PHILOSOPHY Auburn Counseling Associates is a private outpatient clinic specializing in the treatment of mental health and various addictive disorders. It is owned and operated by a group of mental health professionals. We are committed to the delivery of high quality treatment and consultative services designed to meet behavioral health needs of the community. In order to meet this commitment, a multidisciplinary staff of psychiatrists, psychologists, social workers, nurses and counselors provide services within a holistic treatment and preventive framework. Each person is treated as a whole person with a variety of influences contributing both to their problems and to their strengths in coping. The quality of the staff is reflected by their academic and professional credentials as well as by their substantial individual and collective experience in the fields of mental health and alcoholism and other addictions. Community input is sought through advisory board membership and through referral source feedback to help identify changing and unmet needs in the community so that services can be tailored to meet these needs and to increase the quality of all the services provided. Referrals may be made to the clinic or to specific clinicians. Referrals are accepted from professionals, friends, family, other community agencies,  work or school settings and insurance carriers as well as direct contact from those seeking treatment. The clinic is Blue Cross approved as an outpatient psychiatric clinic (OPC) and for outpatient substance abuse treatment. It is licensed by the State of Michigan Bureau of Health Systems and is accredited by the Commission on Accreditation of Rehabilitation Facilities.

A. Permissible Uses and Disclosures without Your Written Authorization
We may use and disclose PHI without your written authorization, excluding Psychotherapy Notes as described in Section II, for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.

1. Treatment: We may use and disclose PHI in order to provide treatment to you. For example, we may use PHI to diagnose and provide counseling and psychiatric services to you. In addition, we may disclose PHI to other health care providers involved in your treatment.

2. Payment: We may use or disclose PHI so that services you receive are appropriately billed to, and payment is collected from, you or your health plan. By way of example, we may disclose PHI to permit your health plan or its managed care organization to provide authorization which is necessary for your plan to pay for treatment services. We may disclose PHI to your insurer or third-party payer in order to bill for services we have provided. We may also bill you and disclose PHI to other parties to assist with billing and/or collection.

3. Health Care Operations: We may use and disclose PHI in connection with our health care operations, including quality improvement activities, reminders of appointments, follow-up regarding your treatment and our services, training programs, and administrative oversight such as audits, accreditation, certification, investigations, and licensing or credentialing activities.

4. Required or Permitted by Law: We may use or disclose PHI when we are required or permitted to do so by law. For example, we may disclose PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. In addition we may disclose PHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. We are required by law to report to the Family Independence Agency any reasonable suspicion of abuse or neglect. Other disclosures permitted or required by law include the following: disclosures for public health activities; health oversight activities including disclosures to state or federal agencies authorized to access PHI; disclosures to judicial and law enforcement officials in response to a court order or other lawful process; disclosures for research when approved by an institutional review board; and disclosures to military or national security agencies, coroners, medical examiners, correctional institutions, or otherwise as authorized by law.

1. Psychotherapy Notes: Notes recorded by your clinician documenting the contents of a counseling session with you ("Psychotherapy Notes") will be used only by your clinician and will not otherwise be used or disclosed without your written authorization. In order to be covered in this category, the notes must be separate from the rest of the medical record.

3. Marketing Communications: We will not use your health information for marketing communications without your written authorization.

4. Other Uses and Disclosures: Uses and disclosures other than those described in Section I.A. above will only be made with your written authorization. For example, you will need to sign an authorization form before we can send PHI to other individuals or organizations not directly involved in treatment, payment, or operations such as a life insurance company, a school, a probation officer, an employee assistance representative at work, or your attorney. You may revoke any such authorization in writing at any time except to the extent that we have already taken action in reliance on the authorization.

II. YOUR INDIVIDUAL RIGHTS

A. Right to Inspect and Copy. You have a right to inspect and request a copy of your PHI that is contained in a designated record set for as long as we maintain the PHI. You do not have a right of access to information compiled in reasonable anticipation of or for use in civil, criminal, or administrative actions or proceedings. If you are a parent or legal guardian of a minor, please note that certain portions of the minor's medical record will not be accessible to you. Under limited circumstances, we may deny access to your records. For example, we may deny access if, in our professional judgment, we determine that access is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision. All requests for access must be made in writing. We may charge a fee for the costs of copying, mailing or other costs incurred in complying with your request. If you request a copy of your records, you will be asked to sign a form acknowledging that we cannot be responsible for the privacy of the information being disclosed to you.

B. Right to Request Communications by Alternative Means or at Alternative Locations. You may request, and we will accommodate, any reasonable written request for you to receive PHI by alternative means of communication or at alternative locations. For example, you might request the use of a specific address or phone number. You do not need to provide an explanation of the reason for such requests.

C. Right to Request Restrictions. You have the right to request a restriction on PHI used for disclosure for treatment, payment or health care operations. For example, you may request that we not call you to remind you of appointments. You must request any such restriction in writing addressed to the Privacy Officer as indicated below. We are not required to agree to any such restriction you may request.

D. Right to Accounting of Disclosures. Upon written request, you may obtain an accounting of certain disclosures of PHI made by us after April 14, 2003. This right applies to disclosures for purposes other than treatment, payment or health care operations, excludes disclosures made to you or disclosures otherwise authorized by you, and is subject to other restrictions and limitations. The first accounting in a 12-month period will be provided free of charge but you may be charged for the cost of any additional accountings requested.

E. Right to Request Amendment: You have the right to request that we amend your health information. Your request must be in writing, directed to the Privacy Officer, and it must explain why the information should be amended. We may deny your request under certain circumstances. For example, we may deny a request if we believe the information is correct as is or if we did not create that part of the record, as in information obtained from another provider. If we deny your request for amendment, you have the right to file a statement of disagreement and we may give you a rebuttal to your statement.

F. Right to Obtain Notice. You have the right to obtain a paper copy of this Notice by submitting a request to the Privacy Officer at any time.

G. Questions and Complaints. If you desire further information about your privacy rights, or are concerned that we have violated your privacy rights, you may contact the Privacy Officer at (810) 744-3300 or by mail at 3600 S. Dort Hwy., Suite 44, Flint, MI 48507. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint with the Director or with us.

A. Effective Date. This Notice is effective on April 14, 2003.