices. It will follow the privacy practice described in this notice. 

II. HOW CBT MILWAUKEE LLC MAY USE AND DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT, PAYMENT OR HEALTHCARE OPERATIONS

The following categories describe the ways that CBT Milwaukee LLC may use and disclose your health information. For each type of use and disclosure, an example is presented. 

TREATMENT. Treatment is when CBT Milwaukee provides, coordinates or manages your healthcare.  CBT Milwaukee LLC may use your information to contact you about appointments or to speak with another healthcare provider involved in your treatment.   

PAYMENT. Your health information may be used to bill and collect payment for the treatment and services provided to you. For example, for payment purposes, CBT Milwaukee LLC will provide you with an invoice detailing the service provided. If you are submitting a bill to your insurance for reimbursement, then CBT Milwaukee LLC will provide you an invoice that also includes your diagnosis. 

HEALTHCARE OPERATIONS. CBT Milwaukee LLC may use or disclose your health information for activities relating to the evaluation of patient care, business planning and compliance with the law. Your health information may be used to conduct or improve healthcare operations. For example, CBT Milwaukee LLC may use your health information to evaluate treatment or to comply with a required audit.

III. HOW YOUR HEALTH INFORMATION MAY BE USED OR DISCLOSED WITHOUT YOUR WRITTEN AUTHORIZATION

The following categories describe the ways that CBT Milwaukee LLC may use and disclose your health information without your authorization. For each type of use and disclosure an example is presented. Disclosures without authorization include those: 

Required by Law. CBT Milwaukee LLC may use and disclose your health information when that use or disclosure is required by law. For example, if there is reasonable cause to believe a child or adult (who is protected by state law) may be abused, neglected, or financially exploited, this may be reported to the appropriate authorities. 

For Public Health. CBT Milwaukee LLC may release your health information to local, state or federal public health agencies subject to the provisions of applicable state and federal law. For example, if a health oversight agency, such as a state board, is investigating a license, competence or practice, CBT Milwaukee may be required to disclose your health information.  

Regarding Victims of Abuse, Neglect or Violence. If there is reasonable cause to believe a child or adult who is protected by state law may be a victim of abuse, neglect or violence then CBT Milwaukee LLC may disclose your information to a government authority authorized by law to receive reports.

For Health Oversight Activities. CBT Milwaukee LLC may disclose your health information to health agencies authorized by law to conduct audits, investigations, inspections, licensure and other proceedings related to oversight of the health care system. 

For Judicial and Administrative proceedings. CBT Milwaukee LLC may disclose your health information in response to a court order for an administrative or judicial proceeding. Under most circumstances when the request is made through a subpoena, it must meet certain conditions to allow for disclosure.  

Related to Law Enforcement or Specialized Government/Military Activities. CBT Milwaukee LLC may disclose your health information to law enforcement or government officials for purposes such as identifying or locating a suspect, fugitive, or missing person, or complying with a court order or other law enforcement purposes.  

For Coroners and Medical Examiners. CBT Milwaukee LLC may disclose your health information to coroners and medical examiners. For example, this may be necessary to determine the cause of death. 

To Avert a Serious Threat of Harm to Yourself or Others. If you communicate a threat of imminent harm/danger against yourself or others or if there is a clear, imminent risk of physical injury being inflicted against yourself or others, CBT Milwaukee LLC may make disclosures that are necessary to protect you or that individual from harm.  

Worker’s compensation. Both state and federal law allow the disclosure of your health care information without authorization when it is related to a worker’s compensation injury. These programs may provide benefits for work-related injuries or illness.

For Health Information. CBT Milwaukee LLC may use or disclose your health information to provide information to you about treatment alternatives or other health related benefits and services that may be of interest to you.

For Emergency Purposes. If you are incapacitated or experiencing some emergency in which you can not provide authorization, CBT Milwaukee LLC is permitted limited use and disclosure of information in order to obtain assistance/help that is in your best interest. 

IV. WHEN CBT MILWAUKEE LLC IS REQUIRED TO OBTAIN AN AUTHORIZATION TO USE OR DISCLOSE YOUR HEALTH INFORMATION

Except as described in this Notice of Privacy Practices, CBT Milwaukee LLC will not use or disclose your health information without written authorization from you.  

If you do authorize CBT Milwaukee LLC to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, CBT Milwaukee LLC will no longer be able to use or disclose health information about you for the reasons covered by your written authorization. CBT Milwaukee LLC will be unable to take back any disclosures that have already been made with your permission.

V. YOUR HEALTH INFORMATION RIGHTS 

You have the following rights with respect to your protected health information:

The right to obtain an electronic or paper copy of your medical record 

• You can ask to see or obtain an electronic or paper copy of your medical record and other health information on file, but the request must be in writing. 

• You have the right to request that the copy be provided in an electronic form. If it is not readily producible then CBT Milwaukee LLC will work with you to provide it in a reasonable electronic format. CBT Milwaukee LLC will provide a copy or a summary of your health information (if you agree), within 30 days of your request. There may be a reasonable, cost-based fee.

• In certain circumstances, your request may be denied and CBT Milwaukee LLC will provide a reason in writing.

The right to request a correction to your medical record

• If you think something in your medical record is incorrect or incomplete you can ask for a correction. To request an amendment, you must make your request in writing to CBT Milwaukee LLC at the address listed below. You must also provide a reason for your request. 

• CBT Milwaukee LLC is not required to change your health information and if your request is denied, CBT Milwaukee LLC will provide you with information about the denial. 

The right to request limits on what information is used or shared

• You can ask CBT Milwaukee LLC not to use or share certain health information for treatment, payment, or operations. CBT Milwaukee LLC is not required to agree to your request, and your provider may say “no” if it would affect your care.

The right to choose how health information is sent to you

• You can ask that CBT Milwaukee LLC contact you in a specific way (for example, office phone rather than home phone) or to send mail to a different address. 

• CBT Milwaukee LLC will say “yes” to all reasonable requests.

The right to obtain a list of those with whom information has been shared

• You can ask for a list (accounting) of the times your health information has been shared, who it was shared  with, and why for six years prior to the date you ask. CBT Milwaukee LLC will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked to be made). One accounting a year is for free but there will be a reasonable, cost-based fee if you ask for another one within 12 months. This request must be submitted in writing to CBT Milwaukee LLC. You will receive a reply within 60 days, unless you agree to a 30-day extension. 

The right to receive breach notification. 

• If CBT Milwaukee or one of its  business associates experiences a breach of your health information that qualifies under the federal healthcare privacy rules you will be notified of the breach and about any steps you should take to protect yourself from potential harm resulting from the breach. 

The right to obtain a copy of this privacy notice

• You have the right to obtain a paper copy of this notice at any time even if you have agreed to receive the notice electronically. 

VI. CHANGES TO THIS NOTICE

CBT Milwaukee LLC is required to abide by the terms of this Notice of Privacy Practices. However, CBT Milwaukee LLC has the right to change the terms of this Notice at any time. Any changes will apply to health information on file already. A revised Notice will be posted in the office and on the company website (if applicable). You may also request a copy of this Notice from your provider. 

VII. WHAT TO DO IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED 

If you think your privacy rights have been violated, or you disagree with a decision made about access to your records, you may file a complaint with CBT Milwaukee’s Privacy Officer, Jennifer L. Francis, PhD at 414.381.1719 or jfrancis@cbtmilwaukee.net. Your request or complaint must be filed in writing to assist in the investigation of your complaint. 

You also may send a written complaint to U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to: 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints.

CBT Milwaukee LLC will not retaliate against you for filing a complaint.

If you have any questions or concerns regarding your privacy rights or the information in this notice, please speak with the Privacy Officer, Dr. Jennifer Francis. 

VIII. EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on Oct 1 2024